Relative Change of Protidemia Level Predicts Intradialytic Hypotension

Abstract

Background Hemodialysis patients are at risk of intradialytic hypotension ( IDH ), which is associated with mortality and cardiovascular and neurological events. The use of biomarkers of volemia such as relative change in protidemia and BNP (B‐natriuretic peptide) levels to predict IDH remains unknown. Methods and Results We conducted a prospective observational study, which enrolled 170 chronic hemodialysis patients in a single center from September 2015 to March 2016. BNP and the relative change of protidemia level (Δprotidemia=postdialysis protidemia−predialysis protidemia) were measured monthly over 6 months. A logistic mixed regression model was used to define the best biomarkers that predict the 30‐day risk of IDH . Receiver operating characteristic analysis area under the curve was used to define the cutoff values of Δprotidemia that predict IDH A logistic mixed model reveals that Δprotidemia predicts the 30‐day risk of IDH but not BNP or age; odds ratio=1.12, 95% CI 1.08‐1.17), odds ratio=0.81, 95% CI (0.64; 1.07) and odds ratio =0.015 95% CI (0.99; 1.03), respectively. Adding the ultrafiltration rate did not improve the model. A receiver operating characteristic curve analysis showed that Δprotidemia of 10 g/L allowed for discrimination of the patients with IDH (area under the curve= 0.67; 95% CI 0.62‐0.72, P <0.05). There was an increase in area under the curve to 0.71 (95% CI 0.63‐0.76) in a subgroup of hemodialysis with BNP <300 ng/L, for a cutoff value of 11 g/L, especially for the nondiabetic patients. Conclusions Relative change in protidemia level (Δprotidemia) outperforms BNP and ultrafiltration rate as a predictor for 30‐day risk of IDH . These results should be confirmed by a prospective study.

Intradialytic hypotension prediction using covariance matrix-driven whale optimizer with orthogonal structure-assisted extreme learning machine

“…Some of them also included serum biomarkers in the analysis to improve accuracy. Assayag et al (2020) analyzed B-natriuretic peptide using a logistic mixed model to predict the 30-day risk of IDH. The accuracy was still not satisfactory.…”

“… Ozen and Cepken (2020) found that white blood cell (WBC) values were significantly higher in patients developing IDH. The difference between post-dialysis protidemia and pre-dialysis protidemia outperformed BNP (B-natriuretic peptide) and ultrafiltration rate as a predictor for the 30-day risk of IDH ( Assayag et al, 2020 ). Nephrologists still seek a simplified and readily available method, especially in the HD setting, when many patients start treatments while waiting for ultrafiltration prescriptions.…”

Electrochemical skin conductance by Sudoscan®: a new tool to predict intradialytic hypotension

“…Thus, we could not assess to what extent hypovolaemia and dysautonomia contribute to the pathophysiology of IDH. Our current practice to prevent IDH also includes the adjustment of the dry weight according to the ΔProtidaemia, which is assessed monthly and could reduce the frequency of IDH in our population during the follow-up [ 25 ]. The association between pre-dialysis HD ESC and IDH was only significant after 45 days.…”

Personalized prevention and treatment strategies for hypotension patients during maintenance hemodialysis

“…Some studies have found potential predictors of IDH, such as TNF-α, IL-1 β [17] , propeptide level (Δ Prot) [18], Δ OER (oxygen uptake rate) [19], coronary artery calcium score (CACS) [20] and so on. Studies have shown that Δ OER > 19% 15 minutes after the start of dialysis or > 36% final increment at the end of dialysis can help identify high-risk IDH patients with hemodynamic instability, but this method can only be applied to patients with permanent central venous catheters [19].…”