RecruitingNot ApplicableNCT04163614

Blood Pressure Slopes and Ultrafiltration in Hemodialysis Patients

Using Intradialytic Blood Pressure Slopes to Guide Ultrafiltration in Hemodialysis Patients

Sponsor

VA Office of Research and Development

Enrollment

69 participants

Start Date

Feb 10, 2021

Study Type

INTERVENTIONAL

Conditions

Hypertension End Stage Renal Disease Extracellular Volume Overload Intradialytic Hypotension

Summary

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 differences in the structure and function of the heart influence blood pressure during dialysis.

Eligibility

Min Age: 18 Years

Plain Language Summary

Simplified for easier understanding

This study is looking at how to better manage blood pressure in patients on hemodialysis (kidney dialysis). Many dialysis patients have high blood pressure, which can be dangerous, but blood pressure also tends to drop during dialysis sessions. This study tests whether adjusting the rate of fluid removal during dialysis can improve blood pressure control. **You may be eligible if...** - You are currently on hemodialysis - Your blood pressure is consistently high before dialysis (above 140 mmHg systolic) or after dialysis (above 130 mmHg systolic), based on 2-week averages **You may NOT be eligible if...** - You have been on dialysis for less than 2 months - You are pregnant - Your blood pressure drops dangerously low during dialysis sessions - Your blood pressure is extremely high (above 180 mmHg on average) - You routinely take clonidine or midodrine during dialysis sessions - You have a pacemaker or defibrillator (for certain measurement procedures) Talk to your doctor to see if this trial is right for you.

This summary was AI-generated to explain the trial in plain language. It is not medical advice. Always discuss eligibility with your doctor before enrolling in a clinical trial.

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Interventions

OTHERIBPS-Guided Ultrafiltration

Each month, the study investigator will review the average intradialytic blood pressure slope from the prior two weeks. A prespecified algorithm will be used to prescribe additional fluid removal/weight reduction based on this slope.