Kidney Week

Abstract: TH-PO211

Crit-Line Monitoring Decreases Intradialytic Hypotension

Session Information

• Hemodialysis and Frequent Dialysis - I
  November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Harford, Antonia, Dialysis Clinic Inc, Albuquerque, New Mexico, United States

Antonia Harford,

• Whittle, Donna D., Dialysis Clinic Inc, Albuquerque, New Mexico, United States

Donna D. Whittle,

• Young, Michael A., Dialysis Clinic Inc, Albuquerque, New Mexico, United States

Michael A. Young,

• Paine, S., Dialysis Clinic Inc, Albuquerque, New Mexico, United States

S. Paine,

• Jiang, Huan, Dialysis Clinic Inc, Albuquerque, New Mexico, United States

Huan Jiang,

• Gul, Ambreen, Dialysis Clinic Inc, Albuquerque, New Mexico, United States

Ambreen Gul,

• Zager, Philip, Dialysis Clinic Inc, Albuquerque, New Mexico, United States

Philip Zager,

Background

Published clinical studies on the use of blood volume monitoring to guide ultrafiltration in hemodialysis (HD) have had mixed results. We conducted a continuous quality improvement (CQI) project to assess the impact of Crit-Line monitoring during routine care in a chronic HD facility operated by a large, non-profit dialysis provider. We postulated that Crit-Line monitoring would decrease intradialytic hypotension & hospitalization due to fluid overload.

Methods

After a 6-month baseline period, we conducted 1 month staff training on Crit-Line use, followed by a 2^nd 6-month period with Crit-Line monitoring with each HD. 29 HD patients contributed a mean of 62 & 61 treatments to the baseline & Crit-Line periods, respectively. Mean & 95% confidence intervals (95% CI) for age & vintage were 62.6 (57.6, 67.6) & 4.7 (2.2, 7.2) years, respectively. Males & diabetics comprised 72% & 38% of the patients, respectively. Hypotension was defined as systolic blood pressure (BP) < 100 mmHg or symptoms associated with a drop in BP. Dialysate temperature & composition did not change significantly between the 2 time periods. We used Poisson regression models, adjusted for sex, diabetes, vintage & BMI, to compare treatment related events including cramping, symptomatic hypotension, & leaving treatment > 1 kg from estimated dry weight (EDW) & hospitalization during the baseline period & the 6-months in which Crit-Line monitoring was used.

Results

Intradialytic hypotension was significantly lower during Crit-Line monitoring (OR 0.37, 95% CI 0.2, 0.7). Other adverse events including all-cause & cardiovascular hospitalization rates did not differ across the 2 time periods (see table).

Conclusion

Crit-Line use was associated with a statistically significant decrease in the frequency of intra-dialytic hypotension; however there was no association with hospitalization. Well trained staff are essential to the optimal use of Crit-Line monitoring.

Funding

• Commercial Support – Dialysis Clinic, Inc.