Assessment of postdialysis recovery time and associated hemodynamic changes by cardiometry in hemodiafiltration compared to conventional hemodialysis in patients on regular renal replacement therapy

Abstract

Background Dialysis recovery time (DRT) has been shown to be a reliable marker of health-related quality of life (HRQOL) and increased mortality. More than 65% of prevalent HD patients report a DRT ≥2 h. The aim of this work was to study the relation of postdialysis fatigue to; demographic, social, clinical, laboratory characteristics and hemodynamic changes assessed by cardiometry of ESRD patients on regular renal replacement therapy using different dialysis modalities (HD and HDF). Also to compare between HD and HDF regarding clinical, laboratory characteristics and hemodynamic changes assessed by cardiometry. Patients and methods This cross-sectional study was carried out at Menoufia University Hospitals and Ain Shams University Hospitals included 73 ESRD patients, 50 patients on conventional HD from Menoufia University Hospitals and 23 patients on HDF from Ain Shams University Hospitals. Patients were classified according to the occurrence of PDF (TIRD ≥2 h) into two groups: - Group (I): Patients without postdialysis fatigue & Group (II): Patients with postdialysis fatigue. And also were classified hemodialysis modality into two groups: - Group (A): Patients on regular conventional HD & Group (B): Patients on regular HDF. We compared groups with respect to influential factors (socio-demographics, clinical and laboratory factors). Results The proportion of intradialytic hypotension episodes & ultrafiltration rate (UFR) was significantly higher in group II (P value = 0.034, 0.000). Group II patients had significantly lower hemoglobin level (Hb), dialysis adequacy (Kt/V), calcium(Ca) & vitamin D level (P value = 0.007, 0.001, 0.03 & 0.004 respectively) and significantly higher C‑reactive protein (CRP), Interleukin-6 (IL-6), Delta change of fluid thoracic content (Δ FTC) and Delta change of cardiac output (Δ CO) (P value = 0.01, 0.004, 0.04 & 0.008, respectively). There were significant positive correlations between PDF and UFR & Δ CO and negative correlation with Kt/V &Vitamin D. In multivariate analysis, UFR, Kt/V& Δ CO were independent predictors of PDF. There were statistical differences regarding (age, gender, occupation& original kidney disease) among group B (P value of <0.05) with decreased incidence of hypotension episodes & PDF. Group B had significantly higher Hb, Kt/V, Ca, vitamin D& iron (P value = 0.04, 0.001, 0.001, 0.02 & 0.02, respectively) and significantly lower Intact Parathormone (PTH), IL-6, Δ FTC & Δ CO (P value=0.02, 0.01, 0.006 & 0.01, respectively). Conclusion Ultrafiltration, dialysis adequacy and Delta change in cardiac output by cardiometry could be considered as independent predictors for postdialysis fatigue.