Using Intradialytic Blood Pressure Slopes to Guide Fluid Removal in Hemodialysis Patients A Randomized Trial Comparing Personalized Ultrafiltration to Standard Care

What this Trial Is About

This research is focused on United States Veterans with end stage renal disease (ESRD) who require maintenance hemodialysis (HD). Veterans with ESRD face high rates of death and hospitalization, mainly due to cardiovascular problems linked to excess body fluid. The study aims to test a new method for fluid removal during dialysis based on monitoring patients' blood pressure patterns, comparing it to standard care. Additionally, the study will explore how heart structure and function affect blood pressure during dialysis. Participants will be randomly assigned to one of two groups. In the control group, their blood pressure and fluid status will be managed by their usual nephrologists. In the experimental group, researchers will adjust fluid removal each month using a personalized algorithm based on recent blood pressure changes during dialysis. The study will last at least four months, with monthly updates to the fluid removal plan for the experimental group. Various heart and fluid assessments will be performed, including bioimpedance and echocardiograms. During the study, participants will undergo monitoring of ambulatory blood pressure over 44 hours and assessments of fluid volume, heart resistance, and episodes of low blood pressure during dialysis. The study will also analyze heart function through echocardiograms taken on non-dialysis days. Outcomes measured include changes in blood pressure, fluid status, and frequency of low blood pressure events. The total participation time includes a four-month treatment period and additional baseline evaluations. Safety and symptom monitoring will be conducted throughout the study.

Blood Pressure Slopes and Ultrafiltration in Hemodialysis Patients