The following is a summary of “Non-invasive intradialytic percutaneous perfusion monitoring: a view to the heart through the skin,” published in the July 2023 issue of Nephrology by Penny et al.
Hemodialysis (HD) induces cardiovascular stress, leading to myocardial injury. Non-invasive skin perfusion monitoring can detect and ameliorate this response. Researchers performed a retrospective study to assess skin perfusion dynamics during HD and compare it with directly measured myocardial perfusion and cardiac contractile function.
In this cohort study, they examined the microcirculatory response during conventional HD in 12 patients using continuous percutaneous perfusion monitoring. Cardiac echocardiography was conducted before HD and during peak-HD stress to evaluate the development of regional wall motion abnormalities (RWMAs). Myocardial perfusion imaging was performed using intravenous contrast and CT-based methods at (pre-HD and peak-HD stress). Changes in pulse strength derived from photoplethysmography (PPG) during HD were compared with the development of HD-induced RWMAs (indicative of myocardial stunning) and myocardial perfusion changes.
They observed a correlation between the lowest reduction in pulse strength (PPG) and the development of RWMAs (P= 0.03), as well as changes in global myocardial perfusion (CT) (P= 0.05). The ultrafiltration rate (mL/kg/hour) significantly influenced HD-induced circulatory stress [(associated with the greatest pulse strength reduction (P= 0.01), a reduction in global myocardial perfusion (P= 0.001), and the development of RWMAs (P= 0.03)].
Study concluded that PPG-based monitoring is valuable for assessing hemodynamic stability and detecting cardiac injury during HD, but further evaluation is needed.
Source: frontiersin.org/articles/10.3389/fneph.2023.1124130/full