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

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. Electronic supplementary material The online version of this article (10.1186/s12882-019-1542-4) contains supplementary material, which is available to authorized users.

Utility of Cardiac Power Hemodynamic Measurements in the Evaluation and Risk Stratification of Cardiovascular Conditions

“…Detailed journal article demographics, outcomes, and disease state definitions of the condition examined are highlighted in Table 3 . In the final analysis, 41 studies [ 3 , 6 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ] were included covering a total of 33,906 patients. When determining the use of CP in the determination of prognosis throughout the various disease processes, we categorized the articles based on the disease process they were associated with, as shown in Table 1 .…”

Hidden risks associated with conventional short intermittent hemodialysis: A call for action to mitigate cardiovascular risk and morbidity

“…BIC has interesting features to measure the hemodynamic response to fluid removal ( e.g., cardiac output and total peripheral vascular resistance) during dialysis. Based on these findings, it has been suggested that dialysis patients might be clustered into various categories defined as low or high cardiac output, low or high total peripheral vascular resistance, or normal hemodynamics[ 207 , 208 ]. BIC has the potential to support physicians to individualize dialysis treatment, although this would need to be tested in interventional studies[ 208 ].…”

Dialysis-Induced Cardiovascular and Multiorgan Morbidity

“…From a mechanistic view, preservation of hemodynamic status in response to fluid removal during dialysis requires a synergistic increase of cardiac output (stroke volume, ejection fraction, contractility, heart rate), total peripheral vascular resistance, and venous tone. 150 As discussed in a previous paragraph, the hemodynamic response to fluid removal in dialysis is complex and involves a combination of the patient characteristics, dialysis conditions, and the neurohumoral stress response. 151 Considering the complexity of the hemodynamic response to ultrafiltration, an intervention focusing only on 1 specific component may fall short in most patients.…”

“…Initial results have been promising and suggest that dialysis patients might be divided into different categories based on their predominant hemodynamic response to fluid removal (e.g., low or high cardiac output, low or high total peripheral vascular resistance or normal hemodynamics). 150,167 This approach has the potential to help physicians define individualized actions based on the patient's hemodynamic category, although interventional studies now needed to define its clinical value. 167 The same applies to other methods aiming to categorize individual hemodynamic characteristics.…”