Author: Chan, King Yu
Title: Detection of pre-intradialytic hypotension during haemodialysis in patients with end stage renal disease
Degree: DHSc
Year: 2017
Subject: Hong Kong Polytechnic University -- Dissertations
Hemodialysis -- Complications
Department: Faculty of Health and Social Sciences
Pages: 233 pages : illustrations
Language: English
Abstract: Introduction: Kidney transplantation is beneficial to patients with end-stage renal disease (ESRD). Receiving kidney transplants, these patients recover their normal physical functions and good and healthy mental functioning. However, the ratio of kidney transplantation among patients remains low. As such, the waiting list for kidney transplantation is relatively long, and patients waiting for kidney transplantation rely on peritoneal dialysis and haemodialysis. In addition to peritoneal dialysis and kidney transplantation, haemodialysis is an effective renal replacement therapy for patients with ESRD. Haemodialysis is an effective treatment used worldwide in a dialysis outpatient facility, in a hospital, or at home. Unfortunately, haemodialysis treatments may lead to intradialytic hypotension (IDH). IDH is a sudden decrease in a patient's blood pressure during haemodialysis. IDH may also cause life-threatening complications, such as cardiac arrhythmias, cardiopulmonary collapse, brain damage and stroke, and sudden death. The occurrence of IDH should be predicted to prevent such complications during haemodialysis, but effective predictive models have yet to be established. This study aimed to investigate the potentiality of developing an effective predictive model that can be used to predict the occurrence of IDH. Method: Sixty-eight patients suffering from ESRD and requiring temporary or long-term haemodialysis treatment were recruited, and they signed written consents for the study. All of the participants were examined once during their haemodialysis sessions. They experienced at least one episode of IDH but did not show any symptom of hypotension. In our study, IDH is defined as a decrease in systolic blood pressure by 30mmHg or more below the predialysis measurement or to an absolute value below 100 mmHg.
The baseline blood pressure measurements of the participants at the start of the haemodialysis session and their clinical and health information were obtained for analysis. Each participant's systolic and diastolic blood pressures were measured every 15 min and recorded continuously by using a high-resolution digital video camera during the haemodialysis session. The time of haemodialysis onset was documented by reviewing the recorded video. The saturation of oxygen levels and the heart rates of the patients were determined and recorded by using a digital video camera. Video contents were transformed into still images at 1 frame per minute. Differences in the saturation of oxygen levels and heart rates of each patient were calculated and characterized by determining their corresponding standard deviations every 5 minutes through successive sequences from the start of haemodialysis. The standard deviations of the saturation of oxygen levels and heart rates were further transformed into positive integers by Truncation and Rounding. Afterward, data were analyzed through sequence alignment and Boolean algebra. Results: Three Patterns derived from the variations of the saturation of oxygen levels and heart rates were developed as predictors to determine the pre-occurrence of IDH within 30 minutes. The accuracy of these Patterns for the prediction of IDH occurrence was 80%. Therefore, the variations of oxygen levels and heart rates can be used as predictors to develop an alarm system. This can then be used to ensure timely interventions for patients undergoing haemodialysis and thus prevent IDH. Conclusions: Variations of saturation of oxygen levels and heart rates are associated with IDH. Such differences can also predict the pre-occurrence of IDH within 30 minutes. This study demonstrated that such differences can be used as viable non-invasive measures to develop an alarm system for the prediction of IDH occurrence. Nevertheless, further research on a sizable pool of subjects should be conducted to verify the effectiveness and consistencies of the proposed system.
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