Issn Print: 0265-0215

Publication Date: 2010/06/12


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Haemodynamic response to haemodialysis: 4AP7–2

M. Wells; S. Panday; K. Hakim; C. Byrne; R. Mahajan

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Background and Goal of Study: During haemodialysis, conventional noninvasive haemodynamic BP monitors (NIBP), which provide intermittent measurements, may miss some haemodynamic events. Additionally, the presence of fistulae in patients with renal failure may render intra-arterial monitoring difficult or not feasible. The Finometer, a continuous beat-by-beat, non-invasive haemodynamic monitor, may provide a feasible alternative. Using Finometry we observed the gross haemodynamic changes occurring during routine haemodialysis as part of a service evaluation.
Materials and Methods: 25 patients were continuously monitored throughout their haemodialysis sessions, which lasted between 3.5 and 4.5 hours. Their mean age was 61.3 (18.6), 13 male and 12 female.
Results and Discussion: An interpatient variability in the magnitude and timing of haemodynamic changes throughout the haemodialysis period was encountered. Of the 25patients, there was a significant decrease (more than 30% decrease from baseline value, for more than 20 min) in SBP, MBP, stroke volume (SV) and total peripheral resistance (TPR) in 7, 6, 10 and 6 patients respectively during their haemodialysis sessions. Furthermore, the mean (SD) of time periods where there were more than 30% decreases from baseline values in SBP, MBP, SV and TPR, were 20.9 (39.2), 17.8 (36.5), 40.2 (60.1), 39.4 (73.3) min respectively. Highest blood pressure (BP) values during the course of haemodialysis were associated with significant decreases in SV and significant Increases in TPR while heart rate (HR) remained stable. On the other hand, when BP reached its lowest values, only SV decreased significantly.
Conclusion(s): Interpatient variability in haemodynamic responses to haemodialysis, along with significant haemodynamic changes that occur during the course of routine haemodialysis, may urge the need for conducting further studies to justify the regular use of Finometry in the haemodialysis setting, which might provide safer haemodynamic practice, through early diagnosis and treatment of haemodynamic mishaps.
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