Microcirculation During Haemodialysis

Sublingual Microcirculatory Flow Measurements During Haemodialysis in Relation to Blood Volume Change

• 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).

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)

Inclusion Criteria:

• dialysis patient
• age > 18
• informed consent

Exclusion Criteria:

• no adequate access
• instable hemodynamics