Prognostic Utility of Impedance Cardiography Measurements in Elderly Hemodialysis Patients with Coronary Artery Disease

Abstract

Aim: We evaluated the utility of impedance cardiography (IC) in elderly hemodialysis (HD) patients with coronary artery disease (CAD). Patients and Methods: Seventy-five HD patients (30 with CAD) participated. IC cardiac output (ICCO), systemic vascular resistance and pulse pressure (PP) were calculated at baseline, and 30 and 180 days after study entry. ICCO was compared to echocardiography cardiac output (ECO). Relationships of IC measurements and cardiovascular mortality were assessed. Patients were followed up for 6 years after study entry or until death due to cardiovascular events. Results: ICCO and ECO were strongly correlated (r = 0.94, p < 0.001). ICCO correlated inversely with PP (r = –0.61; p < 0.001). Thirty fatal cardiovascular events were recorded. Using the bayesian’ information criterion, multivariate Cox regression models revealed that increased PP and New York Heart Association (NYHA) class as well as decreased diastolic blood pressure (DBP) were predictors of cardiovascular mortality. Having a DBP <60 mm Hg (adjusted for NYHA) yielded a hazard ratio of 2.8 (95% confidence interval = 1.2–6.7). Conclusion: IC accurately estimates the hemodynamic status in HD patients with CAD. Deterioration of cardiovascular performance expressed by decreased DBP values, adjusted for NYHA, may help to predict outcome.

Emergency care of the dialysis patients

“…Karakitsos et al [24] performed a prospective observational study among 75 HD patients in whom measurements were taken on a midweek morning of a non-dialysis day. The research showed that the CO obtained by ICG (BioZ System) (mean 4.4 ± 1 L) and the CO measured by echocardiography (4.3 ± 0.9 L) were strongly correlated (r = 0.94; p < 0.001).…”

Evaluation of intradialytic hypotension using impedance cardiography

“…In another study, impedance cardiography was used to assess patients' fluid status during dialysis, using thoracic fluid content and cardiac output [12]. Karakitsos et al compared impedance cardiography with echocardiography in hemodialysis patients [13]. They showed that impedance cardiography can estimate hemodynamics in hemodialysis patients with coronary artery disease and help predict outcome in certain patients.…”