Nephrol Dial Transplant Vol. 19 No. 10 © ERA-EDTA 2004; all rights reserved
Change in definition could change results
Sir,Tisler et al. [1] published their findings about patients' survival suffering from intradialytic hypotension (IDH). To our knowledge this is the first study to have defined IDH with these criteria. Although up to now there has not been a consensus on IDH definition, some past issues use different definitions. Begin et al. [2] selected their patients when they represented IDH in 30% of haemodialysis sessions. Hoeben et al. [3] defined IDH as at least three episodes of a decrease in systolic blood pressure (by at least 20 mm Hg to <100 mm Hg) accompanied by symptoms (dizziness, blurred vision, nausea, vomiting, cramps, or fatigue) in 50% of HD treatments over 1 month. Like another article published by these authors [4], Barnas et al. [5] defined IDH as a dialysis-induced fall in mean arterial pressure to <65 mmHg in >25% of the dialysis sessions in the previous 2 months. However, Tisler et al. characterized their frequent IDH patients with the occurrence of 10 or more hypotension episodes during the run-in time.
This could have an effect on the number of patients who have divided in three groups and increase number of patients in frequent IDH group. So some patients have been noted as frequent IDH who are not really suffering from this problem as previously defined. We think regarding this issue that if authors modify their definition, the number of patients who are categorized as frequent IDH would decrease and it would affect the final results.
Conflict of interest statement. None declared.
Nephrology Department Emam Hossein Hospital Tehran Iran Email: rezab{at}medscape.com
References
- Tisler A, Akocsi K, Borbas B et al. The effect of frequent or occasional dialysis-associated hypotension on survival of patients on maintenance haemodialysis. Nephrol Dial Transplant 2003; 18: 2601–2605
[Abstract/Free Full Text] - Begin V, Deziel C, Madore F. Biofeedback regulation of ultrafiltration and dialysate conductivity for the prevention of hypotension during hemodialysis. ASAIO J 2002; 48: 312–315[CrossRef][Web of Science][Medline]
- Hoeben H, Abu-Alfa AK, Mahnensmith R, Perazella MA. Hemodynamics in patients with intradialytic hypotension treated with cool dialysate or midodrine. Am J Kidney Dis 2002; 39: 102–107[Medline]
- Alappan R, Cruz D, Abu-Alfa AK, Mahnensmith R, Perazella MA. Treatment of severe intradialytic hypotension with the addition of high dialysate calcium concentration to midodrine and/or cool cialysate. Am J Kidney Dis 2001; 37: 294–299[Medline]
- Barnas MG, Boer WH, Koomans HA. Hemodynamic patterns and spectral analysis of heart rate variability during dialysis hypotension. J Am Soc Nephrol 1999; 10: 2577–2584
[Abstract/Free Full Text]
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