Intradialytic non-invasive hemodynamic monitoring: usefulness of cardiac preload values in predicting hemodynamic instability.

Autor:	Rojo MÁF; Servicio de Nefrología, Hospital Universitario de Toledo, Toledo, Spain. Electronic address: mdefr@sescam.jccm.es., Izquierdo RD; Servicio de Nefrología, Hospital Universitario de Toledo, Toledo, Spain. Electronic address: rdtejeiro@gmail.com., Alonso MV; Servicio Cardiología, Hospital Universitario de Toledo, Toledo, Spain. Electronic address: mario.baquero@gmail.com., Rodríguez DR; Servicio de Nefrología, Hospital Universitario de Toledo, Toledo, Spain. Electronic address: dabaibar@sescam.jccm.es., Bravo LC; Servicio de Nefrología, Hospital Universitario de Toledo, Toledo, Spain. Electronic address: lcueto@sescam.jccm.es., Rodríguez IC; Servicio de Nefrología, Hospital Universitario de Toledo, Toledo, Spain. Electronic address: icarmena@sescam.jccm.es., Herrero DC; Servicio de Nefrología, Hospital Universitario de Toledo, Toledo, Spain. Electronic address: dcarro@sescam.jccm.es., Reina CJC; Servicio de Nefrología, Hospital Universitario de Toledo, Toledo, Spain. Electronic address: ccabezasr@sescam.jccm.es., Hormigos FJA; Servicio de Nefrología, Hospital Universitario de Toledo, Toledo, Spain. Electronic address: fjahijadoh@sescam.jccm.es.
Jazyk:	angličtina
Zdroj:	Nefrologia [Nefrologia (Engl Ed)] 2024 Nov-Dec; Vol. 44 (6), pp. 846-856. Date of Electronic Publication: 2024 Dec 06.
DOI:	10.1016/j.nefroe.2024.11.024
Abstrakt:	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 < 0.001). 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 < 0.0001), (70.01 ± 2.1 vs. 68.97 ± 1.1; p < 0.0001), 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 < 0.05) and (3201 ± 325 vs. 3432 ± 231; p < 0.05), respectively. Patients who started the session with lower preload (ΔSV after infusion of 250 cc ≥ 10%) more frequently developed IDH (p < 0.001). Conclusions: Non-invasive hemodynamic monitoring and preload data may constitute a valid tool in managing the volume status of HD patients and preventing IDH. Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest. (Copyright © 2024. Published by Elsevier España, S.L.U.)
Databáze:	MEDLINE
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