A protocol-based treatment far intradialytic hypotension in hospitalized hemodialysis patients

Human serum albumin is used in hemodialysis (HD) units as treatment for hyp otension despite its high cost and undetermined efficacy. During a 4-month period in 1995, albumin was used in 22% of 1,296 consecutive HD treatments in the HD unit or intensive care units (ICUs) at our tertiary-care hospital . We evaluated the safety and efficacy of a protocol designed to minimize a lbumin use for treating HD-associated hypotension (HDAH). The protocol cons isted of the stepwise use of saline, mannitol, and albumin for the purpose of achieving physician-determined ultrafiltration goals. Patients were exem pted from receiving the protocol for age younger than 18 years, freshly dec lotted angioaccess, or cardiovascular instability. The protocol was evaluat ed prospectively in 2,559 consecutive dialysis sessions (15% in ICUs) in 44 2 patients. Hypotension occurred during 608 sessions (24%), and attending n ephrologists elected to initiate the protocol in 71% of these cases. Of the 433 instances in which the protocol was begun, reversal of hypotension was achieved without the need for albumin In 91% and with the addition of albu min in an additional 2%. Protocol treatment was not completed because of nu rsing error in 1% or clotting of filter or angioaccess in 4%. Use of the pr otocol failed to reverse hypotension in only 2% of the cases in which it wa s completed. Albumin was administered in only 6% of the 2,559 HD treatments . In summary, our protocol-based approach to HDAH was effective, easy for n urses to use, albumin sparing, and cost reducing. (C) 1999 by the National Kidney Foundation, Inc.