Characterising haemodynamic responses to Conventional Haemodialysis

People with kidney failure treated with haemodialysis suffer from high rates of end-organ damage. This thesis describes research work focusing on understanding the haemodynamic stress during dialysis and its negative impact on end organs. Our results show that a higher frequency of blood pressure (BP) variation assessed using extrema point frequency analysis correlated with high levels of cardiac biomarkers, in keeping with the association of higher BP variation with adverse outcomes in the general population. We have explored this frequency of BP variation further by categorising patients into two groups based on the ratio of high and low-frequency BP changes. These two categories of patients demonstrated differing haemodynamic responses during dialysis. Understanding this haemodynamic behaviour might help us individualise therapies to address haemodynamic stress. We explored the extent of the impact of haemodynamic stress on the structure of the brain. We demonstrated a phenomenon of accelerated ageing when compared to age and sex-matched healthy population. Moreover, the observed association of reduction in the grey and white matter volumes with dialysis vintage emphasises the potential contribution of HD- specific processes in the pathogenesis of these changes. Finally, we explored the role of cool dialysis as an intervention to mitigate the risks of dialysis-induced haemodynamic stress using intradialytic magnetic resonance imaging of heart, brain and kidneys which enabled us to understand the significant structural and haemodynamic changes in these organs during dialysis.