Effect of hemodialysis on impedance cardiography (electrical velocimetry) parameters in children
Meike Wilken1,2,3, Jun Oh1,4, Hans O Pinnschmidt5
1Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Insights
Impedance cardiography (electrical velocimetry, EV) effectively monitored hemodynamic changes in pediatric hemodialysis patients. EV may help optimize treatment for these high-risk cardiovascular patients.
Area of Science:
- Cardiovascular Physiology
- Nephrology
- Medical Device Technology
Background:
- Pediatric hemodialysis (HD) patients face significant cardiovascular risks.
- Monitoring hemodynamic status is crucial for managing these patients.
Purpose of the Study:
- To evaluate impedance cardiography (electrical velocimetry, EV) as a hemodynamic monitoring tool in pediatric HD patients.
- To assess EV's ability to detect cardiovascular changes during and after HD sessions.
Main Methods:
- A prospective, single-center observational study included 54 HD cycles in four pediatric patients.
- EV measurements of various hemodynamic parameters were taken before, during, and after HD.
- Systemic vascular resistance index (SVRI) was calculated.
Main Results:
- EV detected significant hemodynamic alterations linked to HD, including changes in heart rate, stroke volume, and cardiac output.
- Parameters like stroke volume variation (SVV) and variation of ICON (VIC) increased post-HD.
- Fluid withdrawal correlated with observed cardiovascular changes, but alterations also occurred without fluid removal.
Conclusions:
- Hemodynamic parameters monitored by EV change during pediatric HD, with or without fluid withdrawal.
- EV shows potential as a tool to optimize hemodynamic management in pediatric HD patients.
Background:
Pediatric hemodialysis (HD) patients have a high incidence of cardiovascular morbidity and mortality. The study aim was to investigate whether impedance cardiography (electrical velocimetry, EV) is suitable as a hemodynamic trend monitoring tool in pediatric patients during HD.
Methods:
Measurements by EV were obtained before, during, and after HD in a prospective single-center pediatric observational study. In total, 54 dialysis cycles in four different pediatric patients with end-stage kidney disease on chronic HD were included. EV parameters analyzed were heart rate (HR), stroke volume (SV), stroke volume index (SI), cardiac output (CO), cardiac index (CI), thoracic fluid content (TFC), index of contractility (ICON), stroke volume variation (SVV), variation of ICON (VIC), R-R interval (TRR), pre-ejection period (PEP), left ventricular ejection time (LVET), and systolic time ration (STR). Systemic vascular resistance index (SVRI) was calculated.
Results:
EV did measure significant changes in cardiovascular parameters associated with HD. The following parameters increased after HD: HR (9%), SVV (19%), VIC (33%), PEP (8%), and STR (18%). A decrease after HD was measured in SV (18%), SI (18%), CO (10%), CI (10%), TFC (10%), ICON (7%), TRR (7%), LVET (8%), and LVET (8%). SVRI was not affected by HD. The changes were correlated to ultrafiltration. HD cycles without fluid withdrawal also altered cardiovascular parameters.
Conclusions:
Pediatric HD with and without fluid withdrawal changes hemodynamic EV monitoring parameters. Possibly EV may be useful to optimize HD management in pediatric patients.
Related Concept Videos
01:25Hemodialysis I: Introduction
01:24Hemodialysis II: Procedure and Complications
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
01:25Hemodialysis III: Nursing Management