Haemodynamic Instability Clinical Trial
Official title:
An Investigation of Transcapillary Plasma Refill During Ultrafiltration in Haemodialysis
Background: Haemodynamic instability during haemodialysis has long been linked to poor
cardiovascular outcomes. It does not always reflect overall hydration but rather plasma
volume depletion, with a delay in plasma refill from other body compartments, and
vasodilatation, mediated by endothelial factors. Our understanding of these processes remains
largely incomplete. Despite our ability to monitor relative blood volume during haemodialysis
our knowledge concerning the factors affecting plasma refill remain incomplete. This may be
due to variations observed between individuals. Understanding the pattern of fluid shifts
variation between the different body compartment and the factors affecting these behaviours
in different individuals or at different hydration states could be a vital component of our
management of intradialytic haemodynamic instability but also overhydration.
Aims and Objectives: The aim of this study is to describe plasma refill rate, during
haemodialysis using a non-invasive, continuous, real-time data capture during
ultrafiltration. The study will attempt to describe different refilling phenotypes in the
study population and seek association with biochemical and haematological parameters linked
to variability in refilling rates.
Methodology: This study will attempt to describe variations in the plasma refill rate of
prevalent dialysis patients during their normal haemodialysis treatment and during a session
of 3 hours of haemodialysis preceded by 1 hour of isolated ultrafiltration using the in-built
blood volume monitoring module of their haemodialysis machine and the TMON software that
collects continuous, real-time data by interfacing with the computer network. To achieve
this, a bolus of 100-300ml of intravenous dialysis replacement fluid will be administered at
the beginning of each of the 2 studied sessions.
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