María Ángeles Fernández Rojo , Rafael Díaz-Tejeiro Izquierdo , Mario Vaquero Alonso , Dabaiba Regidor Rodríguez , Laura Cueto Bravo , Iván Carmena Rodríguez , David Carro Herrero , Carlos Jesús Cabezas Reina , Francisco Javier Ahijado Hormigos
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引用次数: 0
Abstract
Introduction
Adequate control of patient blood volume in hemodialysis (HD) is essential as a modifiable risk factor for morbidity and mortality. In this study, we propose continuous non-invasive hemodynamic monitoring using bioreactance (Starling™ SV. Baxter) and real-time characterization of cardiac preload data to aid in the accurate assessment of volume status and improvement of tolerance in HD.
Methodology
Observational and prospective study on the relationship between cardiac preload data and intradialytic hemodynamic instability. Forty-six stable HD patients were recruited. Clinical, analytical, and dialysis data were collected from all participants. The protocol included bioimpedance (BIVA), pre- and post-dialysis echocardiography and tissue Doppler, and monitoring of hemodynamic parameters during the session.
Results
According to the Fall20 definition, 24 patients (51.19%) experienced intradialytic hypotension (IDH). We found no relationship between IDH and analytical, echocardiographic, BIVA parameters, or relative blood volume measurement (BVM) values. Regarding hemodynamic monitoring, indexed systolic volume (ISV) was lower in patients with IDH (38.2 ± 0.9 vs. 39.2 ± 1.9; P<.001). Indexed systolic volume variation (ISVV) and heart rate (HR) were higher in the IDH group (14.1 ± 0.7 vs. 13.5 ± 0.7; P<.0001), (70.01 ± 2.1 vs. 68.97 ± 1.1; P<.0001), respectively. Indexed cardiac output (ICO) and indexed peripheral resistances (IPR) were also lower in the IDH group (2.62 ± 0.09 vs. 2.65 ± 0.13; P<.05) and (3201 ± 325 vs. 3432 ± 231; P<.05), respectively. Patients who started the session with lower preload (ΔSV after infusion of 250 cc ≥ 10%) more frequently developed IDH (P<.001).
Conclusions
Non-invasive hemodynamic monitoring and preload data may constitute a valid tool in managing the volume status of HD patients and preventing IDH.
期刊介绍：
Nefrología is the official publication of the Spanish Society of Nephrology. The Journal publishes articles on basic or clinical research relating to nephrology, arterial hypertension, dialysis and kidney transplants. It is governed by the peer review system and all original papers are subject to internal assessment and external reviews. The journal accepts submissions of articles in English and in Spanish languages.
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