İntradiyalitik Besin Alımı ve İntradiyalitik Hipotansiyon

İntradiyalitik hipotansiyon diyaliz sırasında en sık karşılaşılan komplikasyonlardan biridir. Hemodiyaliz hastaları için büyük bir problem olan intradiyalitik hipotansiyonun, diyaliz sırasında besin alımı ile ilişkili olduğu ifade edilmekle birlikte hipoglisemi, malnütrisyon, ek besin sağlama gibi nedenlerden dolayı intradiyalitik beslenmenin ülkemizde ve dünyada desteklendiği bilinmektedir. Diyaliz sırasında hastaların yemek yemesine izin verilmesi hala tartışmalıdır ve diyaliz merkezlerinde intradiyalitik beslenme konusunda çeşitli uygulamalar mevcuttur. Bu derlemede intradiyalitik hipotansiyon, intradiyalitik hipotansiyonun beslenme ile ilişkisi, önleme, tedavi ve hemşirelik yaklaşımları konusunda bilgilere yer verilmiştir.

Anahtar Kelimeler:

Hemşirelik, , hemodiyaliz, kan basıncı, intradiyalitik hipotansiyon, intradiyalitik besin alımı

Intradialytic Food Intake and Intradialytic Hypotension

Intradialytic hypotension is one of the most common complications encountered during dialysis. It is stated that intradialytic hypotension, which is a major problem for hemodialysis patients, is associated with food intake during dialysis, and it is known that intradialytic nutrition is supported in our country and the world due to reasons such as hypoglycemia, malnutrition, and supplying nutrients. Allowing patients to eat during dialysis is still controversial, and there are various practices regarding intradialytic feeding in dialysis centers. In this review, information about intradialytic hypotension, the relationship of intradialytic hypotension with nutrition, prevention, treatment, and nursing approaches are included.

Keywords:

nursing, hemodialysis, blood pressure, intradialytic food intake, intradialytic hypotension,

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1. Süleymanlar G. Kronik böbrek hastalığı. Periton Diyalizi Başvuru Kitabı. Ankara: Güneş Tıp Kitabevleri; 2019. s. 1-16.
2. Süleymanlar G, Utaş C, Arinsoy T, Ateş K, Altun B, Altiparmak MR, et al. A population-based survey of Chronic REnal Disease In Turkey—the CREDIT study. Nephrology Dialysis Transplantation. 2011;26(6):1862-71.
3. Ateş K, Süleymanlar G, Nurhan S. Türkiye’de Nefroloji, Diyaliz ve Transplantasyon–Registry 2017. TC Sağlık Bakanlığı ve Türk Nefroloji Derneği Ortak Raporu. 2019.
4. Kinnel K. Should patients eat during hemodialysis treatments? Nephrology Nursing Journal. 2005;32(5):513.
5. Ahsen A. Hemodiyalizin akut komplikasyonları. Kocatepe Tıp Dergisi. 2011;12(1):54-60.
6. Bansal S, Ansons A, Vishwanath M. Hypotension-induced blindness in haemodialysis patients. Clinical Kidney Journal. 2014;7(4):387-90.
7. Tuna D, Ovayolu N, Kes D. Hemodiyaliz hastalarında sık karşılaşılan problemler ve çözüm önerileri. Nefroloji Hemşireliği Dergisi. 2018;13(1):17-25.
8. Benaroia M, Iliescu EA. Oral intake during hemodialysis: is there an association with intradialytic hypotension? Hemodialysis International. 2008;12(1):62-5.
9. Kooman J, Basci A, Pizzarelli F, Canaud B, Haage P, Fouque D, et al. EBPG guideline on haemodynamic instability. Nephrology Dialysis Transplantation. 2007;22(suppl_2):ii22-ii44.
10. Mahoney C. Should patients eat during dialysis? Nursing. 2007;37(10):57-8.
11. Bradshaw W. Intradialytic hypotension: a literature review. Renal Society of Australasia Journal. 2014;10(1):22- 9.
12. Chiu Y-F, Chen Y-C, Wu P-Y, Shih C-K, Chen H-H, Chen H-H, et al. Association between the hemodialysis eating index and risk factors of cardiovascular disease in hemodialysis patients. Journal of Renal Nutrition. 2014;24(3):163-71.
13. Kistler B, Benner D, Burgess M, Stasios M, Kalantar-Zadeh K, Wilund KR. To eat or not to eat—international experiences with eating during hemodialysis treatment. Journal of Renal Nutrition. 2014;24(6):349-52.
14. Assimon MM, Flythe JE. Intradialytic blood pressure abnormalities: the highs, the lows and all that lies between. American Journal of Nephrology. 2015;42(5):337-50.
15. Rocha A, Sousa C, Teles P, Coelho A, Xavier E. Frequency of intradialytic hypotensive episodes: old problem, new insights. Journal of the American Society of Hypertension. 2015;9(10):763-8.
16. Gul A, Miskulin D, Harford A, Zager P. Intradialytic hypotension. Current Opinion in Nephrology and Hypertension. 2016;25(6):545-50.
17. Agarwal R, Georgianos P. Feeding during dialysis—risks and uncertainties. Nephrology Dialysis Transplantation. 2018;33(6):917-22.
18. Kistler BM, Benner D, Burrowes JD, Campbell KL, Fouque D, Garibotto G, et al. Eating during hemodialysis treatment: a consensus statement from the International Society of Renal Nutrition and Metabolism. Journal of Renal Nutrition. 2018;28(1):4-12.
19. Fotiadou E, Georgianos PI, Chourdakis M, Zebekakis PE, Liakopoulos V. Eating during the hemodialysis session: A practice improving nutritional status or a risk factor for intradialytic hypotension and reduced dialysis adequacy? Nutrients. 2020;12(6):1703.
20. Van Buren PN, Inrig JK. Special situations: Intradialytic hypertension/chronic hypertension and intradialytic hypotension. Seminars in dialysis. 2017;30(6):545-52.
21. De D, Xiang Ai AT. Standardising haemodialysis care by restricting nutrition during dialysis: introducing a quality improvement initiative for renal outpatients. Contemporary Nurse. 2015;50(2-3):206-13.
22. Reeves PB, Mc Causland FR. Mechanisms, clinical implications, and treatment of intradialytic hypotension. Clinical Journal of the American Society of Nephrology. 2018;13(8):1297-303.
23. Workgroup KD. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005;45:S1-S153.
24. Flythe JE, Xue H, Lynch KE, Curhan GC, Brunelli SM. Association of mortality risk with various definitions of intradialytic hypotension. Journal of the American Society of Nephrology. 2015;26(3):724-34.
25. Soliman RA, Fawzy M, Kandil H, Abd el Fattah A. Assessment of hypotension during dialysis as a manifestation of myocardial ischemia in patients with chronic renal failure. The Egyptian Journal of Critical Care Medicine. 2014;2(1):13- 8.
26. Sherman R, Daugisdas J, Ing TS. Hemodiyaliz sırasında sık görülen komplikasyonlar. In: Daugirdas JT, editor. Diyaliz El Kitabı. 5.Baskı. Ankara: Güneş Tıp Kitabevleri; 2020. s. 215-36.
27. Choi MS, Kistler B, Wiese GN, Stremke ER, Wright AJ, Moorthi RN, et al. Pilot study of the effects of high-protein meals during hemodialysis on intradialytic hypotension in patients undergoing maintenance hemodialysis. Journal of Renal Nutrition. 2019;29(2):102-11.
28. Stefánsson BV, Brunelli SM, Cabrera C, Rosenbaum D, Anum E, Ramakrishnan K, et al. Intradialytic hypotension and risk of cardiovascular disease. Clinical Journal of the American Society of Nephrology. 2014;9(12):2124-32.
29. Yüksel Acar C. (2016) Kronik böbrek yetmezliği hastalarında hemodiyaliz uygulaması sırasında besin tüketme miktarının kan basıncına etkisi. Acıbadem Üniversitesi Yayımlanmamış Yüksek Lisans Tezi, İstanbul.
30. ResmiGazete. Hemşirelik Yönetmeliğinde Değişiklik Yapılmasına Dair Yönetmelik 19 Nisan 2011 [Available from: https://www.resmigazete.gov.tr/eskiler/2011/04/20110419-5.htm.
31. Davenport A. Can advances in hemodialysis machine technology prevent intradialytic hypotension? Seminars in Dialysis. 2009;22(3):231-6.
32. Vareesangthip K, Davenport A. Reducing the risk of intradialytic hypotension by altering the composition of the dialysate. Hemodialysis International. 2020;24(3):276-81.
33. Tuna S, Pakyüz SÇ, Çaydam ÖD. Sistematik Derleme: Hemodiyalizdeki Hipotansiyonun Önlenmesi. Nefroloji Hemşireliği Dergisi. 2015;10(2):63-79.
34. Eldehni MT, Odudu A, McIntyre CW. Randomized clinical trial of dialysate cooling and effects on brain white matter. Journal of the American Society of Nephrology. 2015;26(4):957-65.
35. Geng X, Yu J, Xu J, Jin S, Shao W, Wang Y, et al. Role of magnesium in the risk of intradialytic hypotension among maintenance hemodialysis patients. Hemodialysis International. 2020;24(3):351-8.