Interview with
Jeffrey H. Burbank
Founder& CEO of NxStage

Hemodialysis.com Editor Marie Benz: What are the main findings of the study?

The main findings of this retrospective study were that the use of hypertonic mannitol (vs non-use) during the first three sessions of hemodialysis initiation was associated with higher minimum intra-dialytic systolic blood pressure, less decline in SBP during dialysis and lesser odds of experiencing a hypotensive event during dialysis (defined as drop in SBP of >20mmHg form pre-dialysis SBP or an absolute SBP during dialysis of <90mmHg). 

Hemodialysis.com: Were any of the findings unexpected?

Our findings lend support to the theory that intra-dialytic decline in osmolality may play a role in predisposing to the development of hemodynamic instability. 

The mechanism for this observation may relate to:

1) preservation of intravascular volume by limiting the generation of osmotic gradients between the intravascular and intracellular compartments and
2) osmotic stimulation of vasopressin release, which may regulate vascular tone. 

Hemodialysis.com: What should clinicians and patients take away from your report? 

Hemodialysis initiation is a dynamic period when dialysis induced osmotic and fluid shifts are potentially large.  Our retrospective data suggests that the administration of hypertonic mannitol may play a role in improving hemodynamic stability during this period.   

Hemodialysis.com: What recommendations do you have for future research as a result of this study?  

This study was retrospective and follow-up was limited to the hemodialysis initiation period.

Future prospective studies will be required to confirm these findings, assess longer term effects of this treatment and determine optimal dosing strategies.

Future research relating to the dialysis prescription during the critical time of dialysis initiation may be important in minimizing adverse patient complications.

Reference:

Mc Causland FR, Prior LM, Heher E, Waikar SS:
Preservation of Blood Pressure Stability with Hypertonic Mannitol during Hemodialysis Initiation.
Am J Nephrol 2012;36:168-174 (DOI: 10.1159/000341273)
Finnian R. Mc Causland, Sushrut S. Waikar