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Oxygen extraction ratio to identify patients at increased risk of intradialytic hypotension.

ABSTRACT: Intradialytic hypotension (IDH) is a hemodynamic phenomenon recently associated with decreased blood oxygen saturation (SO₂). The ratio between peripheral oxygen saturation (SpO₂) and central venous SO₂ (ScvO₂) or Oxygen Extraction Ratio (OER), which represents a roughly estimate of the amount of oxygen claimed by peripheral tissues, might be used to estimate haemodialysis (HD) related hypoxic stress. Aim of this pilot study was to evaluate the relationship between OER increments during dialysis sessions (?OER) and episodes of IDH. We enrolled chronic HD patients with permanent central venous catheter (CVC) and no fistula, in whom ScvO₂ measurement is at hand. OER ([(SpO₂?-?ScvO₂)/SpO₂]?×?100) was measured in three consecutive HD sessions (HD OER sessions) before HD, after 15', 30' and 60' min and at the end of HD. Then, a one-year follow-up was planned to record the number of IDH episodes. In the 28 enrolled patients (age 74?±?2.6 years), during 12?±?1.2 months of follow up, incidence of IDH was 3.6%. We divided patients into two groups, above or below the median value of ?OER at the end of HD, which was 36%. In these groups, the average incidence of IDH was 7% and 2% respectively (p??19% after only 15' of HD treatment or?>?36% at the end of the session characterize patients with higher rates of hypotension. Intradialytic ?OER, a parameter of tissue hypoxic stress, identifies more fragile patients at greater risk of IDH.

SUBMITTER: Rotondi S

PROVIDER: S-EPMC7910620 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Oxygen extraction ratio to identify patients at increased risk of intradialytic hypotension.

Rotondi Silverio S Tartaglione Lida L De Martini Natalia N Bagordo Domenico D Caissutti Sara S Pasquali Marzia M Muci Maria Luisa ML Mazzaferro Sandro S

Scientific reports 20210226 1

Intradialytic hypotension (IDH) is a hemodynamic phenomenon recently associated with decreased blood oxygen saturation (SO2). The ratio between peripheral oxygen saturation (SpO2) and central venous SO2 (ScvO2) or Oxygen Extraction Ratio (OER), which represents a roughly estimate of the amount of oxygen claimed by peripheral tissues, might be used to estimate haemodialysis (HD) related hypoxic stress. Aim of this pilot study was to evaluate the relatio ...[more]

PMID: 33637839

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Project description:IntroductionIntradialytic cycling is often performed during the first half of hemodialysis because of concerns regarding increased frequency of intradialytic hypotension (IDH) late in hemodialysis. This increases exercise program resource needs and limits utility of intradialytic cycling to treat dialysis-related symptoms.MethodsThis multicenter, randomized, crossover trial compared IDH rate when cycling during the first half versus the second half of hemodialysis in 98 adults on maintenance hemodialysis. Group A cycled during the first half of hemodialysis for 2 weeks and subsequently during the second half for 2 weeks. In group B, the cycling schedule was reversed. Blood pressure (BP) was measured every 15 minutes throughout hemodialysis. Primary outcome was IDH rate (systolic BP [SBP] decrease of >20 mm Hg or SBP <90 mm Hg). Secondary outcomes included symptomatic IDH rate and time to recover post hemodialysis. Data were analyzed using negative binomial and gamma distribution mixed regression.ResultsMean age 64.7 (SD 12.0) and 64.7 (SD 14.2) years in group A (n = 52) and group B (n = 46), respectively. Proportions of females were 33% in group A and 43% in group B. Median time on hemodialysis was 4.1 (interquartile range [IQR] 2.5, 6.1]) years in group A and 3.9 years (IQR 2.5, 6.7) in group B. IDH rate per 100 hemodialysis hours (95% confidence interval [CI]) was 34.2 (26.4, 42.0) and 36.0 (28.9, 43.1) during early and late intradialytic cycling, respectively (P = 0.53). Timing of intradialytic cycling was not associated with symptomatic IDH (relative risk [RR]: 1.07 [0.75-1.53]) or time to recover post hemodialysis (odds ratio: 0.99 [0.79-1.23]).ConclusionWe found no association between the rate of overall or symptomatic IDH and the timing of intradialytic cycling in patients enrolled in an intradialytic cycling program. Increased use of cycling late in hemodialysis may optimize intradialytic cycling program resource use and should be studied as a possible treatment for symptoms common in late hemodialysis.

Project description:BackgroundIntradialytic hypotension (IDH) is a frequent complication of intermittent hemodialysis (IHD), occurring from 15 to 50% of ambulatory sessions, and is more frequent among hospitalized patients with hypoalbuminemia. IDH limits adequate fluid removal and increases the risk for vascular access thrombosis, early hemodialysis (HD) termination, and mortality. Albumin infusion before and during therapy has been used for treating IDH with the varying results. We evaluated the efficacy of albumin infusion in preventing IDH during IHD in hypoalbuminemic inpatients.MethodsA randomized, crossover trial was performed in 65 AKI or ESKD patients with hypoalbuminemia (albumin?<?3 g/dl) who required HD during hospitalization. Patients were randomized to receive 100 ml of either 0.9%sodium chloride or 25% albumin intravenously at the initiation of each dialysis. These two solutions were alternated for up to six sessions. Patients' vital signs and ultrafiltration removal rate were recorded every 15 to 30 min during dialysis. IDH was assessed by different definitions reported in the literature. All symptoms associated with a noted hypotensive event as well as interventions during the dialysis were recorded.ResultsSixty-five patients were submitted to 249 sessions; the mean age was 58 ([Formula: see text]?12), and 46 (70%) were male with a mean weight of 76 ([Formula: see text]?18) kg. The presence of IDH was lower during albumin sessions based on all definitions. The hypotension risk was significantly decreased based on the Kidney Disease Outcomes Quality Initiative definition; (15% with NS vs. 7% with albumin, p?=?0.002). The lowest intradialytic SBP was significantly worse in patients who received 0.9% sodium chloride than albumin (NS 83 vs. albumin 90 mmHg, p?=?0.035). Overall ultrafiltration rate was significantly higher in the albumin therapies [NS?-?8.25 ml/kg/h (-?11.18 5.80) vs. 8.27 ml/kg/h (-?12.22 to 5.53) with albumin, p?=?0.011].ConclusionIn hypoalbuminemic patients who need HD, albumin administration before the dialysis results in fewer episodes of hypotension and improves fluid removal. Albumin infusion may be of benefit to improve the safety of HD and achievement of fluid balance in these high-risk patients. ClinicalTrials.gov Identifier: NCT04522635.

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Oxygen extraction ratio to identify patients at increased risk of intradialytic hypotension.

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Oxygen extraction ratio to identify patients at increased risk of intradialytic hypotension.

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