1. MILITARY HOSPITAL 17
EVALUATION OF INTRADIALYTIC
HYPOTENSIVE COMPLICATION IN CHRONIC
RENAL FAILURE PATIENTS
Nurse. Tran Huu Nhut
Doctor. Tran Cong Loc

2. INTRODUCTION
• Viet Nam: about 5,4 millions of CKD, making up 6,73% of
population and of these 72,000 require hemodialysis (HD) but
only 10% were dialysed.
• HD is one of the most effective and modern renal replacement
therapies that CRF patients can’t miss.
• However, HD is accompanied by several complications. In the
past: due to the technical drawbacks associated with the dialysis
machines and water systems. Nowaday: hypotension (20-50%)
• The complication effects quality of HD, even fatality
• Hypotension is a great interest now.

3. Objectives
1. To identify rate of intradialytic hypotension in
chronic renal failure patients with IIIb and IV
stage.
2. To study some risk factors of intradialytic
hypotension.

4. OVERVIEW
Artificial kidney system

5. OVERVIEW
• According to Bregman and colleagues, hypotension is
a common complication
– Hypotension: 20-30%
– Cramps: 5-20%
– Nausea and vomiting: 5-15%
– Headache: 5%
– Chest pain: 2-5%
– Back pain: 2-5%
– Itching: 5%
– Fever, chills, infection: < 1%

6. OBJECTS AND METHODS
Objects and criterias
• Objects
70 patients were diagnosed IIIb or IV stage CRF,
indicated maintenance hemodialysis.
• Criterias
- > 16 years old
- Indicated IIIb or IV stage CRF (according to
Nguyen Van Xang criteria)
- Consent of patients.

7. • Exclusion criterias
- Psychiatric and confused patients can’t answer
investigative questions.
- Hypotension occurs prior to hemodialysis.
• Study time and location
- Time: From June to August, 2014.
- Location: Department of Hemodialysis, Da Nang
general hospital and ICU, Military hospital 17.

8. Method
Research design : prospective, cross-sectional description.
Methodology
Patient preparation:
• Ask history, exam clinically
• Weight (between 2 HD sessions, before and after of
HD)
+ Heart rate: before, during and after HD. During HD: every
30 minutes.
+ Blood pressure: measure prior to HD 10 minutes and during
HD at: starting HD, 30, 60, 120 minutes,….ending HD and
at anytime patients have symptoms of hypotension.

9. Materials
• B.Braun Dialysis machine (Germany), Gambro and
Nipro Dialysis machine (Japan) with automatic
hemofiltration control system.
• GE Osmonics RO system for hemodialysis (USA).
• Nikko sphygmomanometer and stethoscope (Japan).
• Tanita scale (Japan)

11. Evaluation methods
Diagnostic criteria of intradialytic hypotension: According to
Emili and colleagues
• Decrease in systolic BP by ≥10mmHg compared with pre-dialysis
BP and associated with symptoms as dizziness, nausea
and vomiting, sweating, convulsion, delirium, confusion…
• Decrease in systolic BP by ≥ 10mmHg with pre-dialysis BP <
100mmHg
• Systolic BP <100mmHg with pre-dialysis BP <150 mmHg.
• Systolic BP < 110mmHg with pre-dialysis BP >150 mmHg.

12. Research variables
• Demographic characteristics
- Age, gender
• Intradialytic hypotension
- Hypotensive rate
- Hypotensive time
• Risk factors of intradialytic hypotension
- Age, dialysis period, weight gain between 2 sessions
Data analysis
• Epi Info 6.0.

13. RESULTS AND DISCUSSION
Age data
Age (year) Number of pts (n) Rate (%)
≤ 30 10 14,3
31 - 40 9 12,8
41 - 50 16 23,0
51 - 60 18 25,7
> 60 17 24,2
Total 70 100
Nguyễn Cao Luận and colleagues (51-60 years old: 32%)

14. Gender data
46%
54%
Female
Male
Nguyễn Cao Luận (male52%, female 48%)

15. Hypotensive rate
Hypotensive rate of patients
Complication
Number of
patients
Total of
patients (n)
Rate (%)
Hypotension 17 70 24
Chu Thị Dự : 38%, Bregman H và Daugirdas JT : 20-30%
Hypotensive rate of dialysis times
Complication
Total of
hypotensive
times
Total of
hemodialysis
times
Rate (%)
Hypotension 84 1640 5,1
Cù Tuyết Anh: 8,8%. Hoàng Quang Trung : 5,8%

16. Hypotensive times
Hypotensive
times
Number of
hypotension
Rate (%) p
First 60 minutes 5 6,0 < 0,05
Second hour 12 14,3 < 0,05
Third hour 23 27,4 < 0,05
Fourth hour 44 52,3 < 0,05
Total 84 100
Cao Tấn Phước :142.57±47.39 (third hour)
Cù Tuyết Anh: the fourth hour: 27,6%.

17. Risk factors of intradialytic hypotension
Age
Age
(year)
Total of
patients
Number of
HD times
Number of
hypotension
Hypotensive
rate (%)
p
1 < 30 10 232 6 2,6
2 31 - 40 14 328 16 4,9
3 41 - 50 16 376 22 5,8
4 51 - 60 18 424 21 4,9
5 > 60 12 280 19 6,8 p(1&5<0,05)
Total 70 1640 84 5,1
Nguyễn Minh Tuấn : 44% in patients ≥ 65 years old
Santoro: age > 60: 25%.

18. Dialysis period
Dialysis period
(month)
Total of
patients
Total of
dialysis
Number of
hypotension
Hypotensive
rate (%)
p
1 - 6 10 232 15 6,4 > 0,05
7 - 12 6 136 6 4,4 > 0,05
13 - 36 26 616 32 5,2 > 0,05
37 - 60 17 400 16 4,0 > 0,05
> 60 11 256 15 5,8 > 0,05
Total 70 1640 84 5,1

19. Weight gain between 2 sessions
Weight gain
between 2 sessions
Total of
dialysis
Number of
hypotension
Hypotensive
rate (%)
p
1 < 1,0kg 30 1 3,3
2 1,0 – 2,0kg 275 7 2,5
3 2,1 – 3,0 kg 743 41 5,5
4 > 3,0 kg 592 35 5,9 p(2&4<0,05)
Total 1640 84 5,1
Cù Tuyết Anh : gain >4 kg: hypotensive rate is17,2%.

20. CONCLUSIONS
1. Intradialytic hypotensive rate and time:
- 17 patients had hypotension at least 1 time, making up 24%
- Number of hypotension was 84 times, making up 5,1%
- Hypotensive time: the fourth hour of dialysis process (p<0,05)
2. Risk factors of intradialytic hypotension:
- Age > 60: hypotensive rate was higher than group < 30 (p< 0,05)
- Weight gain between 2 sessions > 3kg: hypotensive rate was
higher than group of 1,0-2,0kg (p<0,05)

21. PROPOSAL
• Patients were consulted about risks, dangers of
hypotensive complication.
• Nurse should have suitable caring plans and reduce
complications during dialysis process.
• To control weight gain between dialysis sessions and
limit excessive weight gain between 2 sessions (not
exceed 1kg within 2 - 3 days).
• Nurse must record vital signs every 15 -30 minutes,
especially at the ending hour in dialysis process

22. THANK YOU !