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Abstract: SA-PO751

Comparison of Stroke Volume Measurements during Hemodialysis Using Bioimpedance Cardiography and Echocardiography

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD


  • Germain, Michael J., Renal and Transplant Assoc of New England, Hampden, Massachusetts, United States
  • Joubert, Jyovani W., Kidney Care and Transplant Services of New England, Agawam, Massachusetts, United States
  • Nathanson, Brian Harris, OptiStatim, LLC, Longmeadow, Massachusetts, United States
  • Chait, Yossi, University of Massachusetts, Amherst, Massachusetts, United States
  • Levin, Nathan W., None, New York, New York, United States

Inadequate fluid management during hemodialysis (HD) has serious morbidity and mortality consequences. Intradialytic fluid management is typically guided by blood pressure, an indirect measure of hemodynamics status. Direct measurements of hemodynamic parameters may improve cardiovascular outcomes by providing empirical bases for intervention. We compare stroke volume (SV) measurements using a non-invasive, regional biompedance cardiography device (NiCaS) with Doppler echocardiography (Echo) in an HD setting.


Stroke volumes were simultaneously measured using the devices in 17 patients receiving maintenance HD. Measurements were made during two weekly HD treatments, and twice within each HD treatment during the first and last hourd, for a total of 64 SV measurements. Agreement between devices was assessed using linear regression, Pearson’s correlation coefficient, a Bland Altman plot, and 4-Quadrant plot each adjusted for repeated measures within patients.


Echo and NiCaS SV mean and 95% CIs were 58.0 (50.1, 65.8) and 56.7 (49.4, 64.0) ml, respectively. NiCaS SV correlated strongly with Echo SV during the first and last hours of treatments (r = 0.93, p<0.001 and r = 0.92, p<0.001, respectively). Linear regression of NiCaS on Echo showed a slope of 0.97, 95% CI (0.91, 1.02) which did not differ from 1, p = 0.20. A Bland-Altman plot and 4-Quadrant plot (Figure, left) indicated the two methods produced comparable measurements. Mean arterial pressure (MAP) changes during first and last hours of treatments did not correlate with SV changes during the same periods (Figure, right).


NiCaS SV measurements correlate with and are similar to Echo SV measurements. Thus, noninvasive NiCaS technology may be a practical method for measuring SV during HD.

(left) A 4-qaudrant plot showing percent change in SV from the first measurement of both Echo and NiCaS devices; (right) Hemodynamic changes between first and last hours of treatments (means of 2 subgroups) showing lack of correlation between changes in MAP and changes in SV.


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