BIOIMPEDANCE - BASED CLINICAL DECISION MAKING IN HEMODIALYSIS PATIENTS DECREASES EPISODES OF HYPOTENSION

OBJECTIVE: Intradialytic hypotension and exaggerated fluid removal during hemodialysis (HD) are related to organ ischemia and resultant increased morbidity and mortality. Fluid overload and congestion due to less than optimal fluid removal, are associated with adverse outcomes. Previous studies performed did not assess clinical decision making that is based mainly on hemodynamics. Thus, our aim was to recruit only new HD patients, and to examine the effect of bioimpedance based management within the first 90 days, a critical timeframe in dry weight determination and HD prescription. DESIGN AND METHOD: The study incorporated 20 new HD patients in an established HD unit. Patients were randomized into standard clinical approach versus hemodynamic monitoring using a whole body bioimpedance device (NICaS, NI Medical, Petah Tikva, Israel). Intradialytic cardiac output, cardiac power, total body water and peripheral resistance were measured during the 1st dialysis session. Each measured session consisted of start, mid and end of dialysis recordings. Hemodynamic measurements during the pilot study interval (three months) were done also at the investigator discretion, whenever decisions on dry weight, diuretic or anti-hypertensive medications were needed. Control group patients were treated conservatively, without bioimpedance or any noninvasive hemodynamic monitoring. We recorded hypotensive episodes (<90/60 mmHg, while pre-dialysis blood pressure > = 90/60 mmHg) cardiovascular hospitalizations and cardiovascular related death. RESULTS: Twenty patients completed the study (12 study, 8 control) thus far. Within a period of three months, there were 81 hypotensive episodes (6.75 episodes per patient per period) in the study group VS 93 (11.625 episodes per patient per period) in the control group (p < 0.05).There were 3 hospitalizations due to cardiovascular events in the control group and one case of cardiovascular death, while study group had no deaths and one hospitalization due to CV complication. CONCLUSIONS: These preliminary results suggest that clinical decision making based on bio-impedance monitoring, when applied to new HD patients from the very beginning of their HD treatments, might confer a benefit in reducing hypotensive episodes and resultant hospitalizations. Our study is ongoing in order to further clarify these promising results.