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

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.

项目概要 目前美国有超过 400,000 人接受维持性血液透析。虽然这 治疗是延长生命的，但临床结果和生活质量较差。目前去除液体的策略 血液透析不精确，血液透析期间和透析后的事件（例如，透析中低血压） （例如，恢复时间延长）是与显着发病率和死亡率相关的常见并发症。 不幸的是，使用血流动力学监测的标准方法来预测这些事件具有挑战性。全部 这凸显了需要更精确地监测和改进血液透析中的液体清除。 连续血细胞比容监测仪已被开发用于非侵入性监测血细胞比容的相对变化 血液透析期间的血管内容量。然而，采用这项技术来做出流体决策 管理水平参差不齐。这主要是由于缺乏数据来显示与内部的一致关联。 透析性低血压或改善临床结果。然而，研究主要集中在血浆容量、 但血容量不足并不是低血压的唯一原因。为了充分发挥这项技术的潜力， 我们计划将血浆容量的变化与血液透析期间液体去除的速率结合起来，以产生 间质组织血管再充盈率的半连续测量 - 称为血浆再充盈率 - 作为患者复原力的动态衡量标准。检查血浆再填充率模式提供了独特的机会 评估整个血液透析治疗过程中患者恢复能力的变化，这一点尚未得到充分探索。 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的方法。使用大型数据集，我们将 通过以下方式检查血浆再充盈率与透析中低血压之间的关系：(1) 确定是否低血压 血浆再填充率与透析期间低血压的血液透析次数有关 (2) 使用时间更新变量开发模型来预测透析内发展的时间 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 率和恢复时间；(4) 探索提供商对该技术可用性的看法。通过这些 并行项目我们将提高对微妙血流动力学变化的理解，这将为未来提供信息 维持性血液透析中精确容量管理的研究和推动工作。此外，如果我们 发现血浆再充盈率在预测透析中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特性来改变用户界面并改善护理服务。 与临床流行病学硕士课程的正式课程相结合，拟议的 申请NRSA奖学金将为王博士提供高级强化培训 生物统计学、统计模型专业知识、原始数据收集，并促进建立一个 透析技术和终末期肾病的研究领域。

项目成果

Dynamics of Plasma Refill Rate and Intradialytic Hypotension During Hemodialysis: Retrospective Cohort Study With Causal Methodology.

血液透析期间血浆再充盈率和透析中低血压的动态：采用因果方法学的回顾性队列研究。

• 发表时间: 2023-04-01
• 作者: Wang, Christina H;Negoianu, Dan;Zhang, Hanjie;Casper, Sabrina;Hsu, Jesse Y;Kotanko, Peter;Raimann, Jochen;Dember, Laura M
• 通讯作者: Dember, Laura M