Kidney Res Clin Pract. 2026 Oct 21. doi: 10.23876/j.krcp.26.064. Online ahead of print.
ABSTRACT
BACKGROUND: Intradialytic hypotension (IDH) is the most common complication of hemodialysis (HD) and is associated with major adverse cardiovascular events and mortality. Current management strategies are reactive, and reliable noninvasive tools for early prediction are lacking. Electrical impedance tomography (EIT) offers noninvasive, real-time monitoring of thoracic fluid content (TFC) and cardiopulmonary parameters, potentially identifying early hemodynamic instability preceding IDH.
METHODS: We enrolled 18 patients with end-stage kidney disease and frequent IDH and monitored 73 HD sessions using a 16-channel EIT system (AirTom) and a noninvasive finger-cuff hemodynamic monitoring system (ClearSight). IDH was defined as a systolic blood pressure (SBP) drop ≥20 mmHg from baseline (IDH1) or an absolute SBP <100 mmHg (IDH2). Measured parameters included TFC, stroke volume (SV), cardiac output, and other hemodynamic indices. Interventions for IDH were applied in a fixed sequence: applying cooled dialysate, passive leg raising, ultrafiltration (UF) reduction, and dialysate bolus infusion.
RESULTS: A total of 32 IDH1 and 31 IDH2 events were observed. TFC declined progressively during HD and correlated with overhydration (R2 = 0.71). In the representative time-point analysis, SV showed the greatest pre-event decrease before both IDH1 and IDH2 events, occurring 6-10 minutes before hypotension onset. Interventions for IDH elicited distinct TFC and SV responses, with dialysate bolus infusion producing the largest increase in SV.
CONCLUSION: A decline in SV precedes IDH onset and may serve as an early physiologic indicator of hemodynamic instability during HD. EIT-based monitoring provides real-time, noninvasive assessment of SV and IDH during HD and may facilitate earlier intervention and individualized management of IDH.
PMID:42902882 | DOI:10.23876/j.krcp.26.064