Proto-dialytic cardiac function relates to intra-dialytic morbid events

Area of Science:

• Nephrology
• Cardiology
• Clinical Physiology

Background:

• Intra-dialytic morbid events (IDME), including intra-dialytic hypotension (IDH) and muscle cramps, are common complications during haemodialysis (HD).
• Cardiac dysfunction is highly prevalent in patients undergoing HD.
• The relationship between early intra-dialytic cardiac function and the occurrence of IDME was investigated.

Purpose of the Study:

• To investigate the association between proto-dialytic cardiac function and the incidence of IDME in haemodialysis patients.
• To identify early haemodynamic predictors of intra-dialytic complications.

Main Methods:

• Continuous monitoring of heart rate, beat-to-beat blood pressure, and cardiac output during the initial 30 minutes of HD using the Task Force™ Monitor.
• Calculation of total peripheral resistance index (TPRI) from cardiac index (CI) and blood pressure.
• Application of univariate, multivariate, and logistic regression analyses, along with Kaplan-Meier survival analysis, to assess the relationship between haemodynamic parameters and IDME.

Main Results:

• Fourteen HD patients were studied; 30 dialysis sessions were analyzed.
• IDH occurred in 4 sessions and muscle cramps in 8 sessions.
• Lower baseline cardiac index (CI) and higher TPRI were significantly associated with an increased risk of IDME (P < 0.05). CI independently predicted IDME (OR: 0.043 per unit; 95% CI: 0.003-0.611), as did TPRI (OR: 1.124 per unit; 95% CI: 1.01-1.25). Patients in the lowest two tertiles of CI experienced IDME, while those in the highest tertile remained event-free (P < 0.002).

Conclusions:

• Low cardiac index (CI) and high total peripheral resistance index (TPRI) within the first 30 minutes of haemodialysis are significant predictors of intra-dialytic morbid events (IDME).
• Early haemodynamic assessment may aid in identifying patients at higher risk for dialysis-related complications.