Improving detection of symptomatic, asymptomatic intradialytic hypotension (AIDH), during hemodialysis (HD) with guided automated blood pressure (BP)
Zasuwa G, Frinak S, and Yee J. Improving detection of symptomatic, asymptomatic intradialytic hypotension (AIDH), during hemodialysis (HD) with guided automated blood pressure (BP). American Journal of Kidney Diseases 2020; 75(4):661.
Am J Kidney Dis
IDH is an HD complication associated with patient morbidity and mortality. IDH detection enables early intervention that may reduce complications. We explored the hypothesis that that continuous intra-access pressure (IAP) measurements using the Vasc-Alert™ algorithm1 (VA) can detect IDH.during HD and initiate a blood pressure (BP) measurement. Undetected A/IDH was defined as a systolic BP (SBP) decline of 40 mmHg from the predialysis SBP and an intradialytic SBP <100 mmHg. Fresenius™ T2 dialysis machines (n=24) with CLiC™ devices that assess blood volume changes had software (LabVIEW) installed to calculate IAP at 20-sec intervals from DM data. IAP was determined by hematocrit (default value, 0.34) and venous pressure (VP) by VA from 3470 treatments among 291 patients over 36 days. Electronic health records and dialysis machine data were merged. IAP curves and slopes were correlated with A/IDH. Figure 1 displays an IDH event after 130 min of treatment. SBP declined from 143/77 to 74/44 mmHg, and goal ultrafiltration was reduced from 2.4 L to 1.9 L, blood flow rate from 385 to 350 ml/min. IAP differences during IDH were significant p<.0001. Inset shows an IAP drop that triggers an alarm. The IAP slope and IAP declines of 30 mm Hg or more correlate with IDH during HD. In Figure 1, episodes of A/IDH revealed by IAP slopes and delta-IAP prior to the event can trigger the BP module. A drop in IAP or IAP slope would enable staff to intercede in a timely fashion to mitigate more severe IDH episodes. Combined analysis of blood volume, IAP, and slope of IAP in an AI algorithm has potential to trigger an IDH alarm. Further research much include larger datasets for validation.