Precision Volume Management During Maintenance Hemodialysis

维持性血液透析期间的精确容量管理

• 批准号: 9909170
• 负责人: Hao Wang
• 金额: $ 7.04万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9909170
• 关键词: Adoption; Adverse event; Aftercare; Award; Biometry; Blood Plasma Volume; Blood Pressure; Blood Vessels; Clinical; Data; Data Collection; Data Set; Degree program; Development; Dialysis procedure; End stage renal failure; Event; Excision; Fellowship; Future; Goals; Heart Rate; Hematocrit procedure; Hemodialysis; Hypotension; Hypovolemia; Interview; Kidney; Kidney Diseases; Kidney Failure; Life; Liquid substance; Maintenance; Master' s Degree; Measures; Methods; Modeling; Monitor; Morbidity - disease rate; National Research Service Awards; Nature; Nurses; Outcome; Outpatients; Patient Care; Patient-Focused Outcomes; Patients; Pattern; Perception; Plasma; Privatization; Provider; Quality of life; Recovery; Research; Research Methodology; Risk Adjustment; Risk Factors; Role; Statistical Models; Stress; Structural Models; Technology; Time; Tissues; Training; United States; Update; Weight; Work; care delivery; clinical application; clinical epidemiology; experience; hazard; health related quality of life; hemodynamics; improved; innovation; insight; interstitial; mortality; mortality risk; new technology; non-invasive monitor; novel; predictive modeling; programs; protocol development; research and development; resilience; time use; uptake; usability; Adoption; Adverse event; Aftercare; Award; Biometry; Blood Plasma Volume; Blood Pressure; Blood Vessels; Clinical; Data; Data Collection; Data Set; Degree program; Development; Dialysis procedure; End stage renal failure; Event; Excision; Fellowship; Future; Goals; Heart Rate; Hematocrit procedure; Hemodialysis; Hypotension; Hypovolemia; Interview; Kidney; Kidney Diseases; Kidney Failure; Life; Liquid substance; Maintenance; Master' s Degree; Measures; Methods; Modeling; Monitor; Morbidity - disease rate; National Research Service Awards; Nature; Nurses; Outcome; Outpatients; Patient Care; Patient-Focused Outcomes; Patients; Pattern; Perception; Plasma; Privatization; Provider; Quality of life; Recovery; Research; Research Methodology; Risk Adjustment; Risk Factors; Role; Statistical Models; Stress; Structural Models; Technology; Time; Tissues; Training; United States; Update; Weight; Work; care delivery; clinical application; clinical epidemiology; experience; hazard; health related quality of life; hemodynamics; improved; innovation; insight; interstitial; mortality; mortality risk; new technology; non-invasive monitor; novel; predictive modeling; programs; protocol development; research and development; resilience; time use; uptake; usability

Project Summary More than 400,000 people currently receive maintenance hemodialysis in the United States. While this therapy is life-extending, clinical outcomes and quality of life are poor. Current strategies to remove fluid with hemodialysis are imprecise, and events both during hemodialysis (e.g., intra-dialytic hypotension) and after (e.g., prolonged recovery time) are common complications associated with significant morbidity and mortality. Unfortunately, these events are challenging to predict with standard methods for hemodynamic monitoring. All of this highlights a need for greater precision in monitoring and improvement in fluid removal on hemodialysis. Continuous hematocrit monitors have been developed to non-invasively monitor relative changes in intravascular volume during a hemodialysis session. Yet, adoption of this technology into decisions on fluid management has been mixed. This is largely due to a lack of data to show a consistent association with intra- dialytic hypotension or improved clinical outcomes. However, studies have largely focused on plasma volume, but hypovolemia is not the only cause of hypotension. In order to leverage the full potential of this technology, we plan to incorporate changes in plasma volume with the rate of fluid removal during hemodialysis to yield a semi-continuous measure of the rate of vascular refilling from the interstitial tissue - termed plasma refill rate - as a dynamic measure of patient resilience. Examining patterns of plasma refill rate offers a unique opportunity to evaluate changes in patient resilience throughout a hemodialysis treatment that has yet to be fully explored. Additionally, the clinical impact of a new technology requires understanding of its ease of integration into the workflow. As such, for this work we will use two complementary approaches. Using a large dataset, we will examine the relationship between plasma refill rate and intra-dialytic hypotension by (1) determining if low plasma refill rates are associated with the number of hemodialysis sessions with intra-dialytic hypotension and (2) to develop a model using time-updated variables to predict the time to development of intra-dialytic hypotension. Concurrently, we will collect primary data to (3) evaluate the association between plasma refill rate and recovery time and (4) explore provider perspectives on the usability of this technology. Through these parallel projects we will improve our understanding of subtle hemodynamic changes that will inform future studies and fuel work towards precision volume management in maintenance hemodialysis. Moreover, if we find a critical role of plasma refill rate in the prediction of intra-dialytic hypotension or recovery time, we can leverage the semi-continuous nature of this technology to alter the user interface and improve delivery of care. In conjunction with formal coursework in a master's program for clinical epidemiology, the proposed application for the NRSA fellowship award will provide Dr. Wang with intensive training in advanced biostatistics, expertise in statistical modeling, primary data collection, and facilitate the establishment of a research niche in dialysis technology and end-stage kidney disease.

项目摘要 目前有40万人在美国接受维持血液透析。同时 治疗是延长生命的，临床结果和生活质量差。当前消除流体的策略 血液透析是不精确的，在血液透析期间（例如，远程低血压）和之后的事件 （例如，延长的恢复时间）是与明显的发病率和死亡率相关的常见并发症。 不幸的是，这些事件通过用于血液动力学监测的标准方法来预测这些事件。全部 这突出了需要在血液透析上监测和改善液体去除方面的精确度。 已经开发了连续的血细胞比容监测器，以非侵入性监测相对变化 血管内血管内体积。然而，采用这项技术来决策 管理层混杂。这在很大程度上是由于缺乏数据来显示与内部的一致关联 透明性低血压或改善的临床结果。但是，研究主要集中在血浆量上， 但是血容量并不是造成低血压的唯一原因。为了利用这项技术的全部潜力， 我们计划将血浆体积的变化与血液透析过程中的液体去除速率结合在一起，以产生 半连续度量的血管补充速率来自间质组织的血浆补充速率 - 作为患者弹性的动态度量。检查血浆补充率的模式提供了独特的机会 评估尚未充分探索的血液透析治疗中的患者弹性变化。 此外，新技术的临床影响需要了解其易于集成到 工作流程。因此，对于这项工作，我们将使用两种互补方法。使用大数据集，我们将 通过（1）确定是否较低 血浆补充速率与患有脊柱内低血压的血液透析疗法数量有关 （2）使用时间更新的变量开发模型以预测远程内部的发展时间 低血压。同时，我们将收集主要数据以（3）评估血浆补充之间的关联 费率和恢复时间以及（4）探讨了有关该技术可用性的提供者的观点。通过这些 平行项目，我们将提高对细微的血液动力学变化的理解，这将为未来带来帮助 研究和燃料在维持血液透析中的精确体积管理方面工作。而且，如果我们 找到血浆补充速率在预测诊断性低血压或恢复时间中的关键作用，我们可以 利用该技术的半连续性质来改变用户界面并改善护理的交付。 拟议的 NRSA奖学金申请将为Wang博士提供高级培训 生物统计学，统计建模方面的专业知识，主要数据收集，并促进建立 研究透析技术和终末期肾脏疾病的细分市场。