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

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2011-05, Vol.26 (5), p.1645-1651
• Main Authors: KOLB, Julia, KITZLER, Thomas M, TAUBER, Theodora, MORRIS, Nicholas, SKRABAL, Falko, KOTANKO, Peter
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Pressure; Cardiac Output; Cohort Studies; Drug intoxications. Doping; Emergency and intensive care: renal failure. Dialysis management; Female; Heart Rate; Humans; Hypotension - etiology; Intensive care medicine; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Male; Medical sciences; Morbidity; Pharmacology. Drug treatments; Prognosis; Renal Dialysis - adverse effects; Risk Factors; Survival Rate
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfq599

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. 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. 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). Low CI and high TPRI in the first 30 min of HD are associated with an increased risk of IDME.