# Using Intradialytic Blood Pressure Slopes to Guide Ultrafiltration in Hemodialysis Patients

> **NIH VA I01** · VA NORTH TEXAS HEALTH CARE SYSTEM · 2020 · —

## Abstract

United States Veterans have disproportionately higher risk for end stage renal disease (ESRD) compared to
the general population. Veterans with ESRD on maintenance hemodialysis (HD) suffer from alarmingly high
mortality rates and hospitalizations mainly related to cardiovascular disease. Extracellular volume (ECV)
excess is a primary contributing factor to cardiovascular disease and the heightened mortality rate in HD
patients. Extracellular volume excess remains difficult to identify in clinical practice, and the standard
approach to fluid management in the clinical setting involves arbitrary trial and error attempts to remove fluid
without invoking hemodynamic instability such as intradialytic hypotension. Bioimpedance spectroscopy (BIS)
is a useful research tool for assessing ECV; however, it is not feasible in routine practice, and there is little data
on how its use affects intermediate and hard clinical outcomes. There is an unmet need for an approach to
guide ultrafiltration in clinical practice that addresses both reduction of ECV and other mortality outcomes as
well as minimization of intradialytic hypotension. The long-term goal of this study is to develop a more precise,
patient-specific fluid management approach to be tested in a large clinical trial aimed at reducing mortality in
Veterans on HD. The overall objective of this project is to utilize our novel, patient-specific ultrafiltration
algorithm as an intervention in a clinical trial using mortality risk factors as the primary outcomes. The central
hypothesis is that prescribing ultrafiltration prospectively based on an individual patient’s intradialytic blood
pressure slopes (IBPS) from recent treatments is superior to standard care at reducing ambulatory blood
pressure and ECV without increasing risk for intradialytic hypotension. Aim 1 will use an un-blinded, controlled
randomized clinical trial to demonstrate the effects of an IBPS-based ultrafiltration prescription compared to
standard clinical practice. Each month, updated ultrafiltration prescriptions for the IBPS group will be
determined based on the most recent treatment data. The primary outcome will be change in mean systolic
44-hour ambulatory blood pressure after 4 months. Other outcomes will include 1) change in post-HD
ECV/body weight using multifrequency bioimpedance spectroscopy, 2) change in post-HD total peripheral
resistance index using a non-invasive cardiac output monitor, and 3) between-group comparison of the
frequency of intradialytic hypotension and intradialytic symptoms. Aim 2 will involve a cross sectional analysis
of baseline data of subjects from Aim 1 in addition to consecutive enrollment of additional hypertensive HD
patients. In addition to Aim 1 measurements, subjects will undergo transthoracic echocardiograms on a non-
HD day to obtain measurements of left ventricular ejection fraction as a metric of systolic function, mitral inflow
and mitral annulus velocities as a metric of diastolic functio...

## Key facts

- **NIH application ID:** 9890299
- **Project number:** 1I01CX002009-01
- **Recipient organization:** VA NORTH TEXAS HEALTH CARE SYSTEM
- **Principal Investigator:** Peter Noel Van Buren
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-07-01 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9890299

## Citation

> US National Institutes of Health, RePORTER application 9890299, Using Intradialytic Blood Pressure Slopes to Guide Ultrafiltration in Hemodialysis Patients (1I01CX002009-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9890299. Licensed CC0.

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