Abstract
End-stage renal disease (ESRD) is treated mainly by hemodialysis, however, hemodialysis is associated with frequent complications, some of them involve the increased intracranial pressure. In this context, monitoring the intracranial pressure of these patients may lead to a better understanding of how intracranial pressure morphology varies with hemodialysis. This study aimed to follow-up patients with ESRD by monitoring intracranial pressure before and after hemodialysis sessions using a noninvasive method. We followed-up 42 patients with ESRD in hemodialysis, for six months. Noninvasive intracranial pressure monitoring data were obtained through analysis of intracranial pressure waveform morphology, this information was uploaded to Brain4care® cloud algorithm for analysis. The cloud automatically sends a report containing intracranial pressure parameters. In total, 4881 data points were collected during the six months of follow-up. The intracranial pressure parameters (time to peak and P2/P1 ratio) were significantly higher in predialysis when compared to postdialysis for the three weekly sessions and throughout the follow-up period (p<0.01) data showed general improvement in brain compliance after the hemodialysis session. Furthermore, intracranial pressure parameters were significantly higher in the first weekly hemodialysis session (p<0.05). In conclusion, there were significant differences between pre and postdialysis intracranial pressure in patients with ESRD on hemodialysis. Additionally, the pattern of the intracranial pressure alterations was consistent over time suggesting that hemodialysis can improve time to peak and P2/P1 ratio which may reflect in brain compliance.
Highlights
The parameters time to peak (TTP) and P2/P1 ratio were generally higher in the predialysis moment compared to the postdialysis moment
This change was repeated over time and a statistically significant difference was demonstrated in all evaluated sessions and months (p
We showed that noninvasive intracranial pressure (ICP) parameters (TTP and P2/P1 ratio) were higher in the first HD session of the week (Fig 3)
Summary
Chronic kidney disease (CKD), a leading cause of mortality and morbidity and a growing public health problem worldwide [1], is a complex disease that requires multiple treatment approaches [2]. The funder (Braincare Desenvolvimento e Inovacão Tecnologica S.A.) only provided support in the form of salaries for author GHF, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funder (Braincare Desenvolvimento e Inovacão Tecnologica S.A.) only provided support in the form of consultant fee for author NNR, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. NNR contributed as a researcher with Methodology, Visualization, Writing – review & editing, as described in the ‘author contributions’ section This commercial affiliation does not alter our adherence to PLOS ONE policies on sharing data and materials. This study aimed to follow-up patients with end-stage renal disease (ESRD) by monitoring ICP before and after HD sessions using a noninvasive method to assess ICP variations during HD treatment
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