Abstract: SA-PO875
Assessment of Plasma Refilling Rate in Dialysis Patients Using Plasma Body Weight Index Can Predict Intradialytic Hypotension
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
- Otsuka, Tadashi, Vanderbilt University , Nashville, United States
- Kaneko, Yoshikatsu, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Kaseda, Ryohei, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Yamamoto, Suguru, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Kon, Valentina, Vanderbilt University , Nashville, Tennessee, United States
- Narita, Ichiei, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Background
Intradialytic hypotension (IDH) is a major risk factor for mortality in hemodialysis (HD). IDH often occurs when plasma fluid removal outpaces plasma refilling rate (PRR) from the interstitial space. Increasing dry weight (DW) can easily increase PRR, but it can precipitate congestive heart failure (CHF). Plasma body weight index (PWI), calculated from plasma total protein (TP) concentration and body weight before and after HD, has been proposed as a convenient surrogate marker, which inversely correlates to PRR. Our aim was to determine if PWI can predict IDH, and if a combination with hANP can be used as a clinical index to determine relevant DW.
Methods
This study retrospectively examined records of 156 dialysis patients from December 30, 2015, to January 5, 2016 in Tachikawa Medical Hospital. IDH was defined by current KDOQI guidelines [a decrease in either systolic BP (SBP) ≥20 mmHg or mean arterial pressure≥10 mmHg as well as associated symptoms]. CHF was defined as patients with dyspnea and low SpO2 level (<96%). PWI was calcurated by using this formula: PWI = [(post TP - pre TP)*100/post TP]/[(pre body weight - post body weight)*100/pre body weight].
Results
IDH and CHF occurred in 28.2% and 7.7% of all patients, respectively. Patients with IDH had higher PWI levels than those without IDH (1.71±1.40 vs. 2.65±1.70, P = 0.007). PWI > 2.0 was predictive of high incidence of IDH (OR = 2.40, 95%CI, 1.12-5.12, P = 0.020), but was not associated with incidence of CHF (OR 1.00, 95%CI, 0.30-3.30, P = 1.000). On the other hand, hANP >100 pg/ml was predictive of high incidence of CHF (OR 3.52, 95%CI, 1.06- 11.71, P = 0.004), but not associated with incidence of IDH (OR 0.79, 95%CI, 0.37-1.71, P = 0.5504). Subdividing the patients into 4 groups by the two cut-off points of PWI and hANP revealed that in the cohort of PWI < 2.0/hANP < 100 pg/ml, there was no incidence of CHF and incidence of IDH was low (13.7%).
Conclusion
PWI is a useful marker to predict IDH. Evaluating hydration status by combining PWI and hANP ia a useful parameter to estimate DW.
Associations between PWI and IDH and CHF
| PWI ≧ 2.0 (n [%]) | PWI < 2.0 (n [%]) | OR (95% CI ) | P Value | |
| Intradialytic hypotension | 32 (35.2) | 12 (18.5) | 2.40 (1.12-5.12) | 0.0201 |
| Congestive heart failure | 7 (7.7) | 5 (7.7) | 1.00 (0.30-3.30) | 1.0000 |
OR, odds ratio; 95% CI, 95% confidence interval.