A pilot study of routine colloid infusion in hypotension-prone dialysis patients unresponsive to preventive measures.

Background And Aims: Intradialytic hypotension may adversely affect the outcome of chronic hemodialysis. The aim of this study was to assess the effects of routine infusion of 20% albumin and 4% gelatin in dialysis hypotension-prone patients unresponsive to prevention measures.

Methods: This was a prospective crossover study (lasting 20 weeks) of routine infusion of 200 mL of these colloids in 10 patients. We analyzed the effect of these colloids by n-of-1 trial methodology (Wilcoxon test) and analysis of variance.

Results: Twenty percent albumin increased systolic blood pressure (SBP) in 6 patients (p<0.05), whereas 4% gelatin improved SBP in only 2 patients (p<0.05). Albumin infusions increased diastolic blood pressure (DBP) in 4 patients (p<0.05), whereas gelatin improved DBP in only 1 patient (p<0.05). Weight gain between dialysis sessions was generally similar during the periods in most patients. An increase in the ultrafiltration rate was observed in 4 of the 6 patients whose blood pressure was improved by colloids (p<0.005). Kt/V and the fall in relative blood volume remained stable during the study, whereas ionic dialysance at the end of the dialysis sessions was improved only by albumin infusion (p<0.05, repeated measures ANOVA).

Conclusions: Systematic colloids infusion during hemodialysis sessions improves hemodynamic parameters in most dialysis hypotension-prone patients unresponsive to usual measures of prevention. Prospective controlled trials are warranted to confirm these preliminary results.