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Medical Science Monitor Basic Research

AmJCaseRep
MedSciTechnol

eISSN: 2329-0358

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Comparison of 3 Times a Week 4- and 5-Hour In-Center Hemodialysis Sessions with Use of Continuous Non-Invasive Hemodynamic Monitoring

Łukasz Czyżewski, Janusz Wyzgał, Janusz Sierdziński, Emilia Czyżewska, Jacek Smereka, Łukasz Szarpak

(Department of Nephrology Nursing, Medical University of Warsaw, Warsaw, Poland)

Ann Transplant 2017; 22:346-353

DOI: 10.12659/AOT.902358


BACKGROUND: Very aggressive ultrafiltration rate (lasting 3.5–4 h) may result in inadequate hemodialysis (HD). Our aim was to characterize HD-induced cardiovascular adaptation and its links to fluid removal during 4- vs. 5-h HD sessions.
MATERIAL AND METHODS: The study involved 50 HD patients. A Cardioscreen device (Messtechnik, Ilmenau, Germany) was used to perform non-invasive hemodynamic measurements during mid-week HD sessions. Body fluids and nutritional status were assessed with a Body Composition Monitor (Fresenius Medical Care). Clinical and laboratory data were also analyzed.
RESULTS: It was shown that when comparing 3 times a week 4- vs. 5-h dialysis sessions, body mass index (BMI [kg/m²]), Kt/V, and ultrafiltration volume (UFV [mL]) were significantly lower in the 4-h dialysis group (23.1±3.5 vs. 27.1±4.7; 1.36±0.28 vs. 1.55±0.23; 1770±601 vs. 2831±836; P<0.05, respectively). Cardiac index (CI [L/min/m²]) and thoracic fluid content (TFC [1/kW]) were significantly reduced in 4-h dialysis sessions (3.1±0.6 to 2.7±0.7; 35.1±8.4 to 32.8±6.8; P<0.05, respectively). In patients treated with 5-h dialysis sessions, we found that heart rate (HR [bpm]) was significantly increased (69±10 to 74±15; P<0.05) and TFC was reduced (34.3±8.9 to 31.5±8.2; P<0.05). In patients treated with 4-h dialysis sessions, systemic vascular resistance index (SVRI [dyn·s·cm^–5/m²]) increased from 2369±799 before HD to 2592±735 after HD (P=0.342).
CONCLUSIONS: The obtained data indicate that in extended (5-h) HD sessions, hemodynamic compensation occurred with increased HR, while in short (4-h) HD sessions, compensation occurred with increased SVRI. Providing longer but less intensive HD is more physiologic than the conventional therapy, and will improve patient tolerability and clinical outcomes.

This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
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