Abstract
BackgroundIntradialytic blood pressure (BP) measurement is currently the main parameter used for monitoring hemodynamics during hemodialysis (HD). Since BP is dependent on cardiac output and total peripheral resistance, knowledge of these parameters throughout the HD treatment would potentially be valuable.MethodsThe use of a novel non-invasive monitoring system for profiling hemodynamic response patterns during HD was explored: a whole-body bio-impedance system was used to assess cardiac index (CI), total peripheral resistance index (TPRI), cardiac power index (CPI) among other parameters in chronic HD patients from 4 medical centers. Measurements were made pre, during and post dialysis. Patients were grouped into 5 hemodynamic profiles based on their main hemodynamic response during dialysis i.e. high TPRI; high CPI; low CPI; low TPRI and those with normal hemodynamics. Comparisons were made between the groups for baseline characteristics and 1-year mortality.ResultsIn 144 patients with mean age of 67.3 ± 12.1 years pre-dialysis hemodynamic measurements were within normal limits in 35.4% but only 6.9% overall remained hemodynamically stable during dialysis. Intradialytic BP decreased in 65 (45.1%) in whom, low CPI (47 (72.3%)) and low TPRI (18 (27.7%) were recorded. At 1-year follow-up, mortality rates were highest in patients with low CPI (23.4%) and low TPRI (22.2%).ConclusionsNon-invasive assessment of patients’ response to HD provides relevant hemodynamic information that exceeds that provided by currently used BP measurements. Use of these online analyses could potentially improve the safety and performance standards of dialysis by guiding appropriate interventions, particularly in responding to hypertension and hypotension.
Highlights
Intradialytic blood pressure (BP) measurement is currently the main parameter used for monitoring hemodynamics during hemodialysis (HD)
Complete medication data were available for 90/144 patients
Additional file 1: Table S1 details the comparison in various indices between the patients included in the four sites
Summary
Intradialytic blood pressure (BP) measurement is currently the main parameter used for monitoring hemodynamics during hemodialysis (HD). Hemodialysis (HD) induces significant hemodynamic imbalances due to rapid intravascular volume reduction, fluid and electrolyte shift, often occur simultaneously. This imposes significant stress on the heart and peripheral vasculature and leads to activation of various compensatory mechanisms necessary for the preservation of. Pre-dialytic low BP and/or the rapid development of IDH will require changes in dialysis plan or a modification of the patient’s chronic drug prescriptions. These modifications are largely based on clinical judgment in the absence of objective hemodynamic data. The objective of this study was to explore and describe the various hemodynamic changes that occur during chronic HD utilizing such a device
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