| 1st Author Year of publication Reference | Aim of the study | Study design Method of BP measurement Follow-up period | Number Population (country, KRT modality) | Primary analysis | Results/Conclusion |
|---|---|---|---|---|---|
| Akdag, 2015 (91) | To determine the effect of reducing dialysate sodium from 140 to 137mmol/L for 6 months vs control | Double blinded, single centre RCT, | 46 | Ambulatory BP measurements over 24 hours | Patients randomised to low dialysis sodium showed reduced systolic ambulatory BP readings (P<0.05) which was not found in the control group. IDWG was found to be significantly decreased in the low-sodium dialysate group after 6 months (P<0.001). |
| Basile, 2016 (89) | To review the effect of different dialysate sodium concentration on pre-dialysis BP and IDH | Systematic review | 23 | Pre-dialysis BP and interdialytic weight gain | Patients treated with higher dialysate sodium had higher IDWG and no difference in BP. |
| Causland, 2022 (92) | To determine the effect of dialysate sodium 138 vs 142mmol/L in hospitalised maintenance HD patients | Double blind, single centre RCT in hospitalised HD patients | 139 | Average decline in systolic BP after HD and rate of IDH | No significant differences in systolic BP decline between the 2 groups (23 ± 16 versus 26 ± 16 mmHg, P=0.57). The proportion of total sessions complicated by IDH was similar in the higher dialysate sodium group, compared with the lower dialysate sodium group (OR 0.72, 95% CI 0.36 to 1.44, P = 0.35). |
| Culleton, 2007 (67) | To determine the effect of frequent nocturnal HD on left ventricular mass | Prospective, two-centre, parallel-group RCT BP assessed by dialysis machine's automated BP cuff immediately post-dialysis 6 months follow up | 52 | Change in left ventricular mass and change in BP | Frequent nocturnal haemodialysis improved left ventricular mass, mean left ventricular mass difference between groups (15.3 g, 95% CI 1.0 to 29.6 g, P = 0.04) and improved BP control. Antihypertensive medication use was reduced or discontinued in 16 of 26 patients randomised to nocturnal haemodialysis and only 3 of 25 patients randomised to conventional haemodialysis (P <0.001). Despite the reduction in use of antihypertensive medications in the nocturnal haemodialysis group, 6-month systolic BP decreased in patients randomised to nocturnal haemodialysis by 7 mm Hg and increased in patients randomised to conventional haemodialysis by 4 mm Hg (mean difference 11 mm Hg, 95% CI −2 to 24 mm Hg). |
| Dasgupta, 2019 (31) | To examine the association between facility practises related to fluid volume management and IDH & mortality | Observational study of facility practises on patient outcomes | 10,250 | IDH and mortality | Routine use of lower dialysate temperature was associated with lower cardiovascular mortality (HR 0.76, 99% CI, 0.58 to 0.98). Routine use of sodium modelling/profiling to limit or prevent intradialytic hypotension was associated with higher all-cause mortality (HR 1.36, 99% CI, 1.14 to 1.63) |
| Davenport, 2006 (94) | The impact of HD centres using predominantly 136 vs 140mmol/L dialysate sodium | Observational study of dialysis practise | 469 | IDWG, proportion of patients receiving antihypertensive agents, number of classes of antihypertensive agents and symptomatic IDH | Patients dialysing in centres with lower dialysate sodium had lower IDWG without increased IDH and had lower proportion taking antihypertensive agents and fewer multiple classes of drugs. |
| Del Giorno, 2020 (102) | To determine the effect of using dialysate magnesium of 0.5 vs 0.75mmol/L over 2 weeks | RCT cross over, open label | 39 | Vascular stiffness and haemodynamic profile | Subjects did not have any difference in IDH rate when using higher dialysate magnesium vs lower dialysate magnesium (RR 1.10, 95% CI 0.90 to 1.34). |
| Dunlop, 2019 (90) | A review effect of different dialysate sodium on pre-dialysis BP and IDH | Cochrane review | 12 studies | Pre-dialysis BP, IDH and interdialytic weight gain | “Low” sodium dialysate reduced IDWG (10 studies: mean difference -0.35kg, 95% CI -0.18 to -0.51), reduced pre-dialysis MAP (4 studies: mean difference -3.58mmHg, 95%CI -5.46 to -1.69) but increased IDH events (9 studies: RR 1.56, 95% CI 1.17 to 2.07) |
| Dunne, 2017 (95) | To compare the effect of stepwise vs linear reduction in sodium during HD | Meta-analysis of RCT involving sodium profiling techniques in chronic HD | 10 articles | Rate of IDH | Stepwise reduction in dialysate sodium during HD session associated with reduced IDH episodes but linear sodium profiling had no effect on IDH |
| Ebrahimi, 2017 (96) | To determine the effect of temperature (35 vs 37C) and dialysate sodium (138mmol/L vs linear profiling from 150 to 138mmol/L) | RCT 2x2 design, cross over | 80 | IDH | Rate of IDH was significantly affect by both temperature and sodium profiling |
| Fagugli, 2001 (68) | Effect of short daily HD vs standard HD on BP control and left ventricular mass | Randomised two-period cross over study | 12 | Change in BP and LV mass | A significant reduction in 24-hour BP during short daily HD was reported (systolic BP DHD, 128 +/- 11.6 mm Hg; SHD, 148 +/- 19.2 mm Hg; P < 0.01; diastolic BP: DHD, 67 +/- 8.3 mm Hg; SHD, 73 +/- 5.4 mm Hg; P = 0.01). The decrease in BP was accompanied by the withdrawal of antihypertensive therapy in 7 of 8 patients during DHD (P < 0.01) |
| Gabbuti, 2003 (100) | To determine the effect of using dialysate bicarbonate (26 vs 32mmol/L) over 6 weeks treatment | RCT cross over trial | 26 | BP, heart rate, IDH | Subjects had increased rate of IDH (5.55 vs 1.7%, P<0.05) and more saline or hypertonic glucose infusions (20.9 vs 13.7% of the dialysis sessions, P<0.05) when receiving high dialysate bicarbonate. |
| Gabutti, 2009 (99) | To determine the effect of using dialysate bicarbonate (26 vs 35mmol/L) and calcium (1.25mmol/L vs 1.50mol/L) at 3 weeks of treatment | RCT cross over study | 21 | Pulse wave analyser, bioimpedance and BNP | An increase in systolic and diastolic BP was observed using either a high calcium (+5.6 and +2.5 mmHg, respectively) or a low bicarbonate (+4.7 and +1.7 mmHg, respectively) concentration |
| Inrig, 2015 (93) | To examine the effect of high dialysate sodium (serum sodium +5mmol/L) vs low dialysate sodium (serum sodium – 5mmol/L) | Participant blinded, investigator unblinded randomised cross over | 16 | Intradialytic changes in serum Endothelin-1, nitrite levels and BP | The average systolic BP throughout all haemodialysis treatments in the week treated with low dialysate sodium concentrations was lower than the week treated with high dialysate sodium concentrations; parameter estimate, 29.9mmHg (95% CI, 213.3 to 26.4, P < 0.001). |
| Jardine, 2017 (69) | To evaluate the effect of increasing weekly haemodialysis hours on quality of life over 12 months compared with standard haemodialysis | RCT, multicentre of in centre and home HD patients | 200 | The primary outcome was change in quality of life Secondary outcomes included medication usage and change in left ventricular mass index | Change in EQ-5D score at study end did not differ between groups BP did not differ between groups at study end. Extended hours were associated with fewer BP-lowering agents In a sub-study with 95 patients, there was no difference in left ventricular mass index (mean difference, −6.0, 95% CI −14.8 to 2.7 g/m2, P=0.18) |
| Kyriazis, 2004 (101) | To determine the effect of changing dialysate magnesium and calcium on BP (performed as 2 studies) | RCT cross over | 8 + 14 | IDH and intradialytic BP | The dialysis solution containing 0.25 mmol/L magnesium and 1.25 mmol/L calcium had the highest rate of IDH, and increasing dialysate magnesium to 0.75mmol/L had lower IDH when dialysate calcium was 1.25mmol/L |
| Lin, 2001 (76) | To assess the advantages in the biochemical, haemodynamic, and clinical effects in uremic patients treated with different frequencies of online-HDF (thrice, twice, once per week) and high-flux HD. | Partially randomised patient preference | 111 | Haemodynamic parameters including maximum drop of systolic BP, episodes of symptomatic hypotension and mean saline infusion volumes during dialysis | Maximum drop of systolic BP, episodes of symptomatic hypotension and mean saline infusion volumes during dialysis were reduced when frequencies of on-line HDF were increased. |
| Maduell, 2013 (77) | To compare the effect of on-line HDF with conventional HD on all-cause mortality, cardiovascular mortality, all-cause hospitalization, and treatment tolerability | Multi-centre RCT | 906 | Treatment tolerability | The incidence of intradialysis symptoms was affected by treatment assignment. There were 679.2 intradialysis hypotension episodes per 100 patient-years in the OL-HDF group versus 937.7 episodes per 100 patient-years in the haemodialysis group (rate ratio 0.72, 95% CI, 0.68 to 0.77, P<0.001) |
| Manji, 2021 (194) | To determine the effect of Low sodium dialysate (137mmol/L) vs standard (140mmol/L) dialysate sodium | RCT cross over | 41 | IDWG and pre-dialysis BP | Results of 6 weeks cross over trial of chronic HD patients receiving twice a week dialysis showed no difference in IDWG or BP. |
| Morena, 2017 (78) | To explore the potential benefits of using on-line HDF versus optimal high-flux HD in elderly ESKD patients. | RCT | 381 | Intradialytic tolerance | No difference in adverse events, which included asymptomatic and symptomatic IDH between the groups. Exploratory analysis which considered the dialysis session as the statistical unit (rather than the patient), suggested that online HDF was associated with fewer episodes of asymptomatic IDH, but there was no difference in symptomatic hypotension between the two treatment groups. After 24 months of-follow-up there were no significant differences in BP. |
| Mustafa, 2016 (86) | To determine if lowering dialysate temperature | Systematic review | 484 | Rate of IDH | Reduced temperature dialysis reduced IDH by 70% (95% CI 49% - 89%) |
| MyTemp, 2022 (88) | To determine the effect of dialysate temperature set at 36.5C vs 0.5-0.9C below body temperature | Open label, cluster multi-centre RCT | 15,413 | Composite end point of Cardiovascular mortality or hospital admissions from MI, ischaemic stroke or heart failure | No difference in composite end-point after 4 year follow up; cooler dialysate vs standard (adjusted HR 1.00, 95% CI 0.89 to 1.11). |
| Nistor, 2015 (79) | To compare convective (HF, HDF, or AFB) with diffusive (HD) dialysis modalities on clinical outcomes (mortality, major cardiovascular events, hospitalisation and treatment-related adverse events) in men and women with ESKD. | Meta-analysis of RCTs | 4,039 | Treatment-related adverse events | No difference in the number of dialysis sessions with hypotension (mean difference, -4.05, 95% CI, -15.39 to 7.3), pre-dialysis systolic BP (mean difference, 1.19, 95% CI -1.46 to 3.84) or pre-dialysis diastolic BP (mean difference, -0.25, 95% CI -1.06 to 0.56). HDF was associated with a lower maximal drop in BP and reduced the rate of hypotension during dialysis compared with HD. |
| Odudu, 2015 (87) | To determine the effect of dialysate temperature set at 37C vs -0.5C below body temperature | Multi-centre, open-label RCT | 73 | Cardiac magnetic resonance imaging | Pre-dialysis mean arterial BP showed no statistically significant difference between groups over 12 months |
| Smith, 2017 (195) | To determine whether recovery time and adverse events during treatments differs between HD and HDF. | Randomised cross over trial | 100 | Recovery time in minutes Incidence of adverse events during treatments | There was no overall difference in recovery time between treatments (medians for HDF vs HD of 47.5 [IQR, 0-240] vs 30 [IQR, 0-210] minutes, respectively, P = 0.9). HDF was associated with an increased frequency of IDH. Symptomatic IDH occurred in 5.3% of HD treatments compared to 8% of HDF sessions (relative risk 1.52, 95% CI 1.2 to 1.9). However, 80% of IDH episodes were mild and successfully managed with temporary discontinuation of ultrafiltration. |
| Stefansson, 2014 (83) | To determine prevalence of IDH and association with cardiovascular events and mortality | USRDS Observational study | 39,497 | IDH according to interdialytic weight gain and association between IDH and CV outcomes and mortality | IDH strongly associated with cardiovascular morbidity and mortality. |
| Tentori, 2013 (97) | To determine the association between facility practises related to dialysate bicarbonate and IDH & mortality | Observational study of facility practises on patient outcomes | 17,031 | mortality | Dialysate bicarbonate concentration was positively associated with mortality. Adjusted HR 1.08 per 4 mEq/L higher, 95% CI 1.01 to 1.15 and adjusted HR 1.07 (95% CI, 0.97 to 1.19) for dialysate bicarbonate ≥38 vs. 33–37 mEq/L. |
| Tsujimoto, 2019 (196) | To review the effect of dialysate temperature on IDH | Cochrane review | 25 studies | IDH | Very low evidence that fixed reduction of dialysate temperature improves IDH rate (8 studies, RR 0.52, 95% CI 0.34 to 0.80) |
| Viegas, 2017 (98) | To determine the effect of using dialysate bicarbonate 34 vs 30mmol/L for 9 months | RCT | 93 | IDH and IDWG | High bicarbonate vs low bicarbonate had no effect on IDH (28.0 vs. 27.4 episodes per 1000 sessions, P=0.906). |
| Wang, 2014 (80) | To compare the effect of convective modalities of dialysis (HDF and HF) versus standard HD | Meta-analysis of RCTs | 1,259 | Episodes of symptomatic hypotension | HDF reduced symptomatic hypotension compared to conventional HD (relative risk 0.49, 95% CI, 0.28 to 0.86). No significant difference in end of treatment BP between treatment groups (weighted mean difference 2.69 mm Hg, 95% CI 0.98 to 4.40). |
| Yu, 2018 (84) | To determine risk factors and prognosis of IDH in HD patients | Single centre observational | 293 | Risk factors associated with IDH and Mortality | IDH is an independent risk factor for long-term mortality in HD patients |
| Zoccali, 2023 (85) | To determine if cold HD prevents IDH and mortality | Observational, incident HD patients. | 8,071 | IDH and mortality after case-mix at facility level adjustment | A 0.5 degree reduction in dialysate temperature was associated with reduced IDH (OR 0.67, 95% CI 0.63 to 0.72), but no effect on mortality (HR 1.01, 95% CI 0.88 to 1.16) |
Navigate to sections