Transonic udgiver med jævne mellemrum nyt omkring fistelflow- og cardiac outputmåling. Vi har netop modtaget dette om cardiac outputmåling.
Large Multi-Center Study Underscores Importance of Cardiac Monitoring during Hemodialysis
In a large southwest Germany multicenter study of 215 hemodialysis patients, Drs. Ferruh Artunc and Stephanie Haag from the University of Tübingen used the Transonic HD03 Hemodialysis Monitor to collect data on their systemic hemodynamics as they underwent hemodialysis. Eighty-five percent of the participants had native fistulas, the remainder had grafts. Their median age was 73 years. Many had cardiac comorbidities. Their median time on dialysis was 47 months.
Cardiac index (CI), access flow (AF) and central blood volume index (CBVI) was measured in each patient at the beginning and at the end of one of their hemodialysis sessions. In a subset of 82 patients, total end-diastolic volume index (TEDVI) and total ejection fraction (TEF) were then derived from the dilution curves generated by the Hemodialysis Monitor. The data were correlated with measurements of blood pressure, heart rate) and fluid status. At the end of a median follow-up of 2.6 years, 65 (30%) patients had died, 25 of whom had died of cardiovascular causes.
Hemodynamic Parameters Fall during Hemodialysis Session
The results of the study indicated that:
- Median CI was 2.8 L/min/m2 at the beginning of a dialysis session; by the end of the session, it had fallen by 10%.
- CBVI was 15 mL/kg at the beginning of the session; by the end it had fallen by 9%.
- Access Flow (AF) was 980 mL/min at the beginning of the session; by the end it had fallen by 4%.
Other results included:
- Peripheral resistance (PR) increased slightly, but blood pressure fell.
- Independent predictors of CI were age and ultrafiltration rate.
- Access flow, overhydration and peripheral resistance were protective influences.
- Total ejection fraction at the beginning of HD is the most robust marker for increased mortality, followed by TEDVI and Systemic Cardiac Index (SCI) defined as CI corrected for AF.
From their study, the clinicians concluded that hemodialysis leads to a reduction of cardiac index due to ultrafiltration while access flow (AF) remains constant. The also concluded that hemodynamic monitoring identifies a significant number of HD patients with cardiac impairment who are at risk for increased mortality.