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Head Out Water Immersion for Hemodynamic Stability During Dialysis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT03057392
Recruitment Status : Completed
First Posted : February 20, 2017
Last Update Posted : April 19, 2017
Information provided by (Responsible Party):
Assaf-Harofeh Medical Center

Brief Summary:

Immersion to the neck before and during hemodialysis session may increase intravascular volume, potentiate the ability to ultrafiltrate excess water, with less symptoms of shock, muscle crumps etc.

The aim of the present study is to compare blood volume, hemodynamic and endocrine parameters of chronic ESRD patients undergoing forth dialysis session in water immersion vs. control regular session.

Condition or disease Intervention/treatment Phase
Intradialytic Hypotension Immersion Other: immersion Other: sham session Not Applicable

Detailed Description:

10 chronic hemodialysis patients, treated in the hemodialysis unit of Asaf-Harofeh Medical Center will be enrolled in the study.

Hemoglobin and albumin will be detected at baseline, and a recent (less than one year) echo will be used for the detection of ejection fraction.

The study will be a cross over study. Each set of studies will consist of two dialysis sessions, an immersion session, and a dry, non-immersion session. The study sessions will be short, 3 hours sessions with 250-350 ml/min blood flow (depends on the patients access) dialysate flow was 500 ml/min and dialysate sodium was 137meq/l. The temperature of the dialysate will be adjusted to 37°C and its composition as follows: Na+ = 137 mEq/L, K+ = 2.0 mEq/L, Ca2+ = 3.0 mEq/L, Mg2+ = 1.0 mEq/L, HCO3-= 30 mEq/L, glucose =100 mg/dL, CH3COO-= 8 mEq/L. The sodium concentration will be constant during treatment.

Ultrafiltration will be determined as the mean of UF during the ten previous sessions±10% according to the patients weight on admission. The immersed and dry session will be done in the midweek sessions, in random order, at least one week apart from each other.

Head-Out Water Immersion

A bath will be used for immersion. The bath will be filled with purified water before each of the session, and will be heated to 34-35°C. Patients will enter the bath and sat upright for few minutes and then connected to dialysis. The water will circulate through a thermostats and heating device in order to maintain a constant temperature.

Patients with arterio-venous fistula or graft in their arm will be immersed in water up to their axilla, with their arm lining on a floating pad. For patients with perm-cath immersion will only be done up to 5 cm below the catheter insertion.

Study procedure

Subjects will enter the bath and sit for few minutes, after which blood samples will be drown for baseline measurement. During the session blood pressure and heart rate will be measured every 15 minutes by conventional sphygmomanometry. and blood volume will be estimated by using blood volume monitor (Crit-Line).

Blood samples will be drown at baseline and after one hour, and before caseation of the session for plasma renin activity, aldosterone, atrial natriuretic peptide. Baseline and end of session urea will also measured for URR.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 10 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: The Effect of Head Out Water Immersion During Dialysis on Clinical Parameters, Hemodynamic Parameters, and Hormonal Parameters in 10 Hemodialysis Patients
Study Start Date : May 2013
Actual Primary Completion Date : December 2014
Actual Study Completion Date : March 2015

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: immersion and them sham procedure
hemodialysis patients will do a 3 hours dialysis session while sitting in a bath and then have a "dry session" outside the bath
Other: immersion
participants will sit in a 34-35C while receive dialysis

Sham Comparator: sham session and then immersion
dialysis patients will have a 3 hour dialysis session (dry session) and then immersion
Other: sham session
dialysis while sitting in the dialysis chair

Primary Outcome Measures :
  1. symptomatic hypotension during dialysis [ Time Frame: 3 hours ]
    a decrease of systolic BP of 22mmHG or more or decrease of diastolic BP of 10 mmHg or more accompanied with symptoms of muscle crumps, presyncope or syncope

Secondary Outcome Measures :
  1. blood pressure changes compared to baseline [ Time Frame: 3 hours every 15 min ]
    analysis by electronic sphygmomanometer every 15 minutes during the session

  2. Atrial natriuretic peptide change compared to baseline [ Time Frame: 0, 1, 3 hours ]
    blood will be drown from arterial line at baseline, after one hour and after 3 hours before dialysis termination.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 88 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • chronic hemodialysis patients

Exclusion Criteria:

  • anemia (HB<10) active infectious disease cognitive impairment dialysis access installed in the leg inability to cooperate with the study procedure Clinically evident overhydrated patients(edema, pulmonary congestion, pulmonary effusion)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT03057392

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Dialysis Clinic in Asaf Harofhe Medical Center
Zerifin, Israel, 70300
Sponsors and Collaborators
Assaf-Harofeh Medical Center
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Responsible Party: Assaf-Harofeh Medical Center Identifier: NCT03057392    
Other Study ID Numbers: 73/12
First Posted: February 20, 2017    Key Record Dates
Last Update Posted: April 19, 2017
Last Verified: April 2017
Keywords provided by Assaf-Harofeh Medical Center:
Additional relevant MeSH terms:
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Vascular Diseases
Cardiovascular Diseases