Abstract
BackgroundBlood pressure (BP) is currently the main hemodynamic parameter used to assess the influence of fluid removal during hemodialysis session. Since BP is dependent on cardiac output (CO) and total peripheral resistance (TPRI), investigating these parameters may help to better understand the influence of fluid removal on patient’s hemodynamics. We used a novel non-invasive whole-body bio-impedance cardiography device, recently validated in hemodialysis patients, to examine mechanisms of intradialytic hemodynamics in a Chinese dialysis population.MethodsChronic hemodialysis patients in Sichuan Provincial People’s Hospital were enrolled. Demographic data and dialysis prescriptions were collected. Hemodynamic measurements were made pre-treatment, every 20 min during treatment and immediately after treatment in each random dialysis session. These included blood pressure, cardiac index (CI), total peripheral resistance (TPRI) and cardiac power index (CPI). Patients were divided into 5 hemodynamic groups as per their major hemodynamic response to fluid removal: low CPI, low TPRI, high TPRI, High CPI and those with normal hemodynamics.ResultsTwenty-seven patients were enrolled, with 12 (44.4%) males. The average age was 65 ± 12 y. The average body mass index (BMI) was 23.7 ± 3.9 kg/m2. 12 (44.4%) patients were diabetic. Three hundred twenty-four hemodynamic measurements were made. Weight, BMI, total fluid removal, pretreatment systolic BP, CI, TPRI and CI differed significantly among the 5 hemodynamic groups.11.1% of patients had low CPI, 25.9% had low TPRI, 18.5% had high CPI, 3.7% had high TPRI and 40.7% had normal hemodynamics. Hemodynamic differences among the 5 subgroups were significant.ConclusionThis technology provides multi-dimensional insight into intradialytic hemodynamic parameters, which may be more informative than blood pressure only. Using hemodynamic parameters to describe patients’ status is more specific and accurate, and could help to work out specific and effective therapeutic actions according to underlying abnormalities.
Highlights
Blood pressure (BP) is currently the main hemodynamic parameter used to assess the influence of fluid removal during hemodialysis session
The device was validated against pulmonary artery catheter thermodilution on acute heart failure patients [3, 4] and recently was validated against Echocardiography on dialysis patients with correlation factor r = 0.92 which was maintained during fluid removal in maintenance hemodialysis treatments [5]
We examined the mechanisms of intradialytic hemodynamics, including cardiac output, peripheral resistance and cardiac power, in a Chinese dialysis population, in order to evaluate different hemodynamic statuses in this population, and to provide evidence for possible specific preventive and interventional actions, in the management of hypotensive episodes
Summary
Blood pressure (BP) is currently the main hemodynamic parameter used to assess the influence of fluid removal during hemodialysis session. We used a novel non-invasive whole-body bio-impedance cardiography device, recently validated in hemodialysis patients, to examine mechanisms of intradialytic hemodynamics in a Chinese dialysis population. Accurate measurement of cardiac output and total peripheral resistance requires the pulmonary artery catheterization determined cardiac output (CO) thermodilution technique [1], which is unrealistic in the hemodialysis clinic. Recent technological developments provide the capability to non-invasively measure hemodynamic parameters including CO during dialysis session These intradialytic non-invasive measurements provide opportunities to learn the full pattern of hemodynamic responses to fluid removal during hemodialysis and to intervene according to deviations from normal. A novel non-invasive whole-body bio-impedance cardiography device (NICaS, NI-Medical, Israel) has been used recently to assess this in chronic hemodialysis patients [2]. The device has been proven to be more accurate than its predecessor thoracic impedance cardiography [6]
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