Abstract: SA-PO745

Assessment of the Impact of Fluid Removal Rate on Central Arterial Waveform Analysis

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Brier, Michael E., University of Louisville, Louisville, Kentucky, United States
  • Jacobs, Alfred A., University of Louisville, Louisville, Kentucky, United States
  • Aronoff, George, DaVita, Inc., Naples, Florida, United States
Background

Rapid fluid removal during dialysis is associated with poor cardiac outcomes when rates exceed 10 ml/h/kg. We tested the hypothesis that measuring central arterial pressure and waveform analysis including measures of vascular stiffness would help identity those patients at risk.

Methods

Nineteen subjects at the University of Louisville were enrolled in a prospective study measuring central blood pressure and waveform analysis using the SphygmoCor device. Subjects were studied following informed consent on the first and last dialysis treatment of the same week. Measurements were obtained prior to dialysis and at 30 minute intervals. Measurement data were summarized using regression analysis and the resulting slope and intercept were tested against fluid removal rate. We compared central arterial pressures (systolic, diastolic, mean, augmentation), augmentation index, and reflection magnitude.All analyses were performed in SPSS using linear regression.

Results

Subject predialysis weight ranged from 53 to 167 kg. Four subjects were female. Fluid removal rates ranged from 4.1 to 30.8 ml/h/kg and were significanlty related to predialysis weight (p=0.003). The results of the analysis comparing fluid removal rate to measured parameters are shown in the following table.

Conclusion

Comparison of central pressures and vascular stiffness with fluid removal rate demonstrated a significant relationship between central diastolic pressure and central mean pressure. The relationship demonstrated an increase in these measures for those subjects with the greatest fluid removal rate which may be a contributing factor in the observed morbidity and mortality of these patients. This observation is confounded by predialysis weight where the largest fluid removal rates were associated with the smallest patients.Three measures of vascular stiff were not found to be related to fluid removal rates.

ParameterRegression Estimatep value
Central systolic pressure15.20.119
Central diastolic pressure54.60.002
Central mean pressure36.00.011
Augmentation pressure-28.80.227
Augmentation Index-19.20.099
Reflection magnitude-30.80.112

Comparison of individual regression slope results to fluid removal rate.