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

Abstract

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.

Keywords: Cardiac preload; Dry weight; Hemodynamics monitoring; Hipotensión arterial intradiálisis; Intradialytic hypotension; Monitorización hemodinámica; Peso seco; Precarga cardiaca.