Resolution of intradialytic hypotension and changes in hepatic oxygenation following the transition from hemodialysis to intermittent infusion hemodiafiltration: a case report.

An 82-year-old Japanese man had been undergoing hemodialysis (HD) for the preceding 5 months for chronic glomerulonephritis. During HD, the patient experienced recurrent episodes of intradialytic hypotension (IDH) resulting from an ultrafiltration-induced reduction in blood volume. Although we recommended an increase in dry weight to mitigate the onset of IDH, the patient declined this proposal. To maintain systemic hemodynamic stability during dialysis, the treatment modality was changed from HD to intermittent infusion hemodiafiltration (I-HDF). Relative changes in blood volume (%ΔBV) and hepatic regional oxygen saturation (rSO2) during both HD and I-HDF were continuously monitored using a Blood Volume Monitoring System (NIPRO Co., Osaka, Japan) and an INVOS 5100c oxygen saturation monitor (Covidien Japan, Tokyo, Japan), respectively. The decline in %ΔBV at the end of I-HDF was less pronounced than during HD (HD − 16.9%; I-HDF − 12.8%), and hepatic rSO2 remained stable during I-HDF, in contrast to the continuous decrease observed during HD. Moreover, no episode of IDH was observed in the I-HDF. Improved systemic hemodynamic stability observed during I-HDF may be attributable to the preservation of hepato-splanchnic circulation and oxygenation associated with cyclic dialysate infusion, although direct evidence for this association is still lacking.