Abstract: PO1210
Crit-Line Blood Volume Monitoring in a Community Hemodialysis Unit
Session Information
- Hemodialysis and Frequent Dialysis - 4
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Author
- Dukes, Carl Erwin, Carl E. Dukes, MD PA, San Antonio, Texas, United States
Background
A quality improvement (QI) project on fluid management using Crit-Line Blood Volume Monitors (CLM) was conducted by a nephrologist in one community hemodialysis unit in Texas. A goal of the QI project was to decrease the blood pressure medication burden to facilitate better ultrafiltration during treatment. This analysis examines the changes in blood pressure (BP) medication (Med) and associated changes in post-dialysis weight and systolic BP.
Methods
Chronic HD patients of the nephrologist leading the QI project, receiving care during baseline (month before QI project) and the first month of QI project follow-up were included in this analysis. Time was divided into 1-month Baseline, 3-month training period, and 7-month follow-up. The physician reviewed each Crit-Line session and directed the staff to challenge the patient’s weight based on a positive refill curve. In order to facilitate further fluid removal, the vasodilating anti-hypertensive medications were discontinued. Thereafter, the other anti-hypertensive medications such as beta-blockers and RAASi agents were reduced or discontinued.
Results
Patients (n=43) were on average 63 years old, with a HD vintage of 5 years and had a fistula for vascular access (77%). 58% of patients identified as black/African American and 40% identified as Hispanic/Latino. Most patients (74%) had pre-HD systolic BP at baseline in the hypertensive range. 41 patients had BP Med information. During follow-up, 16.7% of patients discontinued BP med, 28.6% reduced BP med pills/day, 4.8% increased BP med pills/day, and the remaining had unchanged BP med. Changes in post and pre HD systolic BP and post-HD weight are presented in the table.
Conclusion
In a single-center QI project addressing fluid management through relative blood volume monitoring, 46% of patient were able to reduce (28.6%) or discontinue (16.7%) blood pressure medication. Patients able to discontinue the medications, had the largest decrease in post-HD weight.
| Change from baseline to last month of QIP | Unchanged BPM (n=19) | Reduced BPM (n=12) | Discontinued all BPM (n=7) | Increased BPM (n=2) |
| Post-HD Weight (kg) | -1.37 ± 4.57 | -0.78 ± 6.77 | -2.19 ± 4.44 | 0.18 ± 7.97 |
| Pre-HD Systolic BP (mmHg) | 0.18 + 14.5 | 1.8 ± 17.5 | -2.7 ± 25.0 | -19.4 ± 34.3 |
| Post-HD Systolic BP (mmHg) | 3.0 ± 14.2 | 0.11± 18.2 | -4.5 ± 35.4 | -7.5 ± 18.2 |
Funding
- Commercial Support –