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Non-invasive venous waveform analysis (NIVA) for volume assessment in patients undergoing hemodialysis: an observational study

BACKGROUND: Accurate assessment of volume status to direct dialysis remains a clinical challenge. Despite current attempts at volume-directed dialysis, inadequate dialysis and intradialytic hypotension (IDH) are common occurrences. Peripheral venous waveform analysis has recently been developed as a...

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Autores principales: Alvis, Bret D., Polcz, Monica, Miles, Merrick, Wright, Donald, Shwetar, Mohammad, Leisy, Phil, Forbes, Rachel, Fissell, Rachel, Whitfield, Jon, Eagle, Susan, Brophy, Colleen, Hocking, Kyle
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245891/
https://www.ncbi.nlm.nih.gov/pubmed/32448178
http://dx.doi.org/10.1186/s12882-020-01845-2
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author Alvis, Bret D.
Polcz, Monica
Miles, Merrick
Wright, Donald
Shwetar, Mohammad
Leisy, Phil
Forbes, Rachel
Fissell, Rachel
Whitfield, Jon
Eagle, Susan
Brophy, Colleen
Hocking, Kyle
author_facet Alvis, Bret D.
Polcz, Monica
Miles, Merrick
Wright, Donald
Shwetar, Mohammad
Leisy, Phil
Forbes, Rachel
Fissell, Rachel
Whitfield, Jon
Eagle, Susan
Brophy, Colleen
Hocking, Kyle
author_sort Alvis, Bret D.
collection PubMed
description BACKGROUND: Accurate assessment of volume status to direct dialysis remains a clinical challenge. Despite current attempts at volume-directed dialysis, inadequate dialysis and intradialytic hypotension (IDH) are common occurrences. Peripheral venous waveform analysis has recently been developed as a method to accurately determine intravascular volume status through algorithmic quantification of changes in the waveform that occur at different volume states. A noninvasive method to capture peripheral venous signals is described (Non-Invasive Venous waveform Analysis, NIVA). The objective of this proof-of-concept study was to characterize changes in NIVA signal with dialysis. We hypothesized that there would be a change in signal after dialysis and that the rate of intradialytic change in signal would be predictive of IDH. METHODS: Fifty subjects undergoing inpatient hemodialysis were enrolled. A 10-mm piezoelectric sensor was secured to the middle volar aspect of the wrist on the extremity opposite to the access site. Signals were obtained fifteen minutes before, throughout, and up to fifteen minutes after hemodialysis. Waveforms were analyzed after a fast Fourier transformation and identification of the frequencies corresponding to the cardiac rate, with a NIVA value generated based on the weighted powers of these frequencies. RESULTS: Adequate quality (signal to noise ratio > 20) signals pre- and post- dialysis were obtained in 38 patients (76%). NIVA values were significantly lower at the end of dialysis compared to pre-dialysis levels (1.203 vs 0.868, p < 0.05, n = 38). Only 16 patients had adequate signals for analysis throughout dialysis, but in this small cohort the rate of change in NIVA value was predictive of IDH with a sensitivity of 80% and specificity of 100%. CONCLUSIONS: This observational, proof-of-concept study using a NIVA prototype device suggests that NIVA represents a novel and non-invasive technique that with further development and improvements in signal quality may provide static and continuous measures of volume status to assist with volume directed dialysis and prevent intradialytic hypotension.
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spelling pubmed-72458912020-06-01 Non-invasive venous waveform analysis (NIVA) for volume assessment in patients undergoing hemodialysis: an observational study Alvis, Bret D. Polcz, Monica Miles, Merrick Wright, Donald Shwetar, Mohammad Leisy, Phil Forbes, Rachel Fissell, Rachel Whitfield, Jon Eagle, Susan Brophy, Colleen Hocking, Kyle BMC Nephrol Technical Advance BACKGROUND: Accurate assessment of volume status to direct dialysis remains a clinical challenge. Despite current attempts at volume-directed dialysis, inadequate dialysis and intradialytic hypotension (IDH) are common occurrences. Peripheral venous waveform analysis has recently been developed as a method to accurately determine intravascular volume status through algorithmic quantification of changes in the waveform that occur at different volume states. A noninvasive method to capture peripheral venous signals is described (Non-Invasive Venous waveform Analysis, NIVA). The objective of this proof-of-concept study was to characterize changes in NIVA signal with dialysis. We hypothesized that there would be a change in signal after dialysis and that the rate of intradialytic change in signal would be predictive of IDH. METHODS: Fifty subjects undergoing inpatient hemodialysis were enrolled. A 10-mm piezoelectric sensor was secured to the middle volar aspect of the wrist on the extremity opposite to the access site. Signals were obtained fifteen minutes before, throughout, and up to fifteen minutes after hemodialysis. Waveforms were analyzed after a fast Fourier transformation and identification of the frequencies corresponding to the cardiac rate, with a NIVA value generated based on the weighted powers of these frequencies. RESULTS: Adequate quality (signal to noise ratio > 20) signals pre- and post- dialysis were obtained in 38 patients (76%). NIVA values were significantly lower at the end of dialysis compared to pre-dialysis levels (1.203 vs 0.868, p < 0.05, n = 38). Only 16 patients had adequate signals for analysis throughout dialysis, but in this small cohort the rate of change in NIVA value was predictive of IDH with a sensitivity of 80% and specificity of 100%. CONCLUSIONS: This observational, proof-of-concept study using a NIVA prototype device suggests that NIVA represents a novel and non-invasive technique that with further development and improvements in signal quality may provide static and continuous measures of volume status to assist with volume directed dialysis and prevent intradialytic hypotension. BioMed Central 2020-05-24 /pmc/articles/PMC7245891/ /pubmed/32448178 http://dx.doi.org/10.1186/s12882-020-01845-2 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Technical Advance
Alvis, Bret D.
Polcz, Monica
Miles, Merrick
Wright, Donald
Shwetar, Mohammad
Leisy, Phil
Forbes, Rachel
Fissell, Rachel
Whitfield, Jon
Eagle, Susan
Brophy, Colleen
Hocking, Kyle
Non-invasive venous waveform analysis (NIVA) for volume assessment in patients undergoing hemodialysis: an observational study
title Non-invasive venous waveform analysis (NIVA) for volume assessment in patients undergoing hemodialysis: an observational study
title_full Non-invasive venous waveform analysis (NIVA) for volume assessment in patients undergoing hemodialysis: an observational study
title_fullStr Non-invasive venous waveform analysis (NIVA) for volume assessment in patients undergoing hemodialysis: an observational study
title_full_unstemmed Non-invasive venous waveform analysis (NIVA) for volume assessment in patients undergoing hemodialysis: an observational study
title_short Non-invasive venous waveform analysis (NIVA) for volume assessment in patients undergoing hemodialysis: an observational study
title_sort non-invasive venous waveform analysis (niva) for volume assessment in patients undergoing hemodialysis: an observational study
topic Technical Advance
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245891/
https://www.ncbi.nlm.nih.gov/pubmed/32448178
http://dx.doi.org/10.1186/s12882-020-01845-2
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