Browsing by Author "Coelho, Augusto"
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- Effect of Dialysis Day on Intradialytic Hypotension RiskPublication . Rocha, Ana; Sousa, Clemente Neves; Teles, Paulo; Coelho, Augusto; Xavier, EvaBackground/Aims: Intradialytic hypotension (IDH) is a serious and frequent complication of hemodialysis (HD). Thus far, data are scarcely available to assess the impact of first versus subsequent HD sessions of the week in IDH. Therefore, the purpose of this work was to evaluate IDH risk in patients on thrice-weekly HD. Methods: We conducted an analysis of all blood pressure (BP) measurements obtained during 492 HD treatments given to 41 prevalent adult patients over a one month period. A logistic regression model for repeated binary observations was used to determine the association between hypotension and patient and dialysis factors. Results: The incidence of IDH was 32.5%. First dialysis session of the week was associated with a 9% higher risk of hypotension relatively to the second one. The risk was even higher from the first to the third session of the week (60%) and from the second to the third (50%). A higher hypotension odds ratio was also associated with age (1.03, 90%CI: 1.01-1.06), higher predialysis BP (1.04, 90%CI: 1.03-1.05) and higher phosphorus level (1.38, 90%CI: 1.07-1.76). The risk decreased 24.4% for each additional antihypertensive drug taken by the patient. Conclusions: The odds of hypotension occurrence decrease throughout dialysis sessions of the week. Minimizing modifiable risk factors may decrease IDH episodes.
- Frequency of intradialytic hypotensive episodes: old problem, new insightsPublication . Rocha, Ana; Sousa, Clemente Neves; Teles, Paulo; Coelho, Augusto; Xavier, EvaSymptomatic intradialytic hypotension (IDH) continues to be an important complication of hemodialysis treatment. There is some evidence that besides an IDH episode, repeated episodes could represent an even more important independent risk factor for mortality in hemodialysis patients. A retrospective cross-sectional study was performed to study 18 dialysis treatments in 43 patients during 6 weeks. Relationships of IDH episodes with baseline variables were examined using a Poisson regression model (generalized linear model). IDH was frequent (93% of patients) and highly variable by patient (0%-100%). Multivariate analysis showed that patients who experienced frequent hypotensive episodes had a lower dry weight (90% confidence interval [CI]: 0.95-0.99), higher phosphorus levels (90% CI: 1.07-1.47), greater prevalence of diabetes mellitus (90% CI: 1.11-2.71), and hypertension (90% CI: 1.04-2.45). Dry weight, hypertension, and phosphorus levels are modifiable risk factors to possibly reduce the rate of IDH episodes. The potential protective role of phosphorus warrants further investigation.