Microcirculation During Haemodialysis

Study Overview
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Brief Summary
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SDF is validated by measuring changes in microcirculation in sepsis patients with MOF (Boerma studies). SDF is validated by measuring changes in microcirculation in stable chronic hemodialysis patients (NDT 2009 Bemelmans). Ultrafiltration in stable chronic hemodialysis leads to a decrease in sublingual microcirculatory flow (NDT 2009 Bemelmans). Trendelenburg position improves the sublingual microcirculatory flow at the end of hemodialysis treatment (NDT 2009 Bemelmans). Hemodialysis with ultrafiltration leads to a significant reduction of myocardial perfusion and cardiac output (NDT 2009 Dasselaar) Cardiac output measurement during dialysis is not practical. BVM is a validated method for hypotension due to ultrafiltration to prevent the amount of ultrafiltration online change based on the measured haemoconcentration (ref Dasselaar et al NDT 2005). BCM is a validated measurement to the dry weight in hemodialysis patients measured by a bioimpedance technique (NDT Passauer et al 2009).

Detailed Description
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The search for an optimal method of ultrafiltration with minimal hypoperfusion of vital organs. Stabile hemodialysis patients with dialysis dependancy for more than 3 months, with adequate access Study duration 3 weeks Number of hemodialysis treatment for purposes of study: 3 Timing hemodialysis treatments for Study session Monday or Tuesday after the weekend (randomized design in the sessions) session a: 5 hours total duration: 4 hours HD without UF followed by 1 hour GUF Session b: 4 hours total duration: 4 hours HD with UF session c: 4 hours total duration: 4 hours HD with UF and BVM UF is determined by actual target weight. Measurements during sessions: In each session in advance: blood pressure, pulse, weight, BCM, laboratory tests (Hb, Hct, Na, K, urea, creatinine, calcium, albumin, phosphate, nt-proBNP, troponin T, CRP) During each session at t = 0, t = 1 hour, t =2 hours and t = 4 hours: SDF, blood pressure, pulse, UF at that time, UF rate at that time End each session: blood pressure, pulse, weight, BCM, laboratory tests (Hb, Hct, Na, K, urea, creatinine, calcium, albumin, phosphate, nt-proBNP, troponin T, CRP)

Official Title
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Sublingual Microcirculatory Flow Measurements During Haemodialysis in Relation to Blood Volume Change

Conditions
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Complication of Hemodialysis

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: dialysis patient age > 18 informed consent Exclusion Criteria: no adequate access instable hemodynamics

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| dialysis patients<br>dialysis patients, stabil, dialysis dependancy for more than 3 months, with adequate access | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Difference between sublingual microvascular flow index between 2 types of ultrafiltration |  | 3 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hemodialysis, intensive care, microcirculation