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Hemodialysis sessions are often complicated by the occurrence of intradialytic hypotension (IDH), mainly due to the decrease of central blood volume. Blood oxygen content may play a role in hypotension onset and can reflect changes in cardiac output and tissue perfusion. Currently, there is an increasing interest in intradialytic monitoring, throug...
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Context 1
... Table 2 are reported delta blood pressure values measured at the end of treatment (NoHypo sessions) or before a hypotensive event (Hypo sessions) and ∆SO 2 from the last 30 minutes of treatment or before the hypotensive event. The different distribution of ∆SO 2 in Hypo and NoHypo sessions is shown in Figure 2. ...
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Citations
... The authors of [30], [31], studied the influence of heart rate variation and/or decreased oxygen saturation in patients with a view to predicting IDH. In the first work they reported satisfactory results, where they achieved an AUC of 0.63. ...
Predicting whether patients will experience intradialytic hypotension (IDH) during hemodialysis (HD) is not an easy task. IDH is associated with multiple risk factors, meaning that traditional statistical models are unable to find the relationships that affect it. In this context, the use of models based on machine learning (ML) can allow the discovery of complex relationships, since they can solve problems without being explicitly programmed. In this work we developed, evaluated and identified an ML-based model that is capable of predicting at the beginning of the HD session whether a patient will suffer from IDH during its prolonged development. To develop the ML models, we used the hold-out and cross-validation methods; while, to evaluate the performance of the models we used the metrics F1-score, Matthews Correlation Coefficient, areas under the receiver operating characteristic (AUROC) and precision-recall curve (AUPRC). In this sense, we selected and used a reduced combination of variables from clinical records and blood analytics, which have proven to be decisive for the occurrence of IDH. The predictive results obtained through our work confirmed that the best ML model was based on the XGBoost model, achieving values of 0.969 and 0.945 for AUROC and AUPRC respectively. Therefore, our study suggests that the XGBoost model has a very high predictive capacity for the appearance of an IDH in HD patients and presents great versatility and flexibility in terms of supporting informed decision-making by medical staff.
... [11][12][13] RBV at the time of IDH has been shown to have significant intersubject variability, but for a given individual, there appears to be a relatively stable critical RBV preceding IDH. 14 There are some data to suggest that central venous oxygen saturation (ScvO 2 ) decreases more in sessions where IDH occurs. 15 Studies investigating IDH frequently define sessions based on whether an IDH event occurs, or define patients as being prone to IDH or not, but little attention has been given to how the incidence of IDH onset varies within the HD session. We aimed to: (i) characterize the incidence of IDH in discrete time intervals within an HD session; (ii) investigate whether any routinely collected parameters were associated with the time of IDH; and (iii) consider whether the time of IDH is associated with mortality. ...
Intradialytic hypotension (IDH) is a common complication of hemodialysis, but there is no data about the time of onset during treatment. Here we describe the incidence of IDH throughout hemodialysis and associations of time of hypotension with clinical parameters and survival by analyzing data from 21 dialysis clinics in the United States to include 785682 treatments from 4348 patients. IDH was defined as a systolic blood pressure of 90 mmHg or under while IDH incidence was calculated in 30-minute intervals throughout the hemodialysis session. Associations of time of IDH with clinical and treatment parameters were explored using logistic regression and with survival using Cox-regression. Sensitivity analysis considered further IDH definitions. IDH occurred in 12% of sessions at a median time interval of 120-149 minutes. There was no notable change in IDH incidence across hemodialysis intervals (range: 2.6-3.2 episodes per 100 session-intervals). Relative blood volume and ultrafiltration volume did not notably associate with IDH in the first 90 minutes but did thereafter. Associations between central venous but not arterial oxygen saturation and IDH were present throughout hemodialysis. Patients prone to IDH early as compared to late in a session had worse survival. Sensitivity analyses suggested IDH definition affects time of onset but other analyses were comparable. Thus, our study highlights the incidence of IDH during the early part of hemodialysis which, when compared to later episodes, associates with clinical parameters and mortality.
... Paradossalmente nei pazienti in trattamento emodialitico cronico con CVC quale accesso vascolare, nonostante la disponibilità dell'emogasanalizzatore spesso proprio all'interno dell'ambulatorio di emodialisi, molto raramente si ricorre alla misurazione di PO 2 SO 2 e PCO 2 nonostante l'intergioco tra riempimento vascolare, gittata cardiaca, sovraccarico idrico e /imbibizione polmonare rappresenti una problematica con la quale il nefrologo si confronta quotidianamente. [25]. Ciò in accordo con la consolidata evidenza che la valutazione seriata dei parametri emodinamici piuttosto che il loro singolo valore, rappresenta la più appropriata ed efficiente modalità di monitoraggio [ ...
The hemodialysis might interfere with patients hemodynamic, as the technique allows a sophisticated game with extra and intravascular fluids. As the cardiocirculatory response could sometimes be unpredictable, it is interesting to collect valuable information by reaching a deep understanding of the tissue metabolism which is mirrored by the blood gas analysis of variations in arterial and central venous blood samples. Particularly interesting are the time course variations of the central venous hemoglobin saturation (ScvO2), which are directly related to the patient with O2-demand as well asto the O2-Delivery (DO2). The ScvO2 is determined by four parameters (cardiac output, Hb concentration, arterial Hb saturation and O2 consumption): If the fluids subtraction during dialysis was about to determine an occult hypoperfusion, the ScvO2 reduction would be a timely warning sign to be considered. Moreover, while the normal veno-arterial PCO2 difference is 2-4 mmHg, whenever a mismatch between O2-demand and DO2arise, a larger v-aPCO2 difference should be observed.
The 3rd International Symposium of Public Health (3rd ISOPH), was held at Wyndham Hotel, Surabaya, East Java, Indonesia from 31st October-1st November 2018. More than three-hundred attendees from 5 countries gathered to discuss research and applications in public health roles. The papers contained in this Proceedings cover a wide range of topics including: nutrigenomics and public health: the paradigm shift to disease prevention, tobacco use and dependence, health financing and health insurance, the application of ICT in health care, emerging and re-emerging infectious diseases: threats to human health, maternal and child health, primary health care, mental health, nutrition-enhancing as strategic investment, occupational health, environment health, health politics and policy, non-communicable disease, communicable disease and tropical disease, emerging and re-emerging disease, health service management, community
resilience and public health practice, disaster management. The members of 3rd ISoPH Review Committee reviewed 290 abstracts and selected 73 papers published in ISBN publication. Preparation of these proceedings would not be possible without the assistance of 3rd ISoPH scientific committee. Thank you to Prof. Dr. Mohammad Nasih, SE., Mt., Ak., CMA (Rector of Universitas Airlangga), Prof. Dr. Tri Martiana, dr., M.S. (Dean Faculty of Public Health), Dr. Nyoman Anita Damayanti, drg., MS. (Coordinator of Doctoral Programme in Public Health) and Purwaningsih, S.Kp., M.Kes (Chair of 3rd ISoPH Organizing Committee) for their guidance and encouragement.
