Title: A PROSPECTIVE NON-RANDOMISED INTERVENTIONAL STUDY OF GOAL DIRECTED ULTRAFILTRATION COMPARED WITH CLINICAL DRY WEIGHT ASSESSMENT IN ACHIEVING EUVOLEMIC STATUS OF PATIENTS ON MAINTENANCE HEMODIALYSIS

Biography:

Asoc Prof Dr Ch Sudhiranjan Dash is an Adult Nephrologist and Transplant Physician at one of the Private Hospital at Mumbai, India. He holds the degree in Nephrology subspecialty and has 19 Years of experience in clinical practice and teaching. He was a clinical Fellow at Univerisity Health network , University of Toronto, Canada in the year 2009-2010. He was awarded (SCE-Nephrology),ESENeph(European Society of Nephrology) by Royal college of Physicians & Surgeons, UK.  He had worked in the capacity of Associate Professor in the department of nephrology at Sir J J Hospital & Grant Medical college, Mumbai. Besides he has keen interest in utilisation of AI in Digital Health platform and did certificate course from prestigious Indian Institute of Science , Bangalore. He has published an  article about  intital experience of difficulties faced by HD patients during Covid-19 pandemic in the “Study of COVID-19 Pandemic in representative dialysis population across Mumbai, India: An Observational Multicentric Analysis” in Journal of Association of Physicians(JAPI).

Abstract

An accurate assessment of intravascular volume status in haemodialysis patients presents a significant challenge. Current clinical practice to determine  dry weight is flawed due to interobserver variability and non-reproducibility. This miscalculation results in either  chronic hypervolemia or hypovolemia with intra or interdialytic hypertension and hypotension respectively. The quest for non-invasive volume assessment tools to aid in  estimation of dry weight still continues. Current study was aimed at goal directed ultrafiltration removal compared with clinical dry weight assessment in achieving euvolemic status of patients on chronic haemodialysis.

It was a prospective single centre non-randomised, non-invasive interventional study on haemodialysis patients, for 12 months. Patients enrolled in study were advised to follow prescription of thrice per week hemodialysis with 4 hours duration per session. At the time of enrolment at day 0 and during the run in phase of 1 month we considered those patients to be our clinical standard dry weight control group. After one month the same population served as the test population. At zero month, pre and post dialysis IVCCI, B lines was checked. Again post dialysis B lines were checked at 6th and 12th month. Post dialysis IVCCI was assessed again at 3rd, 9^th and 12th month.

Fifty two patients participated and  46 completed the study. Ultrasound guided Inferior Ven cava collapsing index(IVCCI) and B lines were measured at intervals at 0,3,6along with cardiac parameters. Dry weight was estimated first clinically by trial and error. New dry weight target was set when B-lines were less than 4 in the eight site Lung Ultrasound and IVCCI  between 50%–75%, after 30 minutes post dialysis. The mean age of our study population is 57 years with slightly male preponderance (58%). Majority of our study population has had Diabetes(73.1%) and Hypertension (75%) as comorbidities. At zero month Pre HD IVCCI >50% was observed in 28.8 % of patients. At 12th month post HD IVCCI > 50% was observed in 82.6% patients showing statistically  significant  value. At zero month pre and post HD USG chest was done. About 69.2% patients had Pre HD B lines >4 and Post HD B lines > 4 was observed in 38.5% patients. At 12th month post HD B lines > 4 was observed in 17.4 % patients showing statistically significant value. Approximately 23.91% patients did not require dry weight modification throughout study. Nineteen percent patients did not achieve dry weight in spite of all interventions.. Overall 56.5% patients achieved dry weight during study period. There were 46.3% of patients with NYHA grade 3 dyspnoea observed at the start of study which was reduced to 2.2% showing statistical  significance.

Clinical assessment when bundled with non-invasive technology of assessment of dry weight showed encouraging result. B-lines and IVCCI estimation could be additional tools to achieve target weight goals reducing complications and increasing compliance.