Lansink, J.G.F. (Joost) (2013) ‘Non-invasieve continue bloeddrukmetingen bij chronische hemodialysepatiënten’. thesis, Medicine.
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Abstract
Introduction: Hypertension is common in hemodialysis patients. Blood pressure regulation in hemodialysis patients is controversial and the blood pressure target values are not defined yet. Intradialytic hypotension (IDH) is the most frequent complication during hemodialysis. IDH develops suddenly and is unpredictable with the current periodic blood pressure monitoring. The aim of this study was to assess whether non-invasive continuous finger pulse blood pressure measurements by the Portapres® are suitable and reliable in chronic hemodialysis patients, and can predict IDH. Patients and methods: An observational prospective pilot study was performed in which blood pressure measurements by the Portapres® (TNO-TPD, Finapres Medical Systems BV, Amsterdam, Netherlands) were compared with the clinical observations and conventional oscillometric upper arm blood pressure measurements of the dialysis machine (Gambro Hospal BV, Breda, Netherlands). The degree of similarity and the difference between the Portapres® and the conventional measurements were compared. In addition, the time percentage of acceptable continuous measurements and the number of registered hypotensive episodes based on pre-determined reference values by using the Portapres® were studied. Chronic hemodialysis patients (> 3 months of treatment) in the ZGT Almelo were included in this study. No exclusion criteria were applied. Subgroups were made based on hemodialysis-related data obtained from the patient records from the ZGT. Analyses were made by using the BeatScope® software. Results: During 23 hemodialysis sessions in 22 patients continuous measurements were done. Acceptable valid measurements were obtained in 9 (39%) hemodialysis sessions (detection dialysis time ≥ 70%). The median time percentage of acceptable adequate measurements was 60%. 39 hypotensive episodes were observed with the Portapres® during this time (systolic blood pressure decrease ≥ 20 mmHg or MAP decrease ≥ 10 mmHg), of which 18 (46%) occured after changing the vingercuff. From the 5 observed IDH, 1 could be registered with the Portapres® as a hypotensive episode. For both the systolic and diastolic blood pressure a reasonable intra-class correlations were found of 0.51 and 0.54 respectively. Better correlations were found in the subgroups in patients without vascular calcifications and/or peripheral vascular disease. The systolic and diastolic blood pressure difference was 8.2 mmHg (p <0.001) and 9.1 mmHg (p <0.001) respectively. Greater systolic blood pressure differences were found in patients with vascular calcifications and/or peripheral vascular disease. Conclusion: The non-invasive continuous finger pulse blood pressure measurements by the Portapres® have no additive value in prosecuting the blood pressure in chronic hemodialysis patients. Among other things, there was a lack of adequate measurements. Also considerable blood pressure differences were detected and the measurements do not correlate well with the conventional measurements, especially in patients with (peripheral) vascular pathology. Although blood pressure fluctuations are frequently observed, IDH was usually not observed and it doesn’t predict symptomatic hypotensions.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Smits, drs. P.J.H. and Woittiez, dr. A.J.J. and ZiekenhuisGroep Twente Almelo |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:06 |
| Last Modified: | 25 Jun 2020 11:06 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2594 |
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