Haemodynamics in CKD: Transition to Renal Replacement therapy
Research type
Research Study
Full title
Impact on Haemodynamics of Initiation of Renal Replacement Therapy (RRT) in patients with end stage chronic renal disease (CKD) (HIRRT-CKD Study)
IRAS ID
216818
Contact name
Aled Phillips
Contact email
Sponsor organisation
Cardiff University
Duration of Study in the UK
0 years, 11 months, 31 days
Research summary
Excess mortality related to cardiovascular disease is well documented in patients with chronic renal disease. This increased mortality is seen in both pre-dialysis patients and also in patients treated with renal replacement therapy (RRT). Heart disease in the context of renal failure is driven by a different set of risks to those of the general population. The increased risk is associated with biochemical abnormalities related to poor kidney function which may affect vascular function and arterial distensibility, and once on dialysis the direct effects of the treatments. Patients with chronic kidney disease (CKD) undergoing haemodialysis (HD) experience major changes in haemodynamics and cardiac stress during the dialysis sessions, with up to a third of hemodialysis sessions complicated by significant falls in patient blood pressure. This is believed to contribute damage to the heart, although these changes and why they occur are not well characterized. Because of these poorly characterized direct stresses on the heart, HD is itself now established as an independent risk factor for the development of heart disease in these patients. It is now apparent that Peritoneal Dialysis (PD) may also have adverse effects on cardiac function which may related to short term metabolic consequences of instillation of high glucose containing fluid into the abdomen and also due to volume/pressure effect which directly affect cardiac filling.
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 chronic renal failure which is a new approach for renal units in terms of assessing haemodynamics. Such a detailed assessment of underlying haemodynamics may uncover new therapeutic targets and guide better management.
We propose to investigate patients with CKD prior to and after initiation of RRT. Our hypothesis is that transition of patients onto dialysis has a direct effect on cardiac function which adversely influences patient cardiovascular outcomes. We also propose that the additional cardiac stresses of RRT differ in PD and HD patients.
REC name
HSC REC B
REC reference
16/NI/0240
Date of REC Opinion
27 Oct 2016
REC opinion
Further Information Favourable Opinion