Inotropic Support in Severe Intra-dialytic Hypotension: A Comparison of Predialysis and Intradialytic Dopamine. A Single Center Retrospective Study

Abstract

Objectives: Despite advances made in dialysis delivery, management strategies for intradialytic hypotension (IDH) has largely remained suboptimal hence the need for more interventions to improve on it. Methods: We compared in this retrospective study, predialysis dopamine (PDD) with intra-dialytic dopamine (IDD) in the treatment of severe IDH. Results: Of the 2968 sessions, 518 (17.45%) had symptomatic IDH, of this, 9.65% had PDD while 12.16% had IDD. The mean age of all participants, participants with PDD, and those with IDD were 50.73 ± 6.51 years, 64.48 ± 8.22 years and 64.64 ± 10.31 years respectively, P=0.001. The intra-dialytic pulse rate increases, with BP reductions, were more with IDD treatments than PDD. Dialysis BFR, ultrafiltration volume, duration and dose were higher with PDD than with IDD treatment, P=0.002, P=0.03, P=0.04 and P<0.001 respectively. Hospitalization, dialysis termination and intra-dialytic death were more common with IDD than with PDD treatment, P=0.08, P=0.001 and P=0.002. PDD was commoner in females, advancing age and diabetes, P=0.08, P=0.93 and P=0.06. Independent associates of IDD were lower predialysis systolic, and diastolic BP, shorter dialysis duration, dialysis termination and intra-dialytic death. Conclusion: The prevalence of overall IDH, of severe IDH using a nadir systolic BP less than 90 mmHg, and of severe IDH using a minimum 20 mmHg intra-dialytic fall in systolic BP were 17.45%, 1.68% and 2.12% respectively. Low dose PDD treatment of severe IDH allows for a relative optimization of the prescribed dialysis, gives higher dialysis dose and reduces the frequencies of dialysis termination and intradialytic death.