الفهرس 
Review of literatureOnly 14 pages are availabe for public view
 |  | from | 145 |  |  |
| | | from | 145 | | |
Abstract
Patients undergoing maintenance hemodialysis have a high risk of experiencing decreases in blood pressure with increased ultrafiltration and weight reduction during hemodialysis treatment. However a small proportion of patients experience an increase in blood pressure shortly after hemodialysis treatment.
Patients with SBP that increased with HD or that failed to decrease from pre- to post dialysis had a 2-fold adjusted increased odds of hospitalization or death at 6 months compared with participants with SBP that decreased with HD
There is still sector of intra-dialytic hypertensive patients with subclinical fluid overload, where patient looks normovolemic by clinical assessment, but still over hydrated as measured by Lung Ultrasound who responded well to gentle ultrafiltration and re-adjusting DBW.
This study was carried out on 88 hemodialysis patients divided into three groups; group (1) patients with intradialytic hypertension (n=12). group (2) including patients with intra-dialytic hypotension(n=28); group (3) hemodialysis patients with no blood pressure variability(n= 48).
All patients were subjected to detailed history taking and physical examination with stress on original kidney disease, uremic symptoms and volume status. Blood pressure was checked pre and post dialysis.
Routine laboratory tests were done plus serum Endothelin-1 was drawn pre dialysis.
IVC diameter was measured within 1 cm from junction of IVC and superior hepatic veins by the same operator pre and post dialysis.
Lung ultrasound was performed with a portable ultrasound scanner (DP20) with a 2-5 MHz convex probe. The same operator did the ultrasound pre and post hemodialysis in the same areas of the chest to reduce the bias Ultrasound examination of the anterolateral chest was carried out with longitudinal scan in the intercostal spaces of the right and left hemi thoraces, we evaluate (4) sonographic lung zones on each side. We divided chest examination to anterior chest wall from midline to anterior axillary line and lateral chest wall examination from anterior axillary line to posterior axillary line. Each part was divided into upper and lower zone, upper zone includes 2nd, 3rd and 4th intercostal spaces (on the right side includes also 5th intercostal space). Lower zone includes intercostal spaces below 5th space on the right side and 4th space on the left side.
Patients with intra-dialytic hypertension had low BMI, IDWG, serum creatinine and serum albumin. They also had high Endothelin-1 and B-lines. There were significant increase in IVC diameter pre & post dialysis in intradialytic hypertensive patients. There was significant negative correlation between change of B lines and BMI, IDWG, serum albmin, creatinine & UF volume. On the other hand there were positive correlation between change of B lines and Endothelin-1 & change of IVC diameter.
Lung ultrasound can be considered a good modality for volume assessment in hemodialysis patients. Cut off value of ≥ 5 pre dialysis B-lines is the best for detecting intradialytic hypertension. We recommend further meta-analysis studies with long term follow up to evaluate lung ultrasound in hemodialysis patients. There are some limitations for lung ultrasound that it cannot be used for assessment of hypovolemia and it is difficult to be done in morbidly obese patients.