E Mancini1, C Perazzini2, L Gesualdo3, F Aucella4, A Limido5, F Scolari6, S Savoldi7, M Tramonti2, L Corazza8, M Atti8, S Severi2,9, P Bolasco10, A Santoro11. 1. Nephrology, Dialysis, Hypertension, Teaching Hospital Policlinico S.Orsola-Malpighi, Bologna, Italy. elena.mancini@aosp.bo.it. 2. Health Sciences and Technologies Interdepartmental Center for Industrial Research, University of Bologna, Cesena, Italy. 3. Renal, Dialysis and Transplantation Unit, Department of Emergency and Transplantation, University of Bari, Bari, Italy. 4. Nephrology and Dialysis Department, I.R.C.C.S. "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy. 5. Nephrology and Dialysis Unit, Azienda Ospedaliera "Fatebenefratelli e Oftalmico", Milano, Italy. 6. Division of Nephrology and Dialysis, Azienda Ospedaliera di Montichiari, Brescia, Italy. 7. Nephrology and Dialysis Unit, Ospedale Civile, Cirié, Turin, Italy. 8. Scientific Affairs Bellco srl, Mirandola, Italy. 9. Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy. 10. Territorial Department of Nephrology and Dialysis, ASL 8, Cagliari, Italy. 11. Nephrology, Dialysis, Hypertension, Teaching Hospital Policlinico S.Orsola-Malpighi, Bologna, Italy.
Abstract
BACKGROUND: Intradialytic hypotension (IDH) has a dramatic impact on the main outcomes of dialysis patients. Early warning of hemodynamic worsening during dialysis would enable preventive measures to be taken. Blood oxygen saturation (SO2) is used for hemodynamic monitoring in the critical care setting and may provide useful information about IDH onset. AIM: To evaluate whether short- and medium-term variations in the SO2 signal (ST-SO2var, MT-SO2var,) during dialysis are a predictor of IDH. METHODS: In this 3-month observational cohort study, 51 hypotension-prone chronic hemodialysis (HD) patients, with vascular access by arteriovenous fistula (AVF) or central venous catheter (CVC), were enrolled. Continuous non-invasive blood SO2 was monitored (fc = 0.2 Hz) by an optical sensor on the arterial line of the extracorporeal circulation; blood pressure (every 30 min), symptoms and their time of appearance were noted. Predictive power of IDH was expressed by the area under curve (AUC) sensitivity and specificity based on intradialytic variations in SO2. RESULTS: A total of 1290 HD sessions were analyzed. Overall, off-line ST-SO2var analysis proved able to correctly predict IDH in 67 % of the sessions where IDH occurred. The best predictive performance was found in the presence of highly arterialized AVF (SO2 > 95 %) (75 % sensitivity; AUC 0.825; p < 0.05). On the contrary, in sessions with CVC, IDH prediction proved more efficient by MT-SO2var (AUC 0.575; p = 0.01). CONCLUSIONS: Intradialytic SO2 variability could be a valid parameter to detect in advance the hemodynamic worsening that precedes IDH. Appropriate timely intervention could help prevent IDH onset.
BACKGROUND: Intradialytic hypotension (IDH) has a dramatic impact on the main outcomes of dialysis patients. Early warning of hemodynamic worsening during dialysis would enable preventive measures to be taken. Blood oxygen saturation (SO2) is used for hemodynamic monitoring in the critical care setting and may provide useful information about IDH onset. AIM: To evaluate whether short- and medium-term variations in the SO2 signal (ST-SO2var, MT-SO2var,) during dialysis are a predictor of IDH. METHODS: In this 3-month observational cohort study, 51 hypotension-prone chronic hemodialysis (HD) patients, with vascular access by arteriovenous fistula (AVF) or central venous catheter (CVC), were enrolled. Continuous non-invasive blood SO2 was monitored (fc = 0.2 Hz) by an optical sensor on the arterial line of the extracorporeal circulation; blood pressure (every 30 min), symptoms and their time of appearance were noted. Predictive power of IDH was expressed by the area under curve (AUC) sensitivity and specificity based on intradialytic variations in SO2. RESULTS: A total of 1290 HD sessions were analyzed. Overall, off-line ST-SO2var analysis proved able to correctly predict IDH in 67 % of the sessions where IDH occurred. The best predictive performance was found in the presence of highly arterialized AVF (SO2 > 95 %) (75 % sensitivity; AUC 0.825; p < 0.05). On the contrary, in sessions with CVC, IDH prediction proved more efficient by MT-SO2var (AUC 0.575; p = 0.01). CONCLUSIONS: Intradialytic SO2 variability could be a valid parameter to detect in advance the hemodynamic worsening that precedes IDH. Appropriate timely intervention could help prevent IDH onset.
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