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Intra-dialytic blood oxygen saturation (SO2): association with dialysis hypotension (the SOGLIA Study)

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Abstract

Background

Intradialytic hypotension (IDH) has a dramatic impact on the main outcomes of dialysis patients. Early warning of hemodynamic worsening during dialysis would enable preventive measures to be taken. Blood oxygen saturation (SO2) is used for hemodynamic monitoring in the critical care setting and may provide useful information about IDH onset.

Aim

To evaluate whether short- and medium-term variations in the SO2 signal (ST-SO2var, MT-SO2var,) during dialysis are a predictor of IDH.

Methods

In this 3-month observational cohort study, 51 hypotension-prone chronic hemodialysis (HD) patients, with vascular access by arteriovenous fistula (AVF) or central venous catheter (CVC), were enrolled. Continuous non-invasive blood SO2 was monitored (fc = 0.2 Hz) by an optical sensor on the arterial line of the extracorporeal circulation; blood pressure (every 30 min), symptoms and their time of appearance were noted. Predictive power of IDH was expressed by the area under curve (AUC) sensitivity and specificity based on intradialytic variations in SO2.

Results

A total of 1290 HD sessions were analyzed. Overall, off-line ST-SO2var analysis proved able to correctly predict IDH in 67 % of the sessions where IDH occurred. The best predictive performance was found in the presence of highly arterialized AVF (SO2 > 95 %) (75 % sensitivity; AUC 0.825; p < 0.05). On the contrary, in sessions with CVC, IDH prediction proved more efficient by MT-SO2var (AUC 0.575; p = 0.01).

Conclusions

Intradialytic SO2 variability could be a valid parameter to detect in advance the hemodynamic worsening that precedes IDH. Appropriate timely intervention could help prevent IDH onset.

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References

  1. Mancini E, Mambelli E, Irpinia M, Gabrielli D, Cascone C et al (2007) Prevention of dialysis hypotension episodes using fuzzy logic control system. Nephrol Dial Transplant 22:1420–1427

    Article  PubMed  Google Scholar 

  2. Palmer BF, Henrich WL (2008) Recent advances in the prevention and management of intradialytic hypotension. J Am Soc Nephrol 19:8–11

    Article  PubMed  Google Scholar 

  3. Agarwal R (2012) How can we prevent intradialytic hypotension? Curr Opin Nephrol Hypertens 21:593–599

    Article  PubMed  Google Scholar 

  4. Shoji T, Tsubakihara Y, Fujii M, Imai E (2004) Hemodialysis-associated hypotension as an independent risk factor for 2-year mortality in hemodialysis patients. Kidney Int 66:1212–1220

    Article  PubMed  Google Scholar 

  5. Tisler A, Akocsi K, Borbas B, Fazakas L, Ferenczi S et al (2003) The effect of frequent or occasional dialysis-associated hypotension on survival of patients on maintenance haemodialysis. Nephrol Dial Transplant 18:2601–2605

    Article  PubMed  Google Scholar 

  6. Daugirdas JT (2001) Pathophysiology of dialysis hypotension: an update. Am J Kidney Dis 38:S11–S17

    Article  CAS  PubMed  Google Scholar 

  7. Cavalcanti S, Ciandrini A, Severi S, Badiali F, Bini S et al (2004) Model-based study of the effects of the hemodialysis technique on the compensatory response to hypovolemia. Kidney Int 65:1499–1510

    Article  PubMed  Google Scholar 

  8. Selby NM, McIntyre CW (2006) A systematic review of the clinical effects of reducing dialysate fluid temperature. Nephrol Dial Transplant 21:1883–1898

    Article  PubMed  Google Scholar 

  9. Paolini F, Mancini E, Bosetto A, Santoro A (1995) Hemoscan: a dialysis machine-integrated blood volume monitor. Int J Artif Organs 18:487–494

    CAS  PubMed  Google Scholar 

  10. Steuer RR, Leypoldt JK, Cheung AK, Senekjian HO, Conis JM (1996) Reducing symptoms during hemodialysis by continuously monitoring the hematocrit. Am J Kidney Dis 27:525–532

    Article  CAS  PubMed  Google Scholar 

  11. Donauer J, Kolblin D, Bek M, Krause A, Bohler J (2000) Ultrafiltration profiling and measurement of relative blood volume as strategies to reduce hemodialysis-related side effects. Am J Kidney Dis 36:115–123

    Article  CAS  PubMed  Google Scholar 

  12. Moret K, Aalten J, van den Wall BW, Gerlag P, Beerenhout C et al (2006) The effect of sodium profiling and feedback technologies on plasma conductivity and ionic mass balance: a study in hypotension-prone dialysis patients. Nephrol Dial Transplant 21:138–144

    Article  CAS  PubMed  Google Scholar 

  13. Maggiore Q, Pizzarelli F, Santoro A, Panzetta G, Bonforte G et al (2002) The effects of control of thermal balance on vascular stability in hemodialysis patients: results of the European randomized clinical trial. Am J Kidney Dis 40:280–290

    Article  PubMed  Google Scholar 

  14. Locatelli F, Buoncristiani U, Canaud B, Kohler H, Petitclerc T et al (2005) Haemodialysis with on-line monitoring equipment: tools or toys? Nephrol Dial Transplant 20:22–33

    Article  PubMed  Google Scholar 

  15. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377

    Article  CAS  PubMed  Google Scholar 

  16. Secher NH, Van Lieshout JJ (2005) Normovolaemia defined by central blood volume and venous oxygen saturation. Clin Exp Pharmacol Physiol 32:901–910

    Article  CAS  PubMed  Google Scholar 

  17. Bauer P, Reinhart KBM (2008) Significance of venous oximetry in the critically ill. Med Intensiva 32(33):134–142

    Article  CAS  PubMed  Google Scholar 

  18. Perner A, Haase N, Wiis J, White JO, Delaney A (2010) Central venous oxygen saturation for the diagnosis of low cardiac output in septic shock patients. Acta Anaesthesiol Scand 54:98–102

    Article  CAS  PubMed  Google Scholar 

  19. Cordtz J, Olde B, Solem K, Ladefoged SD (2008) Central venous oxygen saturation and thoracic admittance during dialysis: new approaches to hemodynamic monitoring. Hemodial Int 12:369–377

    Article  PubMed  Google Scholar 

  20. Mancini E, Corazza L, Soverini ML, Cannarile DC, Cavalcanti S et al (2008) Short-term variability of oxygen saturation during hemodialysis is a warning parameter for hypotension appearance. Comput Cardiol 35:881–883.

    Google Scholar 

  21. Santoro A, Mancini E, Basile C, Amoroso L, Di Giulio S et al (2002) Blood volume controlled hemodialysis in hypotension-prone patients: a randomized, multicenter controlled trial. Kidney Int 62:1034–1045

    Article  CAS  PubMed  Google Scholar 

  22. Perazzini C, Bolasco P, Corazza L, Tramonti M, Mancini E et al (2013) Prediction of intradialytic hypotension based on oxygen saturation variations. Comput Cardiol 40:1223–1226.

    Google Scholar 

  23. McGill R, Tukey JW, Larsen WA (1978) Variations of boxplots. Am Stat 32:12–16

    Google Scholar 

  24. Zhou X, Obuchowski N, McClish D (2002) Statistical methods in diagnostic medicine. Wiley, New York, p 185

    Book  Google Scholar 

  25. Santoro A, Mancini E (2010) Hemodialysis and the elderly patient: complications and concerns. J Nephrol 23(Suppl 15):S80–S89

    PubMed  Google Scholar 

  26. Santoro A, Mancini E (1997) Clinical significance of intradialytic blood volume monitoring. Int J Artif Organs 20:1–6

    CAS  PubMed  Google Scholar 

  27. Dasselaar JJ, Huisman RM, de Jong PE, Franssen CF (2005) Measurement of relative blood volume changes during haemodialysis: merits and limitations. Nephrol Dial Transplant 20:2043–2049

    Article  PubMed  Google Scholar 

  28. Santesson P, Danielsson A, Iseda I, Adamson U, Lins PE et al (2010) Impaired peripheral micro- and macrocirculation during hemodialysis in uremic patients. Int Angiol 29:362–370

    CAS  PubMed  Google Scholar 

  29. Berridge JC (1992) Influence of cardiac output on the correlation between mixed venous and central venous oxygen saturation. Br J Anaesth 69:409–410

    Article  CAS  PubMed  Google Scholar 

  30. Solem K, Olde B, Sornmo L (2010) Prediction of intradialytic hypotension using photoplethysmography. IEEE Trans Biomed Eng 57:1611–1619

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Fabio Grandi, Maria Luigia Colucci and Nicoletta Pergoloni for their help. This work was partially supported by the grants of the project Optimization of Dialysis with Artificial Kidney (POR-FESR - Regione Emilia Romagna).

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Author notes

    Authors and Affiliations

    1. Nephrology, Dialysis, Hypertension, Teaching Hospital Policlinico S.Orsola-Malpighi, Bologna, Italy

      E. Mancini & A. Santoro

    2. Health Sciences and Technologies Interdepartmental Center for Industrial Research, University of Bologna, Cesena, Italy

      C. Perazzini, M. Tramonti & S. Severi

    3. Renal, Dialysis and Transplantation Unit, Department of Emergency and Transplantation, University of Bari, Bari, Italy

      L. Gesualdo

    4. Nephrology and Dialysis Department, I.R.C.C.S. “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy

      F. Aucella

    5. Nephrology and Dialysis Unit, Azienda Ospedaliera “Fatebenefratelli e Oftalmico”, Milano, Italy

      A. Limido

    6. Division of Nephrology and Dialysis, Azienda Ospedaliera di Montichiari, Brescia, Italy

      F. Scolari

    7. Nephrology and Dialysis Unit, Ospedale Civile, Cirié, Turin, Italy

      S. Savoldi

    8. Scientific Affairs Bellco srl, Mirandola, Italy

      L. Corazza & M. Atti

    9. Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, University of Bologna, Cesena, Italy

      S. Severi

    10. Territorial Department of Nephrology and Dialysis, ASL 8, Cagliari, Italy

      P. Bolasco

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    1. E. Mancini
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    Consortia

    on behalf of the Italian Oxygen Saturation Study Group (SOGLIA)

    Corresponding author

    Correspondence to E. Mancini.

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    Conflict of interest

    LC and MA are employes of the Company producing the dialysis machine used in the study. They only had a role of technical support in the use of the sensor and the machine. The other authors have declared that no competing interests exist.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

    Informed consent

    All the patients gave their informed consent before entering the study.

    Additional information

    E. Mancini and C. Perazzini contributed equally to this work.

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    Mancini, E., Perazzini, C., Gesualdo, L. et al. Intra-dialytic blood oxygen saturation (SO2): association with dialysis hypotension (the SOGLIA Study). J Nephrol 30, 811–819 (2017). https://doi.org/10.1007/s40620-016-0346-x

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    • DOI: https://doi.org/10.1007/s40620-016-0346-x

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