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Title Understanding the hemodynamic changes during peritoneal dialysis using a non-invasive cardiac system bio impedance device, NICaS – a pilot study |
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Type Poster Presentation |
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Theme 18th Asian Colloquium in Nephrology (18th ACN 2019) |
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Topic Dialysis: Peritoneal Dialysis |
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Main Author Mathini Jayaballa1 |
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Presenting Author Mathini Jayaballa1 |
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Co-Author Htay Htay1 Manish Kaushik1 Kok Su Fong1 Reshmah Shamsherutheen1 Jason Choo Chon Jun1 Marjorie Foo Wai Yin1 |
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Department / Institution / Country Department of Renal Medicine / Singapore General Hospital / Singapore1 |
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Abstract Content: Introduction, Method, Result, Conclusion Background: There is limited data available about the hemodynamic changes that occurs during peritoneal dialysis (PD) treatment. A new device, NICaS, is a non-invasive apparatus based on whole body electrical bio-impedance for simple non-invasive cardiac output determination. To date, there are no studies that has reviewed the use of this device during PD therapy. Aim: To evaluate the hemodynamic changes during PD therapy using NICaS device. Method: A pilot study including twenty adult incident PD patients. All patients received 1.5L dwell volume with dextrose 1.5% or 2.5% PD fluid over a dwell time 3 hours. NICaS was used to take measurements of their hemodynamics at five time-points: (stage-1) before PD fluid fill, (stage-2) immediately post fill, (stage-3) two hours post fill, (stage-4) before and (stage-5) immediately post drain. Parameters measured by NICaS includes: heart rate(HR), respiratory rate(RR), stroke volume(SV), cardiac output(CO), left ventricular function(LVF), total peripheral resistance(TPR) and total body water(TBW). Other parameters measured separately include blood pressure(BP), intra-peritoneal pressure(IPP) and fluid status with body composition monitor(BCM). Results: 20 patients were included in the study: median age 64.5 years (IQR: 54-70), male (50%), Chinese race (85%), body mass index 23.2 Kg/m2 (IQR 20.85-26.95), presence of diabetes mellitus (40%), ischemic heart disease (20%). Patients were overhydrated by median 3L (IQR 1.15-3.95L). No significant hemodynamic changes occurred including BP, HR, RR, SV, CO, LVF and TPR during and immediately post-PD exchange compared with the pre-PD exchange phase. Compared with pre-PD exchange TBW at stage-1 36.2kg (IQR 30.85-39.9), there was a significant reduction in TBW at stage-3 34.7kg (IQR 30.35-38.75, p 0.016), stage-4 34.2kg (IQR 29.65-38.5, p 0.0009) and stage-5 33.85kg (IQR 29.45-38.4, p 0.0002). No significant change in IPP occurred. Conclusion: The study demonstrated no significant hemodynamic change whilst there was a significant reduction in TBW during PD therapy, using NICaS device.
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