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Abstract: PO1058

Plasma Refill Rate: A Potential Hemodynamic Marker of Intradialytic Hypotension During Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Wang, Hao, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Negoianu, Dan, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Rogg, Sabrina, Renal Research Institute, New York, New York, United States
  • Zhang, Hanjie, Renal Research Institute, New York, New York, United States
  • Hsu, Jesse Yenchih, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
  • Raimann, Jochen G., Renal Research Institute, New York, New York, United States
  • Dember, Laura M., University of Pennsylvania, Philadelphia, Pennsylvania, United States
Background

Intradialytic hypotension (IDH) is difficult to predict. Continuous hematocrit monitoring (CHM) measures relative blood volume to provide non-invasive dynamic monitoring during hemodialysis (HD). We used CHM data with time-updated ultrafiltration rate (UFR) to estimate plasma refill rate (PRR), a potential mediator of hemodynamic status, and studied its relationship to IDH.

Methods

We used CHM performed at 17 Renal Research Institute HD units from 2017 to 2019 to calculate intradialytic PRR standardized to weight and height. We defined IDH as 1) systolic blood pressure (SBP) <90 mmHg and 2) a drop in SBP ≥20 mmHg or in mean arterial pressure ≥10 mmHg associated with symptoms. IDH-prone was defined as having >20% of treatments with IDH. Uni- and multivariable mixed-effects logistic regression were used to evaluate factors associated with low initial PRR (lower quartile) within the first 10 minutes of HD. Bi- and multinomial logistic regression were used to evaluate the relationship between initial PRR and IDH. Data are presented as mean±SD or aOR; 95% CI.

Results

We studied 2,637 patients (61±15 yrs, 57% male, 51% white) with 184,044 total treatments, interdialytic weight gain (IDWG) 2.1±1.4 kg, and UFR 9.5±4.6 ml/kg/h. IDH occurred in 13.7% and 15.8% of treatments by definitions 1 and 2, respectively. PRR (ml/kg/h) over all sessions was 5.0±8.8, 8.4±6.0, 7.9±7.2, and 7.4±11.4 at 10m, 1h, 2h, and 3h, respectively, with substantial variability at both patient and treatment levels. Older age, low BMI, female sex, black race, low albumin, and multimorbidity were associated with low initial PRR. Patients with low initial PRR were more likely to be IDH-prone by definition 1 (aOR 1.95; 1.01-3.72) and definition 2 (aOR 1.50; 0.87-2.56). Patients with low initial PRR were more likely than patients with high initial PRR to be IDH-prone by definition 1 (aOR 2.12; 1.50-2.74).

Conclusion

The dynamics of PRR vary during an HD session and has promise as a marker of hemodynamic instability. We found that several patient and treatment factors classically associated with IDH were also associated with low initial PRR, independent of IDWG, SBP, and UFR, and that low PRR was associated with IDH. Further investigation into the predictive utility of PRR throughout HD may offer novel insights to extend the use of CHM.

Funding

  • NIDDK Support