PowerPoint Slides for: Pneumatic Compression, But Not Exercise, Can Avoid Intradialytic Hypotension: A Randomized Trial

Background: Conventional hemodialysis (HD) is
associated with dialysis-induced hypotension (DIH) and ineffective
phosphate removal. As the main source of extracellular fluid removed
during HD are the legs, we sought to reduce DIH and increase phosphate
removal by using cycling and pneumatic compression, which would
potentially provide higher venous return, preserving central blood flow
and also offering more phosphate to the dialyzer. Methods:
We evaluated 21 patients in a randomized crossover fashion in which
each patient underwent 3 different HD: control; cycling exercise during
the first 60 min; and pneumatic compression during the first 60 min.
Data obtained included bioelectrical impedance, hourly blood pressure
measurement, biochemical parameters, and direct quantification of
phosphate through the dialysate. DIH was defined as a drop in mean
arterial pressure (MAP) ≥20 mm Hg. Results: There was no difference in the ultrafiltration rate (p = 0.628), delta weight (p = 0.415), delta of total, intra and extracellular body water among the control, cycling, and pneumatic compression (p = 0.209, p = 0.348, and p
= 0.467 respectively). Delta MAP was less changed by pneumatic
compression when compared to control, cycling, and pneumatic compression
respectively (-4.7 [-17.2, 8.2], -4.7 [-20.5, -0.2], and -2.3 [-8.1,
9.0] mm Hg; p = 0.021). DIH occurred in 43, 38, and 24% of patients in control, cycling, and pneumatic compression respectively (p = 0.014). Phosphate removal did not increase in any intervention (p
= 0.486). Higher phosphate removal was dependent on ultrafiltration,
pre dialysis serum phosphate, and higher parathyroid hormone. Conclusion:
Pneumatic compression during the first hour of dialysis was associated
with less DIH, albeit there was no effect on fluid parameters. Neither
exercise nor pneumatic compression increased phosphate removal.