INTRODUCTION: Intradialytic hypotension is a frequent and clinically relevant complication in hemodialysis and is associated with increased mortality. The pathophysiology behind the development of intradialytic hypotension episodes is complex and is influenced by multiple factors. Isolated ultrafiltration as part of sequential dialysis (isolated ultrafiltration followed by hemodialysis) has been proposed as an effective preventive treatment modality to improve hemodynamic stability, however, evidence supporting this approach remains limited and is largely based on older studies. The ISO-UF study is designed to compare hemodynamic responses during sequential dialysis with those observed during hemodialysis. This thesis aims to provide accurate assessment of key hemodynamic parameters, thus facilitating improved understanding and management of intradialytic hypotension during dialysis. METHODS: The ISO-UF study is a randomized, controlled, crossover, two treatments, two period single center study. Patients underwent standardized treatment protocols during the mid-week dialysis session with crossover after four weeks. In protocol 1, patients receivied isolated ultrafiltration for the first half of the session followed by hemodialysis, whereas in protocol 2, hemodialysis was performed for the entire session. Hemodynamic parameters including total peripheral resistance index, cardiac power index, mean arterial blood pressure and systolic blood pressure were monitored by using non-invasive bioimpednace cardiography (NICaS Medical, Israel) before, after and during dialysis treatment at 20-minutes intervals. RESULTS: A total of eight patients were included in the final statical analyses, with an equal distribution of male and female participants. Patients were randomized evenly in both sequences. Seven patients underwent four treatment sessions per protocol, while one patient completed an extended study period with eight sessions per protocol. Treatment-specific mean values were calculated for each patient, and results were analyzed descriptively. Minimal differences were observed in systolic blood pressure (relative change: 1,3%), mean arterial blood pressure (relative change: 1,4%, total peripheral resistance index (relative change: 5,6%) and cardiac power index (relative change: 5,4%) between the two treatment modalities. The incidence of intradialytic hypotension was comparable between both treatment modalities, occurring in 23.6% of hemodialysis and 29.2% of sequential dialysis sessions. DISCUSSION: In this preliminary analysis, sequential dialysis did not demonstrate superior hemodynamic stability regarding total peripheral resistance compared with hemodialysis. Thus, with these preliminary results, there seems to be no superiority of sequential dialysis in the incidence of intradialytic hypotension or hemodynamics overall. Limitations include the preliminary nature of the data with so far only descriptive analysis available. Nevertheless, this promising first descriptive analysis should be further investigated with an increase in sample size and statistical analysis to potentially identify a possible difference and evaluate implications for everyday patients.
Hemodynamics studies in isolated ultrafiltration and hemodialysis
Szemes, B. (Autor/-in). 2026
Studienabschlussarbeit: Diplomarbeit