ESPN 54th Annual Meeting

ESPN 2022


 
The value of non-invasive hemodynamic monitoring during pediatric hemodialysis
ANNA VéGH 1 LóRáNT SAGáT 2 ÁGNES LIEBHARDT 2 GYÖRGY S. REUSZ 1

1- FIRST DEPARTMENT OF PEDIATRICS SEMMELWEIS UNIVERSITY, BUDAPEST, HUNGARY
2- FACULTY OF MEDICINE SEMMELWEIS UNIVERSITY, BUDAPEST, HUNGARY
 
Introduction:

Both hypo- and hypertension during hemodialysis (HD) has been associated with an increased cardiovascular risk. Currently, measuring blood pressure (BP) is the primary method for estimating hemodynamic changes caused by fluid removal (UF). The aim of this study is to assess hemodynamic changes by non-invasive monitoring with electrical velocimetry ™ (EV) during hemodialysis (HD) on pediatric patients.

Material and methods:

Maintenance HD patients of a single pediatric center took part in this study. Anthropometric data, laboratory results and history were collected. Multiple HD sessions were recorded for each patient. Hemodynamic data was measured during HD with an ICON® monitor (Osypka Medical, Germany), BP was recorded every 25 minutes. A BCM device (Fresenius, USA) was used to assess fluid status before and after dialysis.

Results:

Thirty-eight dialysis sessions of thirteen pediatric patients were included in this study, with 10 (71,42%) males. Median [IQR] age was 15,8 [13,3-16,2] years. Median [IQR] predialytic overhydration was 2,8 [0,4-5,2] percent of dry weight. 

Significant decrease of stroke volume (SV) (p=0,015) and thoracic fluid content (TFC) (p<0,0001), as well as increase of heart rate (HR) could be observed, with a correlation to UF: SV (p=0,004; Figure 1.), TFC (p<0,0001; Figure 2.), HR (p=0,05; Figure 3.). Although cardiac output (CO) and mean arterial pressure (MAP) was stable in the whole cohort, subgroup analysis revealed different patterns. Pre- and postdyalitic hypertension was present in 18-18 (47,4-47,4%) patients. No hypotensive event occurred. A 10% change in CO was considered significant. CO increased at 15 (39,5%), decreased at 12 (31,6%), and stayed stable at 11 (28,9%) sessions.



Conclusions:

While MAP stayed stable, EV provided more detailed insight into the compensatory mechanisms during HD. EV could potentially optimize HD management in pediatric patients by revealing hemodynamic changes that go unnoticed by BP monitoring.