Volume Management in Dialysis Patients Guided by Pulse Amplitude Ration

以脉搏振幅比为指导的透析患者容量管理

• 批准号: 8808110
• 负责人: Tariq Shafi
• 金额: $ 7万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8808110
• 关键词: Address; Affect; Ankle; Area; Arrhythmia; Biological Markers; Blood Pressure; Cardiac Catheterization Procedures; Cardiovascular Diseases; Cardiovascular system; Clinical; Congestive Heart Failure; Data; Data Quality; Devices; Dialysis patients; Dialysis procedure; Diastolic blood pressure; Dizziness; Dyspnea; Edema; Excision; Exercise; Fatigue; Fibrosis; Fingers; Fluid overload; Functional disorder; Future; Goals; Health; Heart; Hemodialysis; Home environment; Hypertension; Hypertrophy; Hypotension; Hypovolemia; Impaired cognition; Intervention; Iohexol; Kidney; Left; Left Ventricular Hypertrophy; Left ventricular structure; Liquid substance; Measurement; Measures; Methods; Morbidity - disease rate; Muscle Cramp; Myocardial Infarction; Myocardial Stunning; Outcome; Outpatients; Pathogenesis; Patient Schedules; Patients; Peritoneal Dialysis; Photoplethysmography; Physiologic pulse; Protocols documentation; Pulse Pressure; Quality of life; Questionnaires; Randomized Clinical Trials; Recruitment Activity; Renal function; Research; Residual state; Risk; Safety; Stroke; Symptoms; Testing; Thrombosis; Validation; Valsalva Maneuver; Venous; Ventricular; Weight; base; cardiovascular risk factor; clinical care; design; extracellular; falls; improved; innovation; insight; mortality; novel; patient safety; pressure; public health relevance

 DESCRIPTION (provided by applicant): Cardiovascular disease is the leading cause of morbidity and mortality in dialysis patients and volume overload is a major contributor to its pathogenesis and progression. Central volume excess causes pressure/volume overload of the left ventricle leading to left ventricular hypertrophy, fibrosis and arrhythmias. However, excessive/rapid fluid removal and central volume depletion can also be deleterious by causing hypotension and ischemic complications such as myocardial infarction, stroke and loss of residual kidney function. Volume- related symptoms such as dyspnea, intradialytic cramping and post dialysis fatigue contribute to poor quality of life. Volume management in dialysis patients is difficult as there are no simple methods to assess central volume. The goal of this study is to determine if central volume assessment using a novel non-invasive handheld device that uses changes in blood pressure during Valsalva maneuver to assess central volume can be used for volume management in dialysis patients. We hypothesize that pulse amplitude ratio calculated by the device will be highly correlated with left ventricular filling pressures and volume-related complications in dialysis patients. We plan to test our hypotheses by: 1) measuring pulse amplitude ratio in dialysis patients scheduled for an elective cardiac catheterization; 2) measuring pulse amplitude ratio in dialysis patients in an outpatient dialysis unit, recording episodes of intradialytic hypotension and assessing quality of life; and 3) assessing the feasibility of a fluid management protocol for patients with persistently elevated pulse amplitude ratio. We anticipate that the results of this study will generate high quality data that can be used to design a volume management strategy guided by pulse amplitude ratio and we plan to test this strategy in a future randomized clinical trial. We believe that the results of these studies can potentially change the paradigm of volume management in dialysis patients providing objective data to make individualized decisions that can improve the health and quality of life of dialysis patients.

 描述（由申请方提供）：心血管疾病是透析患者发病和死亡的主要原因，容量超负荷是其发病机制和进展的主要原因。中心容量过多引起左心室的压力/容量超负荷，导致左心室肥大、纤维化和心律失常。然而，过度/快速的液体清除和中心容量耗竭也可能是有害的，因为会引起低血压和缺血性并发症，如心肌梗死、中风和残余肾功能丧失。容量相关症状如呼吸困难、透析中痉挛和透析后疲劳导致生活质量差。透析患者的容量管理是困难的，因为没有简单的方法来评估中心容量。本研究的目的是确定使用新型无创手持设备进行中心容量评估是否可用于透析患者的容量管理，该设备使用Valsalva动作期间的血压变化来评估中心容量。我们假设由该设备计算的脉冲幅度比与透析患者的左心室充盈压和容量相关并发症高度相关。我们计划通过以下方式检验我们的假设：1）测量计划进行择期心导管插入术的透析患者的脉搏振幅比; 2）测量门诊透析单位透析患者的脉搏振幅比，记录透析中低血压事件并评估生活质量; 3）评估脉搏振幅比持续升高患者的液体管理方案的可行性。我们预计，这项研究的结果将产生高质量的数据 这可以用来设计一个由脉冲幅度比指导的容量管理策略，我们计划在未来的随机临床试验中测试这一策略。我们认为， 这些研究可以潜在地改变透析患者的容量管理的范例，提供客观数据以做出可以改善透析患者的健康和生活质量的个体化决定。