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Proto-dialytic cardiac function relates to intra-dialytic morbid events
Julia Kolb1, Thomas M Kitzler, Theodora Tauber
1Department of Internal Medicine, Krankenhaus der Barmherzigen Brüder, Marschallgasse 12, A-8020 Graz, Austria.
Summary
Early cardiac function predicts haemodialysis complications. Low cardiac index (CI) and high total peripheral resistance index (TPRI) during the first 30 minutes of haemodialysis (HD) increase the risk of intra-dialytic morbid events (IDME).
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.
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