Best Practice:

Cardiovascular complications in ESRD patients must be averted or reduced through periodic exams by the patient’s nephrologist, supported by routine cardiac function screening and tests administered by the hemodialysis staff.

“ESRD patients are prone to sudden death, stroke and myocardial infarction between dialysis sessions.”¹

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with End-Stage Renal Disease (ESRD).²  CVD mortality rates of ESRD patients are ten to twenty times that of the general population, thus propelling nephrologists to assume a greater role in their ESRD patients’ cardiac management. Transonic Flow-QC^® tests  during hemodialysis are a cost-effective solution to cardiac function management. Cardiac output (CO), cardiac index (CI) and central blood volume (CBV) measurements, performed by the dialysis staff during the hemodialysis treatment, alert nephrologists to their patients’ potential cardiovascular complications.³

Cardiac Function (Flow-QC^® CO)

Transonic Flow-QC^® CO measurements and cardiac output trending (via supplied software) enables ongoing surveillance of the a patient’s cardiovascular health that assists in diagnosing cardiac overload. When access flow, measured during the dialysis session, is unusually high (>2 L/min), cardiac overload can be suspected. Congestive heart failure may also be indicated if the heart rate drops significantly with compression of the access. Flow-QC^® CO monitoring identifies:

1. Prolonged high access flow (> 2 L/min) that stresses the heart causing cardiomegaly and heart failure;
2. Dangerous ratio between access flow and cardiac output;
3. Low cardiac output that places patients at the risk for cardiovascular complications and sudden death.

Central Hemodynamic Profiling (CHP)

Effective management of cardiac function depends on tests, such as CHP (Fig. 1), that track the heart’s response to the stress of the hemodialysis treatment in order to detect early indications of cardiovascular failure. CHP consists of hourly Flow-QC^® CO measurements throughout the hemodialysis treatment to identify dramatic decreases in cardiac index to a dangerous level due to inappropriate dry weight estimation and/or inadequate medication.

Fig. 1: Central Hemodynamic Profiling (CHP): four CO measurements during a single dialysis session shows CI response to hemodialysis. Acceptable CI values range from 2.5 -4.2 L/min/m2.^4,5

References

1. Cardiovascular Disease — An ESRD Epidemic. Am J Kid Dis 1998; 32(5):Suppl 3.
2. MacRae JM et al, “The Cardiovascular Effects of Arteriovenous Fistulas in Chronic Kidney Disease: A Cause for Concern?” Seminars in Dialysis 2006; 19(15): 349-352.
3. Krivitski, NM, Depner, TA, “Cardiac Output and Central Blood Volume during, Hemodialysis: Methodology,” Adv Ren Replace Ther 1999; 6(3): 225-232.
4. Tucker, T et al, “Central Hemodynamic Profiling (CHP) during Outpatient Hemodialysis (HD),” JASN Abstracts 2002; 13: 209A. (HD268A)
5. Tucker, T et al, “Unrecognized Deterioration of Cardiac Function during Hemodialysis,” J Am Soc of Nephrol Abstracts 2002; 13: 213A. ( HD267A)

Reference List:

Methodology and Validations