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Cardiovascular Disease (CVD): The Silent Killer of Hemodialysis Patients

1/2

of ESRD patients die from CVD

1/3

of ESRD patients are hospitalized from CVD

Complications and death: CVD is the leading cause of morbidity and mortality and is a major cause of complications during hemodialysis treatments in patients with ESRD

30x: In ESRD patients, CVD mortality rates are approximately 30 times higher than those of the general population

35% of deaths occur within the first 12 hours from the beginning of the dialysis session

Patients who do not feel well at the end of a dialysis session are subject to an unidentified decrease in Cardiac Index (CI) to critical ICU levels of <2 L/min/m2

Hemodynamic monitoring provides a unique data set to gain insight into the hemodynamic profile of an individual HD patient with regard to cardiac performance, congestion and compensation of Access Flow (indicated by AF/CO). It also allows the identification of patients at increased mortality risk using TEF, which promises to be a robust risk marker that could be implemented for repeated monitoring of HD patients. While cardiac biomarkers represent static risk markers, many of the hemodynamic parameters are amenable to treatment that, in turn, could improve HD treatment and most importantly prognosis of HD patients. Another advantage of hemodynamic monitoring is the fact that it is directly carried out by the dialysis team without the need for external resources or referrals.

The Cardiovascular Effects of Arteriovenous Fistulas in Chronic Kidney Disease: A Cause for Concern

Hemodynamic effects and changes as a result of AVF creation:
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Immediate:

  • 10-20% increase in cardiac output
  • Increase in stroke volume and heart rate.
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Within one week:

  • Decrease in plasma renin and aldosterone levels.
  • Decrease in systemic vascular resistance and systolic/diastolic blood pressure.
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Long-term consequences:

  • High output cardiac failure

Know your Access Flow to Cardiac Output Ratio

The ratio of access flow to cardiac output is an important clinical indicator. Cardiac function should be assessed with ultrasound dilution technology if the patient displays values in the yellow or red ranges below, recommends MacRae JM et al.

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Up to 25% of cardiac output

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More than 30% of cardiac output

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40% or greater of cardiac output

MacRae JM et al, “Arteriovenous Fistula-associated High-output Cardiac Failure: A

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How Ultrasound Dilution Measurement Helps

Blood pressure changes cannot quantify the cardiac status of HD patients; the most accurate assessment of cardiac function is through ultrasound dilution measurements.

The Transonic HD03 can measure a full complement of cardiac parameters during dialysis through a simple innocuous bolus of saline thus safeguarding the patient from cardiovascular collapse. All HD patients should be regularly monitored for cardiac issues and HD patients with active cardiovascular disease should be frequently assessed.

Saline Indicator Route: Body temperature saline is injected into the venous line, travels through the heart and lungs and returns via the arterial system where a flow/dilution sensor records the diluted concentration.

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New Flow-QC® Cardiac Function Parameters

  • Cardiac Output (CO) 5-8 L/min
  • Cardiac Index (CI) 2.2 - 3.8 L/min/m²
  • Stroke Volume Index (SVI) 32 – 56 mL/m²
  • Total Ejection Fraction (TEF) 40 – 76 %
  • Systemic Vascular Resistance (SVRI) 1900 – 3200 DYNES SEC/CM⁵ /M²
  • Total End Diastolic Volume Index (TEDVI) 6 - 11 mL/kg
  • Central Blood Volume Index (CBVI) ML/KG 13 - 23 mL/kg
  • Active Circulation Volume Index (ACVI) 40 - 70 mL/kg
  • Oxygen Delivery Index (ODI) 420 -500 mL O2/min/m²
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How Non-Invasive Cardiac Function Assessment Can Help Your Patients

Learn more about how this non-invasive assessment can help keep your patients healthy and guard against complications from CVD in our updated guide.

Get the Guide