Key result
Low cardiac index and high total peripheral resistance index in the first 30 minutes of haemodialysis independently predicted intra-dialytic morbid events (OR 0.043 per unit of CI; 95% CI 0.003-0.611).
Why the study?
Does proto-dialytic cardiac function predict intra-dialytic morbid events in haemodialysis patients?
Observational (n=14)
Does proto-dialytic cardiac function predict intra-dialytic morbid events in haemodialysis patients?
Odds Ratio: 0.043 (95% CI 0.003–0.611)
Low cardiac index and high total peripheral resistance index in the first 30 minutes of haemodialysis are associated with an increased risk of intra-dialytic morbid events.
Early haemodynamic monitoring may flag intra-dialytic risk; hypothesis-generating for validation and intervention trials in haemodialysis.
BACKGROUND: Intra-dialytic morbid events (IDME) such as intra-dialytic hypotension (IDH) and muscle cramps frequently complicate haemodialysis (HD). Cardiac dysfunction is highly prevalent in HD patients. We investigated the relationship between proto-dialytic (i.e. early intra-dialytic) cardiac function and IDME in HD patients. METHODS: Heart rate, beat-to-beat blood pressure (BP) and cardiac output were continuously measured during the first 30 min of dialysis treatment using the Task Force™ Monitor. Total peripheral resistance index (TPRI) was calculated from cardiac index (CI) and BP. Univariate, multivariate and logistic regression analyses were employed to relate IDME to haemodynamic predictors; Kaplan-Meier method was employed for time-to-event analysis. RESULTS: Fourteen HD patients (age 67 ± 15 years; 7 females) were studied. Dialysis treatment was complicated by IDH and muscle cramps in 4 and 8 out of 30 sessions, respectively. CI was higher in patients without IDME (2.6 ± 0.5 L/min/m(2)) as compared to those with muscle cramps (2.0 ± 0.3 L/min/m(2)) or IDH (1.8 ± 0.2 L/min/m(2); all P < 0.05). CI and TPRI at baseline independently predicted IDME in a multivariate regression analysis (odds ratio: 0.043 per unit of CI, 95% confidence interval: 0.003-0.611; odds ratio: 1.124 per unit of TPRI, 95% confidence interval: 1.25-1.01). Patients were stratified by tertiles of CI. IDME occurred in the two lower tertiles, whereas patients in the upper tertile were event free (log-rank test, P < 0.002). CONCLUSIONS: Low CI and high TPRI in the first 30 min of HD are associated with an increased risk of IDME.
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Kolb et al. (2010) conducted an observational in Haemodialysis (n=14). Proto-dialytic cardiac index and total peripheral resistance index was evaluated on Intra-dialytic morbid events (IDME) (OR 0.043, 95% CI 0.003-0.611). Low cardiac index and high total peripheral resistance index in the first 30 minutes of haemodialysis independently predicted intra-dialytic morbid events (OR 0.043 per unit of CI; 95% CI 0.003-0.611).
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