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SUDOSCAN in Intradialytic hypotension

Electrochemical skin conductance by SUDOSCAN:
a new tool to predict intradialytic hypotension

Pauline Reach, Maxime Touzot, Yannis Lombardi, Catherine Maheas, Emmanuelle Sacco, Audrey Fels, Hélène Beaussier, Pablo Ureña-Torres, Gilles Chatellier, Christophe Ridel, Mathieu  Zuber.
Article title: Electrochemical skin conductance by Sudoscan®: a new tool to predict intradialytic hypotension.
Nephrology Dialysis Transplantation, gfab183.

P. Reach et al from Groupe Hospitalier Saint-joseph, Paris, France, investigated the clinical utility of SUDOSCAN in the prediction of intradialytic hypotension (IDH), a complication in hemodialysis (HD) patients associated with multiple risk factors including cardiac dysfunction and alterations of the peripheral autonomic nervous system.
The identification of patients at risk of intradialytic hypotension, could help clinicians to tailor a more personalized dialysis therapy.

This prospective monocentric study was conducted on 176 hemodialysis patients (64 ±14 years old) over a 6-month period. Dysautonomia was assessed by the measurements of hand and foot Electrochemical Skin Conductance (ESC) using SUDOSCAN, before hemodialysis.

The primary end point was the incidence of intradialytic hypotension (NKF/K-DOQI definition), according to the presence of a pathological hand and/or foot ESC value, during the 3-month study period (see Graphical abstract  below).

As results, mean pre-dialysis hand and foot ESC were 45±20 µS and 54±22 µS, respectively. 35 and 40 % of patients had a pathological ESC at the hand and foot, respectively. Intradialytic  hypotension (IDH) occurred in 46 patients. Logistic regression showed that pathologic pre-hemodialysis hand ESC was associated with an increased risk of IDH [OR=2.56, IC95% (1.04-6.67), p= 0.04]. The cumulative risk incidence of IDH during the study was 5.65 [IC95% (2.04-15.71), p=0.001]
and 3.71 [IC95% (1.41-9.76), p=0.008], with a pathological hand and foot ESC, respectively.

Conclusion: a pathological hand electrochemical skin  conductance (ESC), as assessed by a non-invasive SUDOSCAN test is associated with an increased risk of intradialytic hypotension.

Graphical abstract:

 
Key words: dialysis, electrochemical skin conductance, intra-dialytic hypotension, Sudoscan®