Microcirculation During Haemodialysis

Medical Centre Leeuwarden

Status

Completed

Conditions

Complication of Hemodialysis

Study type

Observational

Funder types

Other

Identifiers

TPO 776

Details and patient eligibility

About

SDF is validated by measuring changes in microcirculation in sepsis patients with MOF (Boerma studies).
SDF is validated by measuring changes in microcirculation in stable chronic hemodialysis patients (NDT 2009 Bemelmans).
Ultrafiltration in stable chronic hemodialysis leads to a decrease in sublingual microcirculatory flow (NDT 2009 Bemelmans).
Trendelenburg position improves the sublingual microcirculatory flow at the end of hemodialysis treatment (NDT 2009 Bemelmans).
Hemodialysis with ultrafiltration leads to a significant reduction of myocardial perfusion and cardiac output (NDT 2009 Dasselaar)
Cardiac output measurement during dialysis is not practical.
BVM is a validated method for hypotension due to ultrafiltration to prevent the amount of ultrafiltration online change based on the measured haemoconcentration (ref Dasselaar et al NDT 2005).
BCM is a validated measurement to the dry weight in hemodialysis patients measured by a bioimpedance technique (NDT Passauer et al 2009).

Full description

The search for an optimal method of ultrafiltration with minimal hypoperfusion of vital organs.

Stabile hemodialysis patients with dialysis dependancy for more than 3 months, with adequate access
Study duration 3 weeks
Number of hemodialysis treatment for purposes of study: 3
Timing hemodialysis treatments for Study session Monday or Tuesday after the weekend (randomized design in the sessions)
- session a: 5 hours total duration: 4 hours HD without UF followed by 1 hour GUF
- Session b: 4 hours total duration: 4 hours HD with UF
- session c: 4 hours total duration: 4 hours HD with UF and BVM
UF is determined by actual target weight.
Measurements during sessions:
- In each session in advance: blood pressure, pulse, weight, BCM, laboratory tests (Hb, Hct, Na, K, urea, creatinine, calcium, albumin, phosphate, nt-proBNP, troponin T, CRP)
- During each session at t = 0, t = 1 hour, t =2 hours and t = 4 hours: SDF, blood pressure, pulse, UF at that time, UF rate at that time
- End each session: blood pressure, pulse, weight, BCM, laboratory tests (Hb, Hct, Na, K, urea, creatinine, calcium, albumin, phosphate, nt-proBNP, troponin T, CRP)