Kidney Week

Abstract: PO1115

High-Frequency Oscillations of Intradialytic Arterial Oxygen Saturation in Hemodialysis Patients

Session Information

• Hemodialysis and Frequent Dialysis - 2
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Tao, Xia, Renal Research Institute, New York, New York, United States

Xia Tao,

• Thwin, Ohnmar, Renal Research Institute, New York, New York, United States

Ohnmar Thwin,

• Preciado, Priscila, Renal Research Institute, New York, New York, United States

Priscila Preciado,

• Cato, Matthew S., Renal Research Institute, New York, New York, United States

Matthew S. Cato,

• Thijssen, Stephan, Renal Research Institute, New York, New York, United States

Stephan Thijssen,

• Kotanko, Peter, Renal Research Institute, New York, New York, United States

Peter Kotanko,

Background

High-frequency oscillation of arterial oxygen saturation (SaO₂) presenting as repetitive “sawtooth” patterns was observed in sleep apnea patients, but it has never been reported during treatment in hemodialysis (HD) patients. In this study, we explored the prevalence of intradialytic “sawtooth” patterns and their clinical correlates in HD patients.

Methods

We prospectively studied chronic HD patients who didn’t use breathing devices, cardiac pacemaker, nasal oxygen, alpha blockers, short-acting nitrates, or have history of sickle cell anemia and non-sinus cardiac arrhythmia. During two visits per subject, we used the Crit-Line® Monitor to record SaO₂ at a frequency of 1 Hz, and video recording to capture periods of wakefulness for the entire treatment. SaO₂ data were analyzed for occurrence of “sawtooth” patterns (100% increase in standard deviation lasting ≥10s) and oxygen desaturation episodes (ODE, 3% drop from baseline lasting for ≥10s).

Results

16 subjects studied were 54±11 years old, 63% males, 69% African Americans. SaO₂ was 94.3±2.1%. “Sawtooth” patterns covered 19.1% of the recorded treatment time, whereas ODE made up only 0.3%. 9 out of 11 subjects who displayed “sawtooth” patterns, showed them in both visits. “Sawtooth” patterns were more likely to occur during the time when subjects were not awake than during wakefulness (25.3% vs. 17.0% of time in each status). Although ODE were rarely seen, 70% were observed during times when “sawtooth” patterns were also present. Figure 1 shows typical SaO₂ “sawtooth” patterns recorded.

Conclusion

Sleep-related breathing disorders are both highly prevalent and underdiagnosed in HD patients and may be underlying the high-frequency oscillations of intradialytic arterial SaO₂ observed in this study. These observations might be useful in identifying sleep-related respiratory abnormalities in HD patients that may warrant diagnostic workup. Further studies are needed to identify sleep-related SaO₂ oscillations and their relationship to clinical outcomes.

Funding

• Commercial Support –