Prevention of hemodialysis-induced hypotension by increasing the venous return

Patients requiring hemodialysis have a variety of dialysis-associated complications. In particular, hypotension is a potential complication of chronic hemodialysis patients, which unexpectedly occurs during treatment and interrupts the continuation of dialysis, creating feeling of distress for the patients. Recently, the Crit-Line monitor has been clinically used and the signs of dialysis hypotension can be recognized by monitoring the blood volume changes (ΔBV) before the actual onset of the disease. However, the Crit-Line monitor is not omnipotent and can only help to prevent the development of dialysis hypotension secondarily and in a predictive way. In light of stabilizing blood pressure during dialysis and preventing dialysis-associated hypotension, we have focused on the venous return as a factor leading to stabilization of the blood volume changes ΔBV, and investigated the possibility that accelerated venous return results in maintaining blood pressure during hemodialysis. The subjects of this study are 8 hemodialysis patients on maintenance.We used a sequential pneumatic compression massage tool (foot pump) to accelerate the venous return during hemodialysis. First, the venous return was accelerated by a continuous massage with foot pumps during hemodialysis. Conditions of the massage were classified into 3 categories: Condition ① was no massage (control), Condition ② was a slight massage, and Condition ③ was a hard massage. Values of ΔBV were observed under these conditions for two weeks. As a result, more significant stabilization of ΔBV in the latter half of hemodialysis session was found in the groups with massage. Sensory changes were also studied and compared: Pre-dialysis, post-dialysis, and after returning home. In Condition ② a significantly better result of sensory changes was obtained after dialysis than before dialysis. Furthermore, it was confirmed that massage prevents peripheral circulation by measuring the transcutaneous partial pressure of oxygen (tcPO2), which was monitored continuously during hemodialysis. Consequently, any changes showing significant differences were not found during dialysis. In this study, a possible prevention of dialysis hypotension by accelerating the venous return is discussed.