Hemodynamic response to non-pneumatic anti-shock compression garments in patients with renal dysfunction

R Marinovich, Z Li, T Tamasi, K Quinn, S Wong, C W McIntyre, R Marinovich, Z Li, T Tamasi, K Quinn, S Wong, C W McIntyre

Abstract

Background: Patients with chronic kidney disease are at higher risk of developing cardiovascular disease. Chronic exposure to intermittent hemodialysis may be a source of added stress to the cardiovascular system; intradialytic hypotension is a common complication of hemodialysis, and repeated events may lead to hemodynamic stress and ischemic injuries. Administration of non-pneumatic compression stockings to the lower limbs has demonstrated hemodynamic stabilizing effects in other settings and may provide similar benefits in the kidney disease population. Therefore, we conducted this pilot study assessing the feasibility and tolerability of the application of non-pneumatic compression stockings to patients with kidney disease. We also assessed the changes in hemodynamic measurements following the application of the compression stockings to explore the biological feasibility of this being an effective intervention for intradialytic hypotension.

Methods: Fifteen individuals were enrolled in the study (5 healthy, 5 chronic kidney disease patients, and 5 dialysis patients). Outcomes including hemodynamic parameters such as cardiac output, peripheral vascular resistance, and blood pressure were measured using continuous pulse wave analysis. Changes in global longitudinal strain were measured via echocardiography. These outcome measurements were made before and after the application of compression stockings.

Results: All study participants tolerated the compression garments well and without complication. Hemodynamic response to lower body compression caused varying effects on cardiac output, mean arterial pressure and global longitudinal strain. Some individuals saw large improvements in hemodynamic parameters while in others the opposite effect was observed. No consistent response was elicited.

Conclusions: Application of compression stockings to patients with renal dysfunction is well-tolerated. However, significant variations in hemodynamic outcomes exist, and may be a barrier for larger scale trials without prior identification of specific patient characteristics indicating likely benefit from the application of external compression.

Trial registration: ClinicalTrials.gov, Identifier: NCT02915627, Registration Date: Sept 27, 2016.

Keywords: Cardiovascular; Chronic kidney disease; Compression; Dialysis; Hemodynamics.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Representative data series of cardiac output from individual patients of each cohort. Baseline characteristics in approximately 15-min intervals displayed in orange. Application of non-pneumatic compression stocks occurred subsequently, and hemodynamic response is shown in blue
Fig. 2
Fig. 2
Hemodynamic response of patients with kidney disease to non-pneumatic compression stockings. The relative change in cardiac output, mean arterial pressure and global longitudinal strain after the application of non-pneumatic compression stockings in heathy individuals, CKD patients not on dialysis, and dialysis patients are displayed. Cardiac output and mean arterial pressure data were collected via Finometer while global longitudinal strain was obtained via echocardiography

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