Kidney Week

Abstract: SA-PO883

Continuous Intra-Access Pressure (IAP) Monitoring Helps Predict Intradialytic Hypotension (IDH)

Session Information

• Dialysis: Cardiovascular, BP, Volume
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Zasuwa, Gerard, Henry Ford Health System, Detoit, Michigan, United States

Gerard Zasuwa,

• Sands, Jeffrey J., Vasc-Alert LLC, Orlando, Florida, United States

Jeffrey J. Sands,

• Yee, Jerry, Henry Ford Hospital, Detroit, Michigan, United States

Jerry Yee,

• Frinak, Stanley, Henry Ford Hospital, Detroit, Michigan, United States

Stanley Frinak,

Background

IDH is a frequent hemodialysis (HD) complication associated with increased patient morbidity and mortality. Reliable IDH prediction that facilitates early intervention may reduce HD morbidity. We conducted a preliminary study exploring the hypothesis that that continuous IAP measurement using the Vasc-Alert^TMalgorithm (Am J Kidney Dis. 2002;40(4):760-768)can predict IDH during hemodialysis (HD).

Methods

Fresenius^TMT2 dialysis machines (DM) were equipped with onboard computers and customized software to calculate IAP at 20-second intervals via Vasc-Alert. 24 DMs were monitored during routine use during 3 daily shifts 6 days weekly. Treatment and relative blood volume data, collected by the CLiC™ device, was digitally acquired and stored. IDH episodes and measures to resolve them including repositioning, saline administration, and ultrafiltration rate adjustmentwere charted, abstracted, and mergedwith the electronic medical records. IAP waveform was correlated with IDH. Duration and rate of decline of IAPs from a moving average of 10 readings were analyzed.

Results

1,272,290 DM data points were collected from 2,290 HD treatments. A total of 139 IDH events (6%) were recorded and analyzed, yielding an equation demonstrating a linear correlation between IDH and IAP slope:y= −1986x+ 1136.5;RSqr= 0.69). An IAP drop >20 mm Hg over 15 seconds correlated with impending BP decrements. A representative example is shown (figure) where IDH at 11:02 correlated with a BP reduction from 145/84 mm Hg to 113/69 mm Hg. Subsequent IDH episodes at 12:02 and 13:02 were associated with abrupt, significant IAP slope declines.

Conclusion

The IAP slope and prolonged IAP declines of 20 mm Hg or more correlate with IDH during HD. Future analysis of relative blood volume may facilitate development of a more powerfully predictive model of IDH.

Funding

• Clinical Revenue Support