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01.12.2019 | Research article | Ausgabe 1/2019 Open Access

BMC Nephrology 1/2019

Non-invasive hemodynamic profiling of patients undergoing hemodialysis - a multicenter observational cohort study

Zeitschrift:
BMC Nephrology > Ausgabe 1/2019
Autoren:
Keren Doenyas-Barak, Marcia H. F. G. de Abreu, Lucas E. Borges, Helcio A. Tavares Filho, Feng Yunlin, Zou Yurong, Nathan W. Levin, Allen M. Kaufman, Shay Efrati, David Pereg, Ilya Litovchik, Shmuel Fuchs, Sa’ar Minha
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The online version of this article (https://​doi.​org/​10.​1186/​s12882-019-1542-4) contains supplementary material, which is available to authorized users.

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Abstract

Background

Intradialytic 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.

Methods

The 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.

Results

In 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%).

Conclusions

Non-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.
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