Abstract: PO0857
Point-of-Care Ultrasound Measurements to Predict Intradialytic Hypotension: A Cross-Sectional Pilot Study
Session Information
- Fluid, Electrolytes, and Clinical Events with Dialysis: Getting to the "Heart" of the Matter
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Pawly, Chrystel, Lebanese American University, Beirut, Beirut, Lebanon
- Azzam, Wael, Lebanese American University, Beirut, Beirut, Lebanon
- Costanian, Christy, Lebanese American University, Beirut, Beirut, Lebanon
- Matzumura Umemoto, Gonzalo, Washington University in St Louis, St Louis, Missouri, United States
- Ablordeppey, Enyo, Washington University in St Louis, St Louis, Missouri, United States
- Tohme, Fadi, Lebanese American University, Beirut, Beirut, Lebanon
Background
Intradialytic hypotension (IDH) results from excessive ultrafiltration in patients on chronic hemodialysis (HD) and has been linked to increased mortality. Prescribing the right amount of ultrafiltration can be challenging, partly due to the poor sensitivity of physical examination for detection of volume overload in HD patients. POCUS is emerging as a valuable tool in the assessment of volume status. The goal of this study is to determine whether pre-dialysis POCUS measurements are associated with development of IDH.
Methods
Patients >18 years old on HD for at least 6 months and ordered for 2 or more liters of ultrafiltration were included. Two blinded POCUS-trained physicians obtained the following measurements within the first 30 minutes of HD: left ventricular septal and lateral E/e’, portal vein (PV) pulsatility and IVC size. The primary outcome was development of IDH events or post HD orthostasis. IDH was defined as a decrease in systolic blood pressure by > 20 mmHg plus symptoms of IDH. Fischer's and Mann Whitney tests were used to examine the association between IDH events and various demographic, clinical, and POCUS related parameters.
Results
54 measurements on 27 patients were obtained. Average time required by each examiner to obtain all images was 6 minutes (95% confidence interval [CI] 4.2,7.8 ). Average age was 57 (95% CI 52, 62), 85% were black and 44% were females. Average BMI was 32 (95% CI 28, 36), Charlson comorbidity index (CCI) score 7 (95 % CI 6,8), number of anti-hypertensive medications 2.1 (95% CI 1.5, 2.8) and average dialysis vintage 3.9 years (95% CI 2.1 ,5.7). 8 out of 27 patients developed the primary outcome. There was no association between age, sex, ethnicity, BMI, dialysis vintage, Charlson comorbidity index, interdialytic weight gain, IVC size, PV pulsatility, septal E/e' and the primary outcome. There was a significant association between lateral E/e’ and IDH events or post HD orthostasis (p=0.05).
Conclusion
In this pilot study, an elevated lateral E/E’ was associated with lower rates of IDH events or post HD orthostasis. The role of POCUS in guiding fluid removal during HD warrants further exploration