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Abstract: TH-PO1196

A Randomized Cross-Over Trial Using Intradialytic MRI to Compare the Effects of Standard vs. Cooled Haemodialysis on Cerebral Blood Flow and Cardiac Function

Session Information

Category: Dialysis

Authors

  • Gullapudi, Venkata Rukmini Latha, University of Nottingham, Derby, United Kingdom
  • Cox, Eleanor, Sir Peter Mansfield Imaging Centre, Nottingham, United Kingdom
  • Buchanan, Charlotte Elizabeth, University of Nottingham, Derby, United Kingdom
  • Coleman, Sebastian C., University of Nottingham, Derby, United Kingdom
  • White, Kelly, University Hospitals Derby and Burton, Derby, United Kingdom
  • Canaud, Bernard J., FMC Deutschland GmbH, Bad Homburg, Germany
  • Taal, Maarten W., University of Nottingham, Derby, United Kingdom
  • Francis, Susan, Sir Peter Mansfield Imaging Centre, Nottingham, United Kingdom
  • Selby, Nicholas M., University of Nottingham, Derby, United Kingdom
Background

Ischemic end-organ damage during haemodialysis (HD) is a significant problem that may be ameliorated by intradialytic cooling. We performed a randomized trial to compare acute hemodynamic effects of standard HD (SHD) and cooled HD (CHD), using intradialytic magnetic resonance imaging (MRI) to provide concurrent assessments of cerebral blood flow (BF) and cardiac function.

Methods

12 prevalent HD patients were randomly allocated to receive 4 hours either SHD (dialysate temperature 37°C) or CHD (programmed cooling using BTM device). All other HD prescription and operating conditions remained constant. Participants were exposed to initial modality for two weeks before undergoing serial multiparametric MRI (Phillips 3T Ingenia) of the heart and brain pre, during (30min and 180min) and 30min post HD. Cognitive function was assessed pre and post HD. Participants then crossed over to the other modality and the study protocol repeated.

Results

Median age of participants was 59.5yrs (IQR 25), 3 had diabetes and dialysis vintage was 18.5months (IQR 52). Participants were significantly cooled during CHD (CHD -0.40±0.31°C vs SHD 0.28±0.24°C; p=0.02). Ultrafiltration rate was 7.5±2.6ml/kg/hr in CHD vs 6.9±2.7ml/kg/hr in SHD (p=0.3). BF velocities fell in carotid (-19±2%, p<0.001) and basilar arteries (-16±3%, p=0.004) during HD and reached nadir in the 4th hour, as did cardiac index and stroke volume index (-29±2% and -32±2%, both p<0.001). Reductions in left ventricular diastolic filling time and volume were also observed. Changes in cerebral BF and cardiac function were not different between CHD and SHD. Reduction in carotid BF was associated with higher ultrafiltration volumes (R2=0.43, p=0.005) and slower completion of trail making test: part B (R2=0.33; p=0.03). Pre-HD myocardial T1 and left ventricular wall mass were lower after two weeks of CHD as compared to SHD (1281±14ms vs 1308±18ms, p=0.03; 128±12g vs 137±12g, p=0.003).

Conclusion

HD and fluid volume reduction adversely affects cardiac function, carotid and basilar artery BF, with acute changes similar during SHD and CHD. However, lower myocardial T1 and left ventricular mass may indicate reduced myocardial tissue oedema with CHD.

Funding

  • Commercial Support