Abstract: FR-PO850

Changes in Blood Pressure Following a Fluid Management Quality Improvement Project (QIP) during In-Center Hemodialysis (HD)

Session Information

Category: Dialysis

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

Authors

  • Balter, Paul, Renal Research Institute, New Haven, Connecticut, United States
  • Anderson, Ludmila, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Pacelli, Lisa A., Renal Research Institute, New Haven, Connecticut, United States
  • Taylor, Patrice B., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Mullon, Claudy, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Kossmann, Robert J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Ficociello, Linda H., Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background

Fluid and sodium retention are leading causes of hypertension (HT) among HD patients. A QIP with a goal to improve fluid management among patients on thrice weekly HD was conducted. This analysis aimed to determine whether QIP initiation was associated with BP changes among HT patients.

Methods

The QIP utilized Crit-Line® Monitors (CLM III) that non-invasively assess intra-dialytic relative blood volume (RBV) and provide real-time data to allow for ongoing fluid monitoring and management. De-identified data from electronic medical records of active patients at QIP initiation were analyzed. Average values for parameters at baseline (BL; 1 mo. prior to QIP initiation) and during first 3 mos. of the QIP were assessed. Changes in RBV, ultrafiltration volume (UFV), treatment (TX) time, and BP were analyzed. Stratified analyses by BL hypertension (HT) status (HT defined as pre-HD SBP > 140 or pre-HD DBP > 90 mmHg) were conducted. T-test and α=.05 were used to compare the BL and the 3rd month of the QIP.

Results

In total, 54 out of 83 (65%) patients had HT at BL. Although UFV and TX time did not change between BL and mo.3 of the QIP, the majority of measured parameters of BP (Table) improved. On average, pre-HD SBP decreased from 163.3 to 157.8 mmHg (p=.01) and pre-HD DBP decreased from 88.0 to 85.1 mmHg (p=.05). Among normotensive patients (n=29), all BP parameters remained unchanged. The % of RBV removed during HD changed from 8.9% during mo.1 to 9.4% during mo.3 of the QIP among HT patients (p=0.7), and from 9.8% to 10.0% among normotensive patients (p=0.8).

Conclusion

QIP initiation was associated with a decrease in BP parameters among HT patients. Neither TX time nor UFV changed over 4 mos. of observation.

n=54UFV (l)TX Time (min)Pre-HD SBPPre-HD DBPPost-HD SBPPost-HD DBPMin-HD SBPMin-HD DBPMax-HD SBPMax-HD DBP
BL2.42223.1163.388.1148.981.6124.766.8171.497.0
Mo.12.48223.7160.586.4144.580.0120.365.1167.996.3
Mo.22.49220.1158.885.0138.977.1117.664.1163.894.0
Mo.32.51223.6157.885.1140.377.7116.363.3164.294.2
BL vs. Mo.3
p-value
0.40.40.010.050.0030.0080.0030.020.0050.05

Funding

  • Commercial Support