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Effect of hemodialysis on impedance cardiography (electrical velocimetry) parameters in children

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Abstract

Background

Pediatric hemodialysis (HD) patients have a high incidence of cardiovascular morbidity and mortality. The study aim was to investigate whether impedance cardiography (electrical velocimetry, EV) is suitable as a hemodynamic trend monitoring tool in pediatric patients during HD.

Methods

Measurements by EV were obtained before, during, and after HD in a prospective single-center pediatric observational study. In total, 54 dialysis cycles in four different pediatric patients with end-stage kidney disease on chronic HD were included. EV parameters analyzed were heart rate (HR), stroke volume (SV), stroke volume index (SI), cardiac output (CO), cardiac index (CI), thoracic fluid content (TFC), index of contractility (ICON), stroke volume variation (SVV), variation of ICON (VIC), R-R interval (TRR), pre-ejection period (PEP), left ventricular ejection time (LVET), and systolic time ration (STR). Systemic vascular resistance index (SVRI) was calculated.

Results

EV did measure significant changes in cardiovascular parameters associated with HD. The following parameters increased after HD: HR (9%), SVV (19%), VIC (33%), PEP (8%), and STR (18%). A decrease after HD was measured in SV (18%), SI (18%), CO (10%), CI (10%), TFC (10%), ICON (7%), TRR (7%), LVET (8%), and LVET (8%). SVRI was not affected by HD. The changes were correlated to ultrafiltration. HD cycles without fluid withdrawal also altered cardiovascular parameters.

Conclusions

Pediatric HD with and without fluid withdrawal changes hemodynamic EV monitoring parameters. Possibly EV may be useful to optimize HD management in pediatric patients.

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Funding

An impedance cardiography Aesculon® monitor was provided free of charge by the manufacturer (Osypka Medical, Berlin, Germany) for the study. Consumables were financed from hospital resources.

Author information

Author notes

  1. Meike Wilken

    Present address: Department of Gynecology, University Hospital, Halle / Saale, Germany

Authors and Affiliations

  1. Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Meike Wilken, Jun Oh, Dominique Singer & Martin E. Blohm

  2. Division of Neonatology and Pediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Meike Wilken, Dominique Singer & Martin E. Blohm

  3. Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Jun Oh

  4. Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Hans O. Pinnschmidt

  5. Neonatology and Pediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Martin E. Blohm

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  1. Meike Wilken
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  2. Jun Oh
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Contributions

DS and MEB developed the study design. MW collected, analyzed, and presented part of the data in her medical doctoral thesis. MW, JO, HOP, DS, and MEB significantly contributed to data interpretation. HOP developed the linear mixed model analysis. All authors approved the manuscript.

Corresponding author

Correspondence to Martin E. Blohm.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local ethical board (“Ethikkommission der Ärztekammer Hamburg”). All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed parental consent was obtained from all individual participants included in the study.

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Wilken, M., Oh, J., Pinnschmidt, H.O. et al. Effect of hemodialysis on impedance cardiography (electrical velocimetry) parameters in children. Pediatr Nephrol 35, 669–676 (2020). https://doi.org/10.1007/s00467-019-04409-1

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  • DOI: https://doi.org/10.1007/s00467-019-04409-1

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