Characterisation of Haemodynamic Responses to Haemodialysis Using Frequency Analysis
Hemodialysis and Frequent Dialysis – I
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center Abstract Time: 10:00 AM – 12:00 PM
701 Dialysis: Hemodialysis and Frequent Dialysis
Gullapudi, Venkata Rukmini Latha, University of Nottingham, Derby, United Kingdom
Stewart, Jill, University of Derby, Derby, United Kingdom
White, Kelly, University Hospitals of Derby and Burton NHS Foundation Trust, Derby,
Stewart, Paul, University of Derby UK, Derby, United Kingdom
Eldehni, Mohamed Tarek, University Hospitals of Derby and Burton NHS Foundation
Trust, Derby, United Kingdom
Taal, Maarten W., University of Nottingham, Derby, United Kingdom
Selby, Nicholas M., University of Nottingham, Derby, United Kingdom
Group or Team Name
Centre for Kidney research and Innovation Background
Intradialytic haemodynamic instability remains a significant problem, leading to ischaemic end- organ damage. Extrema points frequency analysis of blood pressure (BP) is a method of assessing beat to beat variation in BP, which may have relevance to end-organ perfusion. Our aim was to utilise this method to describe the patterns of individual cardiovascular response to haemodialysis (HD), study its variability and identify factors associated with higher BP frequencies.
50 participants aged >18 years were recruited from our prevalent HD population. Participants’ demographics, HD background, HD prescription and laboratory parameters at each session were recorded. All participants had continuous non-invasive haemodynamic monitoring using pulse wave analysis (Finapres NOVA) during the entirety of three consecutive dialysis treatments. The data generated were then analysed by identifying the frequency and amplitude of local extrema points for mean arterial pressure (MAP).
In total, 44 participants completed all three dialysis sessions with continuous haemodynamic monitoring. 61% were males, mean age was 62.3±16yrs and 43% had diabetes. Analysis of intradialytic trends of haemodynamic measures demonstrated a gradual near-linear decline in BP, cardiac output, stroke volume; and a rise in total peripheral resistance.
In frequency analysis, overall MAP frequency across the study population for the first monitored session was 0.54 Hz (IQR: 0.18). The frequency extracts varied through the dialysis sessions, generally rising and reaching peak in 3rd hour of dialysis. There was intra-individual variation between dialysis sessions, with Coefficient of Variation of average frequency values of 0.01- 0.53. MAP frequencies correlated with dialysis vintage (r=0.307, p=0.043), pro-BNP levels (r=0.318, p=0.038), Baroreflex sensitivity (r=0.319, p=0.035) and average real variability of SBP (r=0.393, P=<0.0001), MAP (r=0.631, P=<0.0001) and DBP (r=0.512, p=<0.0001).
Frequency analysis of BP provides additional information regarding the variability in BP during HD, and this may be of importance when considering effects of HD on organ perfusion. Prospective follow up of participants in this study will allow us to establish the relationship of BP frequency analysis and patient outcomes.