Lysianska O. Cardiorespiratory dysfunction in рatients with end-stage kidney disease on maintenance hemodialysis and its management

The dissertation presents a novel solution to a relevant scientific and practical problem in internal medicine concerning the optimization of diagnosis, monitoring, prognostic assessment, and management of intradialytic oxygenation and hemodynamic disorders in patients with chronic kidney disease stage G5D (CKD G5D) undergoing maintenance hemodialysis and presenting with comorbid conditions. The aim of the study was to determine the clinical and functional features of intradialytic hypoxemia (IH) and intradialytic hypertension (iHTN), establish their prognostic significance, assess the value of non-invasive monitoring of peripheral oxygen saturation (SpO₂) and blood pressure (BP), and substantiate the efficacy and safety of oxygen therapy. The study was based on a comprehensive analysis of clinical, anamnestic, laboratory, functional, and instrumental data obtained from 120 patients with CKD G5D undergoing maintenance hemodialysis. The methodology included assessment of the comorbidity profile, quality of life, respiratory function, hydration status, oxygenation parameters, and hemodynamic indices during hemodialysis sessions using non-invasive SpO₂ and BP monitoring. The results showed that IH and iHTN are clinically significant components of intradialytic cardiorespiratory instability in patients undergoing maintenance hemodialysis. These disorders were associated with comorbid conditions, impaired quality of life, higher hospitalization rates, and unfavorable 12-month clinical outcomes. The coexistence of IH and iHTN was characterized by a greater adverse prognostic impact, supporting the need for dynamic intradialytic monitoring rather than isolated pre- and post-dialysis measurements. Oxygen therapy in patients with confirmed IH improved SpO₂ levels, hemodialysis tolerance, and quality-of-life parameters without adversely affecting systemic hemodynamics. The obtained data highlight the importance of personalized management of patients undergoing maintenance hemodialysis, taking into account comorbidities, oxygenation parameters, BP, hydration status, and intradialytic hemodynamic stability. The results are of practical significance for improving monitoring, risk stratification, and therapeutic correction of intradialytic disorders in patients undergoing maintenance hemodialysis.