Guiding Fluid Removal Using Blood Pressure Patterns in Hemodialysis Patients to Improve Treatment Outcomes

What this Trial Is About

Kidney failure is a costly chronic condition that affects many United States Veterans, with about 13,000 new cases each year often requiring hemodialysis. This study evaluates a new strategy to manage fluid removal during dialysis by adjusting it based on patients recent blood pressure patterns, aiming to improve blood pressure control and reduce dangerous drops during treatment. The research also investigates how heart structure and function affect blood pressure changes in these patients. Participants are randomly assigned to either a control group receiving standard care or an experimental group where fluid removal targets are adjusted monthly using an algorithm based on intradialytic blood pressure slopes IBPS. The study involves monthly updates to ultrafiltration prescriptions for the IBPS group, comparing this approach to usual care over four months. Measurements include blood pressure monitoring, fluid volume assessment using bioimpedance spectroscopy, and cardiac function evaluation with echocardiograms. During the study, participants undergo regular dialysis sessions with blood pressure and fluid status monitored closely. Researchers assess changes in ambulatory systolic blood pressure, extracellular fluid volume, total peripheral resistance, and frequency of low blood pressure episodes during dialysis. Additional heart function tests are done to understand how heart health influences fluid management outcomes. The study aims to provide a personalized and safer fluid removal method to improve outcomes for Veterans on hemodialysis.

Blood Pressure Slopes and Ultrafiltration in Hemodialysis Patients