Interview: Ferruh Artunc on His Abstract from Kidney Week 2016

The Transonic team spoke with professor Ferruh Artunc on the abstract he presented at Kidney Week 2016. Artunc’s abstract is the first study to show a prognostic significance of measuring hemodynamic parameters in HD patients. See what he had to say about it as well as the high cardiovascular death rates among hemodialysis patients below.

This is the third abstract you've published in the area of hemodynamic monitoring of HD patients. What triggered your interest in this area?

Hemodynamics is the core of each hemodialysis treatment. Cardiac index (CI) is still a big unknown in clinical medicine and clinicians rely on changes in blood pressure to assess CI, which is less sensitive. Besides blood pressure, CI is also critically determined by peripheral resistance. The Transonic HD03 monitor allows us to directly measure CI and make inferences of cardiac function.

Do you feel that enough attention is currently being paid to the high cardiovascular mortality rate in the hemodialysis patient community?

All nephrologists agree that cardiovascular mortality is by far the most common cause of death in HD patients. It is important that this cardiovascular mortality is mostly related to heart failure and small vessel disease leading to sudden death or systolic failure.

Echocardiography is central to detect cardiac dysfunction; cardiac biomarkers are also useful to identify patients with an increased risk. Optimal fluid and blood pressure control are essential to reduce cardiac strain.

Do you plan to conduct future studies in this area?

We have been focusing on prognostic associations of biomarkers so far and found the powerful significance of spuriously elevated cardiac troponins in the risk assessment of HD patients. Now we are focusing on hemodynamic parameter measured with the Transonic HD 03 monitor.

We conducted a prospective study with 215 patients which so far is the greatest study in this field. During follow-up we will identify those hemodynamic parameters that are prognostically relevant. We are also in touch with Transonic to derive novel hemodynamic parameters from the recordings that might add valuable data.

Do you think understanding a patient's cardiac output status could help the dialysis care team to modify care and improve the high cardiac morbidity and mortality rates in the HD patient community?

Identification of reduced CI could prompt a bundle of measures to improve cardiac function aiming at improving long-term outcome. On a level of a single HD treatment, monitoring of CI could prevent a critical drop that might induce cardiac injury, referred to as cardiac stunning.

How would you suggest other nephrology teams utilize the Transonic HD03 cardiac function data to improve patient care?

The standard Transonic monitor measures primarily access flow (AF) and helps detect patients with absolutely high access flow (AF > 2.0 l/min). The HD03 monitor helps to additionally measure cardiac output (CO). Knowing the CO of a patient with high AF enables to check if the high flow is still compensated by an adequate increase in CO. That would be reflected by a AF/CO ratio of < 20%, which is the value a normal flow AF. However, if the ratio exceeds 30% of the CO, there is no adequate cardiac compensation anymore. These patients could have an absolute AF of

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