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Kidney Week

Abstract: TH-PO274

Changes of Hemodynamic Parameters over a Single Treatment Week in Patients Undergoing Chronic Intermittent Hemodialysis

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Bohnert, Bernhard N., Eberhard-Karls-Universitat Tubingen Medizinische Fakultat, Tubingen, Baden-Württemberg, Germany
  • König, David, Eberhard-Karls-Universitat Tubingen Medizinische Fakultat, Tubingen, Baden-Württemberg, Germany
  • Artunc, Ferruh, Eberhard-Karls-Universitat Tubingen Medizinische Fakultat, Tubingen, Baden-Württemberg, Germany
Background

Using ultrasound dilution, hemodynamic parameters such as access flow or cardiac output can be measured non-invasively and repeatedly during hemodialysis (HD). No data are available on the changes of these parameters within one week of treatment with long and short dialysis intervals.

Methods

In a prospective cohort study, various hemodynamic parameters were determined in n=44 prevalent HD patients during a 4-hour HD using the HD03 monitor (Transonic). Measurements were taken hourly on the first HD day of the week, on the second and third day at the beginning and end of HD. Access flow (AF, L/min), cardiac index (CI, L/min/m2 body surface area), central blood volume index (CBVI, mL/kg body weight), total cardiac ejection fraction (TEF, %) and total cardiac end-diastolic volume index (TEDVI, mL/kg) were recorded.

Results

The median AF was 1.1 L/min (interquartile range 0.8-1.7) at the beginning of the first HD of the week and did not change during HD. The values were unchanged on the following HD days. The median CI was 3.2 (2.7-3.9) L/min/m2 body surface area at the beginning of the first HD and CI continuously decreased to 85% of the baseline value during the HD (p<0.001). The CI recovered to baseline by the second HD and decreased to a median of 83% of baseline at the end of the second HD (p<0.001). The same pattern was found at the third HD. Median TEF was 53% (46-64) at the start of the first HD of the week and remained constant across all HD treatments. Medians of the central hydration parameters CBVI and TEDVI were 19 (16-25) and 10 (8-12) ml/kg body weight, respectively, at the beginning of the first HD and were lowered significant by 13% and 9%, respectively, at the end of the first HD. The course was similar to that of the CI, with a re-increase until the beginning and a reduction at the end of the second and third HD, respectively. The TEDVI and the CBVI were significantly lower before the beginning of the third HD than before the first HD. Systolic and diastolic blood pressure as well as heart rate showed a course parallel to that of the CI.

Conclusion

HD treatment compromises cardiac index that recurs regularly and reversibly within the treatment week. Central overhydration is highest after the long interval and decreases as the week progresses.