Nefrología Vol. 32 Nº 1 Año 2012
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Nefrologia.2012;32:89-93 | doi: 10.3265/Nefrologia.pre2011.Nov.10967 >

Efecto de la DDVAP intranasal en la prevención de la hipotensión durante la hemodiálisis

Effect of Intranasal DDAVP in Prevention of Hypotension during Hemodialysis


a Department of internal medicine, Faculty of Medicine, Jundishapur University of Medical Sciences, Ahvaz, Iran,
b Science and Research Branch, Department of Chemistry, Islamic Azad University, Omidiyeh, Iran,
Resumen

Introducción: La aparición de hipotensión intradialítica durante la hemodiálisis (HD) en la que el objetivo principal es la eliminación de fluidos, contribuye a una morbilidad excesiva que se asocia con la diálisis. Materiales y métodos: Mediante un ensayo clínico doble ciego, comparamos los posibles efectos de la DDAVP intranasal con los del agua destilada intranasal como placebo en la prevención de la hipotensión intradialítica (HID) en pacientes con HID sintomática diagnosticada. Durante el primer mes del estudio, la pulverización nasal de agua destilada se realizaba 30 minutos antes de todas las sesiones de HD (grupo de placebo, grupo 1) y luego, tras un periodo de reposo de 30 días, utilizamos DDVAP intranasal 30 minutos antes de las sesiones de HD (grupo vasopresina, grupo 2). La presión arterial se medía justo antes de la HD, dos horas después y una vez finalizada la HD. Se definió como episodio de hipotensión la caída de la presión arterial sistólica del más de 10 mmHg. Resultados: Se incluyó en el estudio un total de 17 pacientes (nueve hombres y ocho mujeres de 47,5 años de edad media) con HID sintomática diagnosticada. En ambos grupos, el tipo de membranas de diálisis, la media del flujo sanguíneo, la tasa del flujo dializado y la tasa de ultrafiltración eran los mismos. Ambos grupos se sometieron a 204 sesiones de HD (17 x 12). Los episodios de hipotensión sucedieron en 18 ocasiones (8,82%) en el grupo de vasopresina en comparación con las 125 ocasiones (61,27%) del grupo de placebo y hubo una relación significativa entre ellos (p=0,0001). Además, la presión arterial media en el grupo de vasopresina era de 80.77 y en el grupo de placebo era de 73,92 e igualmente se observó una asociación significativa (p=0,0001). La media Kt/v en el grupo 1 y el 2 fue de 1,29 y 1,28 sin diferencias entre ellos (p=0,896). Conclusión: Estos resultados indican que, en comparación con el placebo, la vasopresina está relacionada de forma significativa con una menor incidencia de los episodios de hipotensión intradialítica durante la hemodiálisis.

Abstract

Introduction: The development of intradialytic hypotension during hemodialysis (HD) in which fluid removal is the primary goal, contributes to the excessive morbidity that is associated with the dialysis procedure. Materials and Methods: In a double blinded clinical trial, we compared the possible effect of intranasal DDAVP with intranasal distilled water as a placebo in prevention of intradialytic hypotension (IDH) in patients with known symptomatic IDH. In the first month of the study, nasal spray of distill water were administrated 30 minutes before all HD session (Placebo Group, Group 1) and then after a 30-day washout period we were used intranasal DDAVP 30 minutes before HD session (Vasopressin Group, Group 2). Blood pressure was measured just before HD, two hours later and after termination of HD. A hypotensive episode was defined as a decline of systolic blood pressure of more than 10mm Hg. Results: In overall Seventeen patients (nine men, eight women; mean age, 47.5 years) with known symptomatic IDH were enrolled in the study. The kind of dialysis membranes, mean of blood flow rate, dialyzate flow rate and ultrafiltration rate were the same in both groups. Each group has 204 HD session (17 * 12). Hypotensive episode occurred 18 times (8.82%) in vasopressin group compared with 125 times (61.27%) in placebo group and there was a significant association between them (p=0.0001). In addition mean arterial blood pressure in vasopressin group was 80.77 and in placebo group was 73.92 and also there was a significant association (p=0.0001). The mean Kt/v in group 1 and 2 were 1.29 and 1.28 without any differences between them (p=0.896). Conclusion: These results indicate that Compared with placebo, Vasopressin is significantly associated with a decreased incidence of intradialytic hypotension episodes during hemodialysis.

Key words: Intradialytic Hypotension, Ultrafiltration hemodialysis, DDAVP
Palabras Clave: Hipotensión intradialítica, Ultrafiltración hemodiálisis, DDAVP
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