Haemodynamics, haemodialysis and Adult CKD v1.0
Research type
Research Study
Full title
Characterisation of Haemodynamics in Haemodialysis Patients with Chronic Kidney Disease
IRAS ID
204754
Contact name
Timothy H Rainer
Contact email
Sponsor organisation
Cardiff University
Duration of Study in the UK
0 years, 3 months, 1 days
Research summary
The haemodialysis mortality in Cardiff is 18% per annum. Patient who have renal failure treated by dialysis are known to have a very high mortality associated with heart disease. Heart disease in the context of renal failure is driven by a different set of risks to those of the general population, with biochemical abnormalities directly related to poor kidney function and effects of the treatments need to keep patients alive both likely to contribute. Patients with chronic kidney disease undergoing haemodialysis experience major changes in haemodynamics and cardiac stress, and up to a third of hemodialysis sessions are complicated by significant falls in patient blood pressure. This is believed to cause damage to the heart. These changes and why they occur however are not well characterized. Because of these poorly characterized direct stresses on the heart, haemodialysis is itself now established as an independent risk factor for the development of heart disease in these patients. Current assessment of these patients involves clinical assessment and basic observations such as heart rate, blood pressure and respiratory rate.
The body has the ability to compensate in the early stages when things go wrong so that on the surface patients do not appear as sick as they really are. Under-diagnosis of severity of illness leads to under-treatment, unnecessary mortality, and unnecessary hospital costs. Earlier diagnosis and consequent treatment will result in prudent healthcare, cost-benefit and better patient outcomes.
Evaluating the true underlying patient haemodynamics such as cardiac output, cardiac power and peripheral pressures and systemic resistance gives vital clues to the hidden seriousness of illness and is a guide to better management. This has been used to address high mortality associated with serious infection. After introducing such a non-invasive, quality improvement, haemodynamic protocol, one intensive care department in Australia was able to reduce its death rate for septic shock, the leading cause of shock and hospital death, at 30 days from 38% to 7%. We are now proposing to use similar technology in the context of dialysis treatment which is a new approach for renal units in terms of assessing haemodynamics. Such a detailed assessment of underlying haemodynamics in haemodialysis patients may uncover cardiac strain and guide better management.
We propose to investigate patients with chronic kidney disease undergoing haemodialysis.
Our hypothesis is that haemodialysis has a direct effect on cardiac function through its effect on similar hemodynamic factors as seen in sepsis, and that this adversely influences patient cardiovascular outcomes. In this proposal we will validate a method for assessing advanced haemodynamic variables by using a new device called Uscom, to quantify serial haemodynamic changes during treatment of patients with renal failure by haemodialysis. This work will therefore better inform the understanding of the link between treatment of patients with renal failure and the well know high risk of death from heart disease.REC name
London - Camberwell St Giles Research Ethics Committee
REC reference
16/LO/1500
Date of REC Opinion
23 Aug 2016
REC opinion
Further Information Favourable Opinion