Download PDF
Dialyse aktuell 2018; 22(08): 350-359
DOI: 10.1055/a-0733-2855
Schwerpunkt | Dialyse
© Georg Thieme Verlag KG Stuttgart · New York

Die Rolle von Hämodynamik und Biosignalen für eine „verträgliche“ Hämodialyse

Intradialytische Ereignisse (IME) sind ein entscheidender Einflussfaktor
Joachim Beige
KfH-Nierenzentrum und Abteilung Nephrologie, Klinikum Sankt Georg, Leipzig, Martin-Luther-Universität Halle/Wittenberg
› Author Affiliations
Further Information

Publication History

Publication Date:
29 October 2018 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die „verträgliche Dialyse“ bedarf einer naturwissenschaftlich exakten Definition unter Beachtung der verschiedenen Dimensionen der Zielqualität von Dialyseverordnung, Freiheit von intradialytischen Ereignissen (intradialytic morbid events: IME) sowie körperlichen Symptomen und psychosozialer Verträglichkeit. Der heute am ehesten gangbare Weg besteht in der Integration verfügbarer intradialytischer Biosignale mit technischen Behandlungsparametern. Als Hypothese kann das Ziel der Erhaltung einer sympathovagalen Balance formuliert werden. Zur Erreichung dieses Ziels sind in der (Dialyse)medizin neuartige technische Ansätze unter Einbeziehung künstlicher Intelligenz nötig. Gefundene und benutzte Algorithmen müssen zwingend offengelegt werden (Open Source Prinzip).

 

  • Literatur

  • 1 Steuer RR, Leypoldt JK, Cheung AK. et al. Hematocrit as an indicator of blood volume and a predictor of intradialytic morbid events. ASAIO J 1994; 40: M691-696
    CrossrefPubMedSearch in Google Scholar
  • 2 Leypoldt JK, Cheung AK, Steuer RR. et al. Determination of circulating blood volume by continuously monitoring hematocrit during hemodialysis. J Am Soc Nephrol 1995; 6: 214-219
    PubMedSearch in Google Scholar
  • 3 Rayner HC, Zepel L, Fuller DS. et al. Recovery time, quality of life, and mortality in hemodialysis patients: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2014; 64: 86-94 doi:10.1053/j.ajkd.2014.01.014
    CrossrefPubMedSearch in Google Scholar
  • 4 Pirkle JL, Comeau ME, Langefeld CD. et al. Effects of weight-based ultrafiltration rate limits on intradialytic hypotension in hemodialysis. Hemodial Int 2018; 22: 270-278 doi:10.1111/hdi.12578
    CrossrefPubMedSearch in Google Scholar
  • 5 Beige J, Sone J, Sharma AM. et al. Computational analysis of blood volume curves and risk of intradialytic morbid events in hemodialysis. Kidney Int 2000; 58: 1805-1809 doi: 10.1046/j.1523–1755.2000.00343.x
    CrossrefPubMedSearch in Google Scholar
  • 6 Beige J, Deussing K. Heart-rate-variability in haemodialysis – work in progress. J Am Soc Nephrol. 2016 27. (Abstract Ed.)
    PubMedSearch in Google Scholar
  • 7 Rubinger D, Backenroth R, Sapoznikov D. Sympathetic nervous system function and dysfunction in chronic hemodialysis patients. Semin Dial 2013; 26: 333-343 doi:10.1111/sdi.12093
    CrossrefPubMedSearch in Google Scholar
  • 8 Maeda K, Fujita Y, Shinzato T. et al. Change in sympathetic activity before, during, and after dialysis-induced hypotension. ASAIO Trans 1990; 36: M462-464
    Search in Google Scholar
  • 9 Neumann J, Ligtenberg G, Klein II. et al. Sympathetic hyperactivity in chronic kidney disease: pathogenesis, clinical relevance, and treatment. Kidney Int 2004; 65: 1568-1576 doi:10.1111/j.1523–1755.2004.00552.x
    CrossrefPubMedSearch in Google Scholar
  • 10 Sapoznikov D, Backenroth R, Rubinger D. Baroreflex sensitivity and sympatho-vagal balance during intradialytic hypotensive episodes. J Hypertens 2010; 28: 314-324 doi:10.1097/HJH.0b013e328332b7af
    CrossrefPubMedSearch in Google Scholar
  • 11 Rubinger D, Backenroth R, Sapoznikov D. Sympathetic activation and baroreflex function during intradialytic hypertensive episodes. PLoS One 2012; 7: e36943 doi:10.1371/journal.pone.0036943
    CrossrefPubMedSearch in Google Scholar
  • 12 Pelosi G, Emdin M, Carpeggiani C. et al. Impaired sympathetic response before intradialytic hypotension: a study based on spectral analysis of heart rate and pressure variability. Clin Sci (Lond) 1999; 96: 23-31
    CrossrefPubMedSearch in Google Scholar
  • 13 Flythe JE, Hilliard T, Castillo G. et al. Symptom prioritization among adults receiving in-center hemodialysis: a Mixed Methods Study. Clin J Am Soc Nephrol 2018; 13: 735-745 doi:10.2215/CJN.10850917
    CrossrefPubMedSearch in Google Scholar
  • 14 Barnas MG, Boer WH, Koomans HA. Hemodynamic patterns and spectral analysis of heart rate variability during dialysis hypotension. J Am Soc Nephrol 1999; 10: 2577-2584
    PubMedSearch in Google Scholar
  • 15 Kotanko P. Cause and consequences of sympathetic hyperactivity in chronic kidney disease. Blood Purif 2006; 24: 95-99 doi:10.1159/000089444
    CrossrefPubMedSearch in Google Scholar
  • 16 Carter JR, Grimaldi D, Fonkoue IT. et al. Assessment of sympathetic neural activity in chronic insomnia: evidence for elevated cardiovascular risk. Sleep. 2018 41. doi:10.1093/sleep/zsy048
    PubMedSearch in Google Scholar
  • 17 Florea VG, Cohn JN. The autonomic nervous system and heart failure. Circ Res 2014; 114: 1815-1826 doi:10.1161/CIRCRESAHA.114.302589
    CrossrefPubMedSearch in Google Scholar
  • 18 Beige J, Koziolek MJ, Hennig G. et al. Baroreflex activation therapy in patients with end-stage renal failure: proof of concept. J Hypertens 2015; 33: 2344-2349 doi:10.1097/HJH.0000000000000697
    CrossrefPubMedSearch in Google Scholar
  • 19 Drew DA, Koo BB, Bhadelia R. et al. White matter damage in maintenance hemodialysis patients: a diffusion tensor imaging study. BMC Nephrol 2017; 18: 213 doi:10.1186/s12882–017–0628–0
    CrossrefPubMedSearch in Google Scholar
  • 20 Polinder-Bos HA, García DV, Kuipers J. et al. Hemodialysis induces an acute decline in cerebral blood flow in elderly patients. J Am Soc Nephrol 2018; 29: 1317-1325 doi:10.1681/ASN.2017101088
    CrossrefPubMedSearch in Google Scholar
  • 21 McIntyre C, Crowley L. Dying to Feel Better: The central role of dialysis-induced tissue hypoxia. Clin J Am Soc Nephrol 2016; 11: 549-551 doi:10.2215/CJN.01380216
    CrossrefPubMedSearch in Google Scholar
  • 22 McIntyre CW, Burton JO, Selby NM. et al. Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. Clin J Am Soc Nephrol 2008; 3: 19-26 doi:10.2215/CJN.03170707
    CrossrefPubMedSearch in Google Scholar
  • 23 McIntyre CW, Odudu A. Hemodialysis-associated cardiomyopathy: a newly defined disease entity. Semin Dial 2014; 27: 87-97
    CrossrefPubMedSearch in Google Scholar
  • 24 Breidthardt T, Burton JO, Odudu A. et al. Troponin T for the detection of dialysis-induced myocardial stunning in hemodialysis patients. Clin J Am Soc Nephrol 2012; 7: 1285-1292 doi:10.2215/CJN.00460112
    CrossrefPubMedSearch in Google Scholar
  • 25 Jakob SM, Ruokonen E, Vuolteenaho O. et al. Splanchnic perfusion during hemodialysis: evidence for marginal tissue perfusion. Crit Care Med 2001; 29: 1393-1398
    CrossrefPubMedSearch in Google Scholar
  • 26 McIntyre CW, Harrison LEA, Eldehni MT. et al. Circulating endotoxemia: a novel factor in systemic inflammation and cardiovascular disease in chronic kidney disease. Clin J Am Soc Nephrol 2011; 6: 133-141 doi:10.2215/CJN.04610510
    CrossrefPubMedSearch in Google Scholar
  • 27 Vanholder R, Glorieux G, Lameire N. The other side of the coin: impact of toxin generation and nutrition on the uremic syndrome. Semin Dial 2002; 15: 311-314
    CrossrefPubMedSearch in Google Scholar
  • 28 Steuer RR, Leypoldt JK, Cheung AK. et al. Reducing symptoms during hemodialysis by continuously monitoring the hematocrit. Am J Kidney Dis 1996; 27: 525-532
    CrossrefPubMedSearch in Google Scholar
  • 29 Leypoldt JK, Cheung AK. Evaluating volume status in hemodialysis patients. Adv Ren Replace Ther 1998; 5: 64-74
    CrossrefPubMedSearch in Google Scholar
  • 30 Wizemann V, Wabel P, Chamney P. et al. The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant 2009; 24: 1574-1579 doi:10.1093/ndt/gfn707
    CrossrefPubMedSearch in Google Scholar
  • 31 Chazot C, Wabel P, Chamney P. et al. Importance of normohydration for the long-term survival of haemodialysis patients. Nephrol Dial Transplant 2012; 27: 2404-2410 doi:10.1093/ndt/gfr678
    CrossrefPubMedSearch in Google Scholar
  • 32 Kron S, Schneditz D, Leimbach T. et al. Determination of the critical absolute blood volume for intradialytic morbid events. Hemodial Int 2016; 20: 321-326 doi:10.1111/hdi.12375
    CrossrefPubMedSearch in Google Scholar
  • 33 Kron S, Schneditz D, Czerny J. et al. Adjustment of target weight based on absolute blood volume reduces the frequency of intradialytic morbid events. Hemodial Int 2018; 22: 254-260 doi:10.1111/hdi.12582
    CrossrefPubMedSearch in Google Scholar
  • 34 Kron S, Schneditz D, Leimbach T. et al. Vascular refilling is independent of volume overload in hemodialysis with moderate ultrafiltration requirements. Hemodial Int 2016; 20: 484-491 doi:10.1111/hdi.12417
    CrossrefPubMedSearch in Google Scholar
  • 35 Rouby JJ, Rottembourg J, Durande JP. et al. Importance of the plasma refilling rate in the genesis of hypovolaemic hypotension during regular dialysis and controlled sequential ultrafiltration-haemodialysis. Proc Eur Dial Transplant Assoc 1978; 15: 239-244
    PubMedSearch in Google Scholar
  • 36 Schneditz D, Kaufman AM, Polaschegg HD. et al. Cardiopulmonary recirculation during hemodialysis. Kidney Int 1992; 42: 1450-1456
    CrossrefPubMedSearch in Google Scholar
  • 37 Agarwal R, Georgianos P. Feeding during dialysis-risks and uncertainties. Nephrol Dial Transplant 2018; 33: 917-922 doi:10.1093/ndt/gfx195
    CrossrefPubMedSearch in Google Scholar
  • 38 Barakat MM, Nawab ZM, Yu AW. et al. Hemodynamic effects of intradialytic food ingestion and the effects of caffeine. J Am Soc Nephrol 1993; 3: 1813-1818
    PubMedSearch in Google Scholar
  • 39 Mancini E, Mambelli E, Irpinia M. et al. Prevention of dialysis hypotension episodes using fuzzy logic control system. Nephrol Dial Transplant 2007; 22: 1420-1427 doi:10.1093/ndt/gfl799
    CrossrefPubMedSearch in Google Scholar
  • 40 Nesrallah GE, Suri RS, Thiessen-Philbrook H. et al. Can extracellular fluid volume expansion in hemodialysis patients be safely reduced using the hemocontrol biofeedback algorithm? A randomized trial. ASAIO J 2008; 54: 270-274 doi:10.1097/MAT.0b013e318169271e
    CrossrefPubMedSearch in Google Scholar
  • 41 McIntyre CW, Lambie SH, Fluck RJ. Biofeedback controlled hemodialysis (BF-HD) reduces symptoms and increases both hemodynamic tolerability and dialysis adequacy in non-hypotension prone stable patients. Clin Nephrol 2003; 60: 105-112
    CrossrefPubMedSearch in Google Scholar
  • 42 Steuer RR, Leypoldt JK, Cheung AK. et al. Hematocrit as an indicator of blood volume and a predictor of intradialytic morbid events. ASAIO J 1994; 40: M691-696
    CrossrefPubMedSearch in Google Scholar
  • 43 Franssen CF, Dasselaar JJ, Sytsma P. et al. Automatic feedback control of relative blood volume changes during hemodialysis improves blood pressure stability during and after dialysis. Hemodial Int 2005; 9: 383-392 doi:10.1111/j.1492–7535.2005.01157.x
    CrossrefPubMedSearch in Google Scholar
  • 44 Santoro A, Mancini E, Basile C. et al. Blood volume controlled hemodialysis in hypotension-prone patients: a randomized, multicenter controlled trial. Kidney Int 2002; 62: 1034-1045 doi:10.1046/j.1523–1755.2002.00511.x
    CrossrefPubMedSearch in Google Scholar
  • 45 Leung KCW, Quinn RR, Ravani P. et al. Randomized crossover trial of blood volume monitoring-guided ultrafiltration biofeedback to reduce intradialytic hypotensive episodes with hemodialysis. Clin J Am Soc Nephrol 2017; 12: 1831-1840 doi:10.2215/CJN.01030117
    CrossrefPubMedSearch in Google Scholar
  • 46 Ronco C, Brendolan A, Milan M. et al. Impact of biofeedback-induced cardiovascular stability on hemodialysis tolerance and efficiency. Kidney Int 2000; 58: 800-808 doi:10.1046/j.1523–1755.2000.00229.x
    CrossrefPubMedSearch in Google Scholar
  • 47 Garzoni D, Keusch G, Kleinoeder T. et al. Reduced complications during hemodialysis by automatic blood volume controlled ultrafiltration. Int J Artif Organs 2007; 30: 16-24
    CrossrefPubMedSearch in Google Scholar
  • 48 du Cheyron D, Lucidarme O, Terzi N. et al. Blood volume- and blood temperature-controlled hemodialysis in critically ill patients: a 6-month, case-matched, open-label study. Blood Purif 2010; 29: 245-251 doi:10.1159/000266481
    CrossrefPubMedSearch in Google Scholar
  • 49 Antlanger M, Josten P, Kammer M. et al. Blood volume-monitored regulation of ultrafiltration to decrease the dry weight in fluid-overloaded hemodialysis patients: a randomized controlled trial. BMC Nephrol 2017; 18: 238 doi:10.1186/s12882–017–0639-x
    CrossrefPubMedSearch in Google Scholar
  • 50 Dolovich J, Marshall CP, Smith EK. et al. Allergy to ethylene oxide in chronic hemodialysis patients. Artif Organs 1984; 8: 334-337
    CrossrefPubMedSearch in Google Scholar
  • 51 Marshall C, Shimizu A, Smith EK. et al. Ethylene oxide allergy in a dialysis center: prevalence in hemodialysis and peritoneal dialysis populations. Clin Nephrol 1984; 21: 346-349
    PubMedSearch in Google Scholar
  • 52 Dolovich J, Bell B. Allergy to a product(s) of ethylene oxide gas: demonstration of IgE and IgG antibodies and hapten specificity. J Allergy Clin Immunol 1978; 62: 30-32
    CrossrefPubMedSearch in Google Scholar
  • 53 Grammer LC, Roberts M, Wiggins CA. et al. A comparison of cutaneous testing and ELISA testing for assessing reactivity to ethylene oxide-human serum albumin in hemodialysis patients with anaphylactic reactions. J Allergy Clin Immunol 1991; 87: 674-676
    CrossrefPubMedSearch in Google Scholar
  • 54 Grammer LC, Patterson R. IgE against ethylene oxide-altered human serum albumin (ETO-HSA) as an etiologic agent in allergic reactions of hemodialysis patients. Artif Organs 1987; 11: 97-99
    CrossrefPubMedSearch in Google Scholar
  • 55 Bacelar Marques ID, Pinheiro KF, de Freitas do Carmo LP. et al. Anaphylactic reaction induced by a polysulfone/polyvinylpyrrolidone membrane in the 10th session of hemodialysis with the same dialyzer. Hemodial Int 2011; 15: 399-403 doi:10.1111/j.1542–4758.2011.00553.x
    CrossrefPubMedSearch in Google Scholar
  • 56 Rodríguez-Sanz A, Sánchez-Villanueva R, Domínguez-Ortega J. et al. Mechanisms involved in hypersensitivity reactions to polysulfone hemodialysis membranes. Artif Organs 2017; 41: E285-E295 doi:10.1111/aor.12954
    CrossrefPubMedSearch in Google Scholar
  • 57 Aljadi Z, Mansouri L, Nopp A. et al. Activation of basophils is a new and sensitive marker of biocompatibility in hemodialysis. Artif Organs 2014; 38: 945-953 doi:10.1111/aor.12297
    CrossrefPubMedSearch in Google Scholar
  • 58 Sirolli V, Ballone E, Di Stante S. et al. Cell activation and cellular-cellular interactions during hemodialysis: effect of dialyzer membrane. Int J Artif Organs 2002; 25: 529-537
    CrossrefPubMedSearch in Google Scholar
  • 59 Bergström J. Ultrafiltration without dialysis for removal of fluid and solutes in uremia. Clin Nephrol 1978; 9: 156-164
    PubMedSearch in Google Scholar
  • 60 Freyschuss U, Danielsson A, Bergström J. Cardiovascular function and arterial blood gases during isolated ultrafiltration in healthy man. Blood Purif 1988; 6: 213-226 doi:10.1159/000169547
    CrossrefPubMedSearch in Google Scholar
  • 61 Leber HW, Wizemann V, Goubeaud G. et al. Hemodiafiltration: a new alternative to hemofiltration and conventional hemodialysis. Artif Organs 1978; 2: 150-153
    CrossrefPubMedSearch in Google Scholar
  • 62 Koda Y, Aoike I, Hasegawa S. et al. Feasibility of intermittent back-filtrate infusion hemodiafiltration to reduce intradialytic hypotension in patients with cardiovascular instability: a pilot study. Clin Exp Nephrol 2017; 21: 324-332 doi:10.1007/s10157–016–1270-z
    CrossrefPubMedSearch in Google Scholar
  • 63 Tentori F, Zhang J, Li Y. et al. Longer dialysis session length is associated with better intermediate outcomes and survival among patients on in-center three times per week hemodialysis: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 2012; 27: 4180-4188 doi:10.1093/ndt/gfs021
    CrossrefPubMedSearch in Google Scholar
  • 64 Locatelli F, Stefoni S, Petitclerc T. et al. Effect of a plasma sodium biofeedback system applied to HFR on the intradialytic cardiovascular stability. Results from a randomized controlled study. Nephrol Dial Transplant 2012; 27: 3935-3942 doi:10.1093/ndt/gfs091
    CrossrefPubMedSearch in Google Scholar
  • 65 Moret K, Aalten J, van den Wall Bake W. et al. The effect of sodium profiling and feedback technologies on plasma conductivity and ionic mass balance: a study in hypotension-prone dialysis patients. Nephrol Dial Transplant 2006; 21: 138-144 doi:10.1093/ndt/gfi118
    CrossrefPubMedSearch in Google Scholar
  • 66 Kooman JP, Katzarski K, van der Sande FM. et al. Hemodialysis: a model for extreme physiology in a vulnerable patient population. Semin Dial 2018; 31: 500-506 doi:10.1111/sdi.12704
    CrossrefPubMedSearch in Google Scholar
  • 67 The Lancet. Artificial intelligence in health care: within touching distance. Lancet 2018; 390: 2739 doi:10.1016/S0140–6736(17)31540–4
    Search in Google Scholar
  • 68 Kammel R, Beige J, Czygan M. et al. Monitoring the activation of the sympathetic nervous system to improve hemodialysis processes. Biomed Tech (Berl). 2013 doi:10.1515/bmt-2013–4225
    PubMedSearch in Google Scholar