IMPACT OF PROGRAMMED BLOOD FLOW DURING HEMODIALYSIS SESSION ON BLOOD PRESSURE AND CARDIAC OUTPUT

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https://storage.unitedwebnetwork.com/files/1099/53623da7a5e988fe43d55b9895680507.pdf

Abstract Title *

IMPACT OF PROGRAMMED BLOOD FLOW DURING HEMODIALYSIS SESSION ON BLOOD PRESSURE AND CARDIAC OUTPUT

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Co-author 1

Carlos Brando brandoglez89@gmail.com University Hospital “Dr. José Eleuterio González” Nephrology Monterrey Mexico -

Co-author 2

José Fidel Veliz Escobar fidelveliz@ufm.edu University Hospital “Dr. José Eleuterio González” Nephrology Monterrey Mexico *

Co-author 3

Rogelio de Jesus Castor Hernández rjcastorhdz@gmail.com University Hospital “Dr. José Eleuterio González” Nephrology Monterrey Mexico -

Co-author 4

Alejandro Francisco Mcnally Arana dr.alexmcnally@gmail.com University Hospital “Dr. José Eleuterio González” Nephrology Monterrey Mexico -

Co-author 5

Ernesto De la Garza Espinoza ernesto_dlg@hotmail.com University Hospital “Dr. José Eleuterio González” Cardiology Monterrey Mexico -

Co-author 6

Sofia Lopez Guzman So.guzman786@gmail.com University Hospital “Dr. José Eleuterio González” Nephrology Monterrey Mexico -

Co-author 7

Alejandro Ordaz Farias Ordaz7@gmail.com University Hospital “Dr. José Eleuterio González” Cardiology Monterrey Mexico -

Co-author 8

José Arturo Vargas Mendoza dr.vargasmendoza@hotmail.com University Hospital “Dr. José Eleuterio González” Cardiology Monterrey Mexico -

Co-author 9

Mara Cecilia Olivo Gutierrez mara_olivo84@hotmail.com University Hospital “Dr. José Eleuterio González” Nephrology Monterrey Mexico -

Co-author 10

Jesus Zacarias Villarreal Martinez zacvilla83@gmail.com University Hospital “Dr. José Eleuterio González” Nephrology Monterrey Mexico -

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

The reduction of blood flow (Qb) in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD), due to fear of hemodynamic instability, is a common practice in outpatient HD centers, thereby decreasing the effectiveness of HD. Therefore, we evaluated clinical and echocardiographic hemodynamic variables before and during the HD session to demonstrate that Qb does not impact the patient’s hemodynamics.

Methods

A cross-sectional clinical trial was conducted in CKD patients on chronic HD at the Regional Center for Kidney Diseases (CRER). A transthoracic echocardiogram (TTE) was performed before the start of the HD session, a second TTE at 15 minutes with Qb of 200 ml/min, and a third TTE at 15 minutes with Qb of 350 ml/min. The first 30 minutes of the HD session were performed without ultrafiltration. After the third TTE, the patient completed their HD session with the parameters prescribed by their attending physician.

Results

Se evaluaron treinta pacientes con ERC en HD de mantenimiento tres veces por semana. La población del estudio fue predominantemente masculina (53,3%); el 90% tenía hipertensión (HTA) y el 56,7% diabetes mellitus (DM). En cuanto al acceso vascular, el 70% tenía un catéter yugular interno derecho tunelizado, con un peso seco promedio de 66,3 kg (DE: 14,9) y un peso pre-HD de 68,7 kg (DE: 14,1), que son afecciones y comorbilidades típicas en esta población (Tabla 1).

Al evaluar las variables clínicas a diferentes velocidades de flujo sanguíneo y compararlas con las mediciones pre-HD, los valores se mantuvieron estables sin diferencias significativas en ningún momento de la medición (Tablas 2 y 3).

Respecto a las variables ecocardiográficas medidas en los tres tiempos antes mencionados, el volumen sistólico (VS), el gasto cardíaco (GC) y la integral velocidad-tiempo (VTI) no disminuyeron al aumentar el flujo sanguíneo, por el contrario, estos parámetros aumentaron a Qb 350 ml/min, sugiriendo mayor eficiencia y eyección cardíaca manteniendo parámetros hemodinámicos estables (Tablas 4 y 5).

Tabla 1 Características basales (n = 30) Variables clínicas (n = 30) Comparación de variables clínicas (valores p) Variables ecocardiográficas (n = 30)

Conclusion

The programmed extracorporeal blood flow (Qb) during the HD session does not negatively impact clinical or echocardiographic hemodynamic variables, remaining safe even in patients with anemia.

Kewords