COMPARISON OF HYPERTONIC SALINE SOLUTIONS AND DEXTRAN IN DIALYSIS-INDUCED HYPOTENSION

The efficacy of three hypertonic saline solutions for treating dialysi s-induced hypotension in a randomized, blinded, crossover clinical tri al of 10 patients (a minimum of three cycles per solution) was compare d. Dialysis-induced hypotension, defined as a decrease in systolic blo od pressure of at least 10 mm Hg or systolic blood pressure less than 100 mm Hg, was treated with an iv bolus of either 10 mL of 23% saturat ed hypertonic saline, 30 mL of 7.5% hypertonic saline, or 30 mL of 7.5 % saline with 6% dextran 70, each containing similar osmolar loads of 80, 80, and 100 mosM, respectively. All three solutions raised systoli c blood pressure within 5 min (mean pretreatment systolic blood pressu re, 87 mm Hg; mean posttreatment systolic blood pressure, 101 mm Hg; P < 0.05). The magnitude of the increase was greater with saturated hype rtonic saline (15 mm Hg) and dextran 70 (17 mm Hg) compared with that with hypertonic saline (9 mm Hg; P < 0.05). At 10 min, dialysis-induce d hypotension was less frequent with saturated hypertonic saline (inci dence, 9%) compared with hypertonic saline (45%). Beyond 10 min, howev er, there was a trend toward a lower incidence of further dialysis-ind uced hypotension with dextran 70. There were no side effects. Given eq ual osmole loads, the more concentrated solution produced a greater in crease in systolic blood pressure. The addition of an oncotic agent su ch as dextran may prolong the blood pressure response beyond 10 min. I t was concluded that hypertonic saline solutions safely and effectivel y treat dialysis-induced hypotension.