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Kidney Week

Abstract: FR-PO422

Intradialytic Hypoxemia In ESRD Patients on Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kunjal, Ryan A., Washington University in St. Louis, St. Louis, Missouri, United States
  • Li, Tingting, Washington University in St. Louis, St. Louis, Missouri, United States
  • Haldaman, Vicki M., Washington University in St. Louis, St. Louis, Missouri, United States
  • Bingel, Brenda, Washington University in St. Louis, St. Louis, Missouri, United States
  • O Brien, Frank J., Washington University in St. Louis, St. Louis, Missouri, United States
Background

Mortality rates amongst end- stage renal disease (ESRD) patients on hemodialysis (HD) are high and death is most often due to cardiovascular disease. Based on previously published retrospective data, low oxygen levels during HD have been associated with all-cause hospitalization and mortality. We aimed to explore this association in our two university managed HD units.

Methods

We looked at HD patients with central venous catheters (CVC) and those with arterio-venous access (AVA). We measured oxygen levels using crit-line monitors (CLM) for 3-4 routine dialysis sessions. For those with CVC, we considered those with mean ScvO2 <63% to have intradialytic hypoxemia. Amongst patients with AVA, we identified those with prolonged intradialytic hypoxemia (PIH) as having SaO2 <90% for > 1/3 of the session. We then examined the differences in clinical characteristics between these high-risk groups with hypoxemia and their control cohorts without desaturation. These characteristics include demographic, session- related, laboratory and CLM parameters.

Results

We enrolled 222 patients, of which 35 had CVC and 187 had AVA. Amongst those with CVC, 22 (62.8%) experienced mean ScvO2 <63% and they had an average 1.4 g/dl higher hemoglobin (95% confidence interval [CI], 0.3 to 2.5, P=0.014). However, they did not have any other significant differences from those with higher mean ScvO2. Amongst those with AVA, 5 (2.7%) experienced PIH and they tolerated 11.2% smaller change in blood volume per hour, (95% CI, 1.1 to 21.3, P= 0.030). No other statistically significant differences were observed. We did however note that amongst patients with either access type, those with intradialytic hypoxemia tended to have higher hospitalization rates in the preceding 6 months and had more C- curve profiles on CLM.

Conclusion

We did identify patients who experienced low oxygen levels during HD. However, the proportion of our AVA cohort with PIH was almost one quarter of that previously reported by Meyring-Wosten, 2016. Desaturation rates among those with CVC were similar to previously published studies. We intend to further determine if the use of supplemental oxygen during dialysis can correct the intradialytic hypoxemia.If this can be successfully accomplished, it may be worthwhile to conduct larger prospective studies to evaluate the impact of this intervention on patient outcomes.