Patient Symptoms on Hemodialysis-Timing, Variability and Causes

项目摘要 美国有超过40万名患者依赖于维持生命的益处， 维持性血液透析（HD）。然而，据估计，超过50%的人会出现衰弱的身体症状。 患者在HD过程中，往往导致生活质量下降。尽管有几十年的经验， 这些症状的确切时间、疗程间的变化和潜在病因仍不清楚。我们 先前的研究表明，血浆渗透压的快速下降可能在这两种疾病中起重要作用。 HD疗程早期的血压下降和症状（如胸痛和头痛）; 而另一些人认为，不准确的容量评估和较高的超滤率可能在以后发挥作用， 在HD会议上。为了解决这些知识差距，在目标1中，我们提出了对 当代HD患者前瞻性队列中患者症状的时间、频率和变异性。在 目标2，我们将利用创新的床旁检测方法来帮助评估容量状态， 确定渗透压下降、超滤率和客观容量指标（肺 超声和下腔静脉直径）与HD期间的患者症状。总括而言，我们的建议是 临床相关、可行和创新。此外，它们将提供重要的初步数据， 与未来的干预性研究和R 01应用相关。建立在基础病理生理学和 我们在临床试验方面的经验，我们的建议有可能改善对患者的护理 因肾衰竭接受维持性血液透析

PROJECT SUMMARY There are over 400,000 patients in the United States that are dependent on the life-preserving benefits of maintenance hemodialysis (HD). However, debilitating physical symptoms are estimated to affect over 50% of patients during the HD procedure, often resulting in reduced quality of life. Despite decades of experience, the exact timing, session-to-session variability, and potential etiologies of such symptoms remain unclear. Our prior work has suggested that rapid rates of decline in plasma osmolality may play an important role in both blood pressure decline and symptoms (such as chest pain and headache) early in the course of HD sessions; while others suggest that inaccurate volume assessment and higher rates of ultrafiltration may play a role later in the HD session. To address these gaps in knowledge, in Aim 1, we propose a detailed analysis of the timing, frequency and variability of patient symptoms in a prospective cohort of contemporary HD patients. In Aim 2, we will leverage innovative point-of-care methods to aid in the assessment of volume status, and determine the association of osmolality decline, ultrafiltration rate and objective volume metrics (lung ultrasound and inferior vena cava diameter) with patient symptoms during HD. In summary, our proposals are clinically relevant, feasible and innovative. Moreover, they will provide important preliminary data that is highly relevant to future interventional studies and R01 applications. Building on the underlying pathophysiology and our experience in performance of clinical trials, our proposals have the potential to improve care for patients undergoing maintenance HD for kidney failure.