Arterial stiffness: hemodialysis versus hemodiafiltration

Ghigolea, Adrian-Bogdan; Gherman-Caprioara, Mirela; Moldovan, Argentina Raluca

doi:10.15386/cjmed-699

Cited by 2 publications

(9 citation statements)

References 22 publications

(12 reference statements)

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“…Cardiac power reduction induces reduction in cardiac output or BP or a combination of both, depending upon the degree of vasoconstriction (increased TPRI). Possible reasons for decreased TPRI (vasodilatation) may include old age, diabetic angiopathy often associated with autonomic dysfunction, and atherosclerotic disease [ 12 , 13 ]. In our study, the low TPRI group had highest percentage of diabetic patients (57.1%) which is frequently associated with autonomic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

The value of non-invasive measurement of cardiac output and total peripheral resistance to categorize significant changes of intradialytic blood pressure: a prospective study

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 99%

The value of non-invasive measurement of cardiac output and total peripheral resistance to categorize significant changes of intradialytic blood pressure: a prospective study

et al. 2018

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“…One cross-sectional study was identified that compared HDF with high-flux HD. 40 The follow-up duration ranged from 16 weeks to 7 years for HDF studies and from 12 weeks to 1 year for HDx studies.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Seven publications reported on cardiovascular outcomes. 22,[38][39][40]46,53,55 Of these, five compared HDF with high-flux HDF 22,[38][39][40]53 with two reporting a statistically significant beneficial effect 10,22,40 and three reporting a numerical benefit 38,39,53 of HDF compared with high-flux HDF. One study compared HDF with HD, where the flux level was not reported, and described a numerical benefit of HDF, 55 and a single study compared HDF with HDx and reported no difference in cardiovascular outcomes.…”

Section: Cardiovascular Outcomesmentioning

confidence: 99%

“…46 Specific cardiovascular outcomes reported included a significant reduction in the occurrence of intradialytic hypotension episodes with HDF compared with high-flux HD 22,53 and compared with HD where the flux was not specified. 55 Two studies reported vascular function outcomes with HDF versus high-flux HD and showed significantly better pulse wave velocity (to measure arterial stiffness), 40 brachial flow-mediated dilatation, 38 and carotid artery distension 38 with HDF compared with high-flux HD. One study compared cardiovascular outcomes between HDF and HDx and found no significant difference between the techniques.…”

Section: Cardiovascular Outcomesmentioning

confidence: 99%

“…All 15 cohort studies were found to be of high quality with a low risk of bias. The only crosssectional study identified was considered to have a low risk of bias 40. 4 | DISCUSSIONOutcomes in maintenance dialysis patients result from a complex equation that involves patient characteristics (age, sex, lifestyle, primary kidney disease, comorbidities, and residual kidney function), RRT schedule (treatment duration and frequency), therapeutic options (HD, HDx, and HDF), practice patterns (caregiver skills, medications, education, quality assurance, and control), and potential hazards (intercurrent disease).…”

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confidence: 99%

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Systematic review to compare the outcomes associated with the modalities of expanded hemodialysis (HDx) versus high‐flux hemodialysis and/or hemodiafiltration (HDF) in patients with end‐stage kidney disease (ESKD)

Mitchell¹,

Hornig

Canaud

2022

Seminars in Dialysis

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Background: This systematic review was performed to identify recent published comparative evidence on the efficacy, effectiveness, and safety of expanded hemodialysis (HDx) versus high-flux HD and/or hemodiafiltration (HDF) for long-term outcomes in end-stage kidney disease.Methods: Systematic literature review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Medline, Medline ® Epub Ahead of Print, EconLit, Embase, and EBM reviews were searched to identify relevant publications from 2013 onwards. Eligibility criteria included clinical studies reporting mortality, hospitalizations, cardiovascular outcomes, economic evaluations, cost studies, and quality of life (QoL) studies.Results: A total of 79 relevant studies were identified with 29 prioritized for detailed analysis; four compared HDx to HD, one compared HDF and HDx, and 24 compared HDF with HD. A total of 13 randomized controlled trial (RCT)-based studies were identified; 11 compared HDF with HD, one compared HDx with HD, and one compared HDF with HDx. Follow-up duration ranged from 16 weeks to 7 years for HDF studies and from 12 weeks to 1 year for HDx studies. HDF showed significant improvements in mortality, cardiovascular outcomes, hospitalizations, and QoL versus high-flux HD. One study reported mortality outcomes for HDx and found no difference versus HDF. QoL benefits with HDx were reported in a small number of studies. Conclusion:The efficacy and safety of HDF is supported by a robust evidence base that includes several RCTs. While HDx may offer benefits over high-flux HD, longterm studies are required to compare HDx with online high volume HDF.

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Arterial stiffness: hemodialysis versus hemodiafiltration

Cited by 2 publications

References 22 publications

The value of non-invasive measurement of cardiac output and total peripheral resistance to categorize significant changes of intradialytic blood pressure: a prospective study

The value of non-invasive measurement of cardiac output and total peripheral resistance to categorize significant changes of intradialytic blood pressure: a prospective study

Systematic review to compare the outcomes associated with the modalities of expanded hemodialysis (HDx) versus high‐flux hemodialysis and/or hemodiafiltration (HDF) in patients with end‐stage kidney disease (ESKD)

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