Abstract: FR-PO854

Increased Stroke Volume Variability during Hemodialysis Is Associated with High Cardiac Output State and Enhanced Mortality

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Sapoznikov, Dan, Hadassah University Medical Center, Jerusalem, Center, Israel
  • Backenroth, Rebecca, Hadassah University Medical Center, Jerusalem, Center, Israel
  • Dranitzki Elhalel, Michal, Hadassah University Medical Center, Jerusalem, Center, Israel
  • Rubinger, Dvora, Hadassah University Medical Center, Jerusalem, Center, Israel
Background

Stroke volume (SV) variability (sdSV) is a measure of the consistency of myocardial responsiveness during hemodynamic alterations, but its significance and predictive value in hemodialysis (HD) patients (pts.) are not well defined. The present study was undertaken to assess:1. the relationship of intradialytic sdSV with clinical data and other hemodynamic measurements and, 2. its effect on survival in chronic HD pts.

Methods

Continuous beat-to-beat intervals (IBI) and systolic (SBP) blood pressure were monitored using Finometer recordings in 119 HD pts. and in 34 age-matched control (C) individuals. Cardiac output (CO), SV and total peripheral resistance (TPR) were assessed using Beatscope software and the ModelFlow simulation method. The standard deviations (sd) of the above indices were considered to represent their variabilities. Kaplan Meier analysis was performrd to assess survival. A cutoff point of sdSV of 6.9 ml was chosen for best Log Rank significance.

Results

Table 1 lists hemodynamic data in C, in pts. with lower sdSV (≦6.9 ml, n=72) and in those with higher sdSV (>6.9 ml, n=47) (see Table 1 below). Clinical data were similar in both HD groups with the exception of more prevalent peripheral vascular disease and use of antihypertensive drugs in pts. with higher sdSV. Kaplan-Meier analysis of 5y survival showed a significantly increased mortality in HD pts. with higher as compared with those with lower sdSV (p=0.01).

Conclusion

Our data show that a special group of HD pts are characterized by high CO, SV and sdSV and decreased TPR. Increased sdSV in HD pts. was associated with decreased survival, as previously reported in pts with high output cardiac failure and preserved renal function. The causes of this syndrome may include inadequate vascular compliance, excessive vasodilatation or the type of vascular access and deserve further investigation.

Table 1.
 CHD Lower sdSVp (vs. C)HD Higher sdSVp (vs.C)p (Higher vs. Lower sd SV)
SBP (mm Hg)125 (21)136 (29)0.015141 (31)0.0810.860
sdSBP (mm Hg)6.1 (2.0)6.4 (2.3)0.7007.4 (2.7)0.0110.007
SV (ml)76 (28)75 (29)0.213108 (31)0.0010.001
sdSV (ml)4.9 (1.8)5.2 (1.3)0.6928.2 (2.5)0.0010.001
CO (L/min)5.8 (1.8)5.5 (2.2)0.1707.2 (2.7)0.0010.001
sdCO (L/min)0.38 (0.16)0.39 (0.17)0.5770.67 (0.31)0.0010.001
TPR (mmHg.s/ml0.914 (0.368)1.060 (0.534)0.0030.747 (0.271)0.0030.001

Data given as median (interquartile range).