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Thursday, February 15th, 2018
Table of Contents

1 Introduction
5 PMID
 [F] Diseases Research  / PubMed Research Articles  /
Assessing Extracellular Volume in Hemodialysis Patients Using Intradialytic Blood Pressure Slopes.

PubMed

 

Resource

Nephron Feb ; ()

Authors

Liu H1; Lu R2; Shastri S3; Sonderman M4; Van Buren PN5;

Author Information
  • 1University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Nephrology, Dallas, Texas, USA.
  • 2University of Texas Southwestern Medical Center, Department of Clinical Sciences, Dallas, Texas, USA.
  • 3University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Nephrology, Dallas, Texas, USA.
  • 4University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Nephrology, Dallas, Texas, USA.
  • 5University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Nephrology, Dallas, Texas, USA.

Abstract

BACKGROUND/AIMS: Extracellular volume (ECV) overload is a mortality risk factor in hemodialysis patients, but no standard approach exists to objectively assess this clinically. We aimed to quantify relationships between slopes of repeated intradialytic blood pressure (BP) measurements and ECV.

METHODS: In a cross-sectional study of 71 hemodialysis patients, we calculated BP slopes from all intradialytic measurements using Gaussian regression. We measured extracellular and total body water (TBW) with bioimpedance spectroscopy. We analyzed unconditional and conditional associations between BP slope and volume metrics with mixed linear models and sensitivity analyses using non-linear intradialytic BP trajectory.

RESULTS: Mean systolic intradialytic BP slope (IBPS) was -0.06 (0.1) mm Hg/min. Post-dialysis extracellular water (ECW)/weight was the volume metric mostly strongly associated with slope (r = 0.34, p = 0.007 for unconditional analysis; β = 1.45, p = 0.001 for conditional analysis). Among subjects with post-dialysis systolic BP ≥130 mm Hg, the association strengthened (r = 0.40, p = 0.006; β = 1.42, p = 0.003). ECV was more strongly associated with the BP slope than with pre-dialysis, post-dialysis, or delta systolic BP (r = -0.07, 0.19, 0.28; p = 0.6, 0.1, 0.03). In nonlinear models, BP trajectory also had the strongest association with post-dialysis ECW/body weight (p < 0.001).

CONCLUSIONS: In hypertensive hemodialysis patients, measurements of ECV excess are more strongly associated with IBPSs than with pre-dialysis, post-dialysis, or change in systolic BP. Among varying volume metrics, post-dialysis ECW/weight has the strongest association with these slopes. Determining IBPS is a novel method to optimize clinical assessment of ECV in hemodialysis patients.

© 2018 S. Karger AG, Basel.

PMID

29439257

Others

Publication Type: Journal Article


This article is licensed under the the National Library of Medicine License. It uses material from the PubMed National Library of Medicine Data.


Last Modified:   2016-03-27


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