Use of non-invasive intracranial pressure pulse waveform to monitor patients with End-Stage Renal Disease (ESRD)

Abstract

End-stage renal disease (ESRD) is treated mainly by hemodialysis, however, hemodialysis is associated with frequent complications, some of them involve the increased intracranial pressure. In this context, monitoring the intracranial pressure of these patients may lead to a better understanding of how intracranial pressure morphology varies with hemodialysis. This study aimed to follow-up patients with ESRD by monitoring intracranial pressure before and after hemodialysis sessions using a noninvasive method. We followed-up 42 patients with ESRD in hemodialysis, for six months. Noninvasive intracranial pressure monitoring data were obtained through analysis of intracranial pressure waveform morphology, this information was uploaded to Brain4care® cloud algorithm for analysis. The cloud automatically sends a report containing intracranial pressure parameters. In total, 4881 data points were collected during the six months of follow-up. The intracranial pressure parameters (time to peak and P2/P1 ratio) were significantly higher in predialysis when compared to postdialysis for the three weekly sessions and throughout the follow-up period (p<0.01) data showed general improvement in brain compliance after the hemodialysis session. Furthermore, intracranial pressure parameters were significantly higher in the first weekly hemodialysis session (p<0.05). In conclusion, there were significant differences between pre and postdialysis intracranial pressure in patients with ESRD on hemodialysis. Additionally, the pattern of the intracranial pressure alterations was consistent over time suggesting that hemodialysis can improve time to peak and P2/P1 ratio which may reflect in brain compliance.

Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients

“…In COVID-19 patients, the combination of P2/P1 with TCD allowed to identify disturbances in cerebral hemodynamics (CH) and predict early poor outcome [31]. Moreover, the application of this system in previously unexplored health conditions has suggested interesting alterations in brain compliance among patients with end-stage renal disease under hemodialysis [32] and robotic prostatectomy surgery because of Trendelenburg positioning [33].…”

Alteração da complacência intracraniana em paciente com doença renal crônica e diabetes mellitus T1: um relato de caso

“…Laboratory data show that the subject of this research presented high blood glucose concentrations during the evaluated period, especially demonstrated by the glycated hemoglobin (HbA1c) test. Likewise, a change in the conformation of the ICP waveform was observed in both monitoring, with peak P2 being greater than peak P1, while under normal conditions the ratio should be P1>P2, with the calculated value of this ratio being less than 1 (P2/P1<1) (Rickli et al, 2021).…”

“…In addition to these changes related to CKD, Rickli et al, 2021 reported in their study the change in brain compliance, through noninvasive monitoring of Intracranial Pressure (ICP), in individuals with stage 5 CKD undergoing hemodialysis. The process of cerebral blood flow (CBF) autoregulation is an important factor that preserves brain volume homeostasis in changes in Cerebral Perfusion Pressure (CPP).…”

Noninvasive intracranial pressure monitoring in women with migraine

“…Recent evidences showed abnormalities in the ICP waveforms in different conditions by using the same non-invasive method as proposed in our study, through assessment of the volume changes in the skull, measured by an electric sensor in millivolts 32 – 35 . Alteration in the P2/P1 ratio were observed in hydrocephalus children 32 , in renal disease patients before and after dialysis 34 and in case studies of children with untreatable headaches and secondary obstructive hydrocephalus 33 and idiopathic intracranial hypertension 35 . On the other hand, no waveform abnormalities were seen in migraineurs in the current study, which represents a less severe disease but still involving a complex neurovascular dysfunction.…”