Using Intradialytic Blood Pressure Slopes to Guide Ultrafiltration in Hemodialysis Patients

Description

Kidney failure has been recognized as one of the most costly chronic conditions among United States Veterans. Approximately 13,000 Veterans develop kidney failure each year, and most require hemodialysis initiation. Hemodialysis patients suffer significantly increased risk of death and hospitalizations, and excessive body fluid is a major cause of this. While empiric aggressive fluid removal during dialysis is one approach to limit fluid overload, this can cause dangerous decreases in blood pressure during dialysis that independently contribute to the high death rate. In this study, I aim to test a new strategy that prescribes fluid removal based on a patient's recent blood pressure patterns during dialysis. This clinical trial will compare my strategy to standard care and assess the outcomes of overall blood pressure change between dialysis treatments in addition to the number of times the blood pressure becomes dangerously low during dialysis. Another aim is to determine how differen

Trial Eligibility

Inclusion Criteria: * Hemodialysis patient * Pre-dialysis systolic blood pressure greater than 140 mmHg averaged over 2 weeks OR post-dialysis systolic blood pressure greater than 130 mmHg averaged over 2 weeks Exclusion Criteria: * HemoDialysis Vintage Less than 2 months * Pregnancy * Mean systolic blood pressure nadir \<95 mmHg in 2 weeks screening * Mean pre- or post-dialysis systolic blood pressure \>180 mmHg * Mean pre to post-HD decrease in blood pressure \>60 mmHg * Routine intradialytic clonidine use * Routine intradialytic midodrine use * Documented antihypertensive medication non-adherence * Mean ultrafiltration rate \>13 mL/kg/hr during 2 week screening * For bioimpedance measurements only: amputation of a major extremity, presence of cardiac defibrillator or pacemaker, presence of a metallic implant (prosthetic joint)

Study Info

Interventions

Locations Recruiting

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