Adjustment of target weight based on absolute blood volume reduces the frequency of intradialytic morbid events

Kron, Susanne; Schneditz, Daniel; Czerny, Jutta; Leimbach, Til; Budde, Klemens; Kron, Joachim

doi:10.1111/hdi.12582

Cited by 22 publications

(59 citation statements)

References 32 publications

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“…In a pilot study, an absolute BV below 65 mL/kg was found to predict intra-dialytic morbid events in 10 out of 12 patients [10]. Absolute BV was more predictive for intra-dialytic morbid events than pre-dialytic OH assessed by BIS [63]. Previously, it was also observed that vena cava diameter, which is also related to intravascular volume, predicted treatment tolerance in an intensive care setting [64].…”

Section: Can Technology Aid the Clinical Decision Process?mentioning

confidence: 87%

Body Fluids in End-Stage Renal Disease: Statics and Dynamics

Kooman

Sande²

2018

Blood Purif

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Background: Abnormalities in fluid status in hemodialysis (HD) patients are highly prevalent and are related to adverse outcomes. Summary: The inherent discontinuity of the HD procedure in combination with an often compromised cardiovascular response is a major contributor to this phenomenon. In addition, systemic inflammation and endothelial dysfunction are related to extracellular fluid overload (FO). Underlying this relation may be factors such as hypoalbuminemia and an increased capillary permeability, leading to an altered fluid distribution between the blood volume (BV) and the interstitial fluid compartments, compromising fluid removal during dialysis. Indeed, whereas estimates of extracellular volume by bioimpedance spectroscopy are highly predictive of mortality, absolute BV assessed by the saline dilution technique was predictive of intra-dialytic morbidity. Changes in relative BV during HD are positively related to ultrafiltration rate (UFR) and, at least in some studies, negatively to FO. High UFR is also related to changes in central venous oxygen saturation (S_cvO₂), a marker for tissue perfusion. On the one hand, high UFR and more pronounced declines in S_cvO₂, but on the other hand, flat relative BV curves are also predictive of mortality; the relation between outcome which statics and dynamics of fluid status appears to be complex. Key Message: While technological developments enable the clinician to monitor statics and dynamics of fluid status and hemodynamics during HD in an accessible way, the role of technology-based interventions needs further study.

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Section: Can Technology Aid the Clinical Decision Process?mentioning

confidence: 87%

Body Fluids in End-Stage Renal Disease: Statics and Dynamics

Kooman

Sande²

2018

Blood Purif

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“…Online measurement of Hct and Hb in the extracorporeal circulation is currently used to track the degree of UF‐induced hemoconcentration during hemodialysis. Recently, Schneditz et al and Kron et al demonstrated that the dilution of blood and the calculated increase in relative blood volume (in %) caused by the infusion of ultrapure dialysate can be used to determine the absolute blood volume (V b , in ) at the time of infusion as:

V_{b} = \frac{{normalV}_{bolus}}{{RBV}_{Post} - {RBV}_{Pre}} . \frac{1}{10}

where V bolus is the volume of the dialysate bolus (in mL), and RBV Pre and RBV Post refer to the relative blood volume (in %) before and after infusion.…”

Section: Methodsmentioning

confidence: 99%

Utility of a blood volume monitor in the management of anemia in dialysis by computing the total hemoglobin mass

Alayoud

Belarabi

Labrini

et al. 2019

Hemodialysis International

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Introduction The degree of interdialytic weight gain and ultrafiltration may influence anemia results in dialysis. The purpose of this study is to evaluate the utility of a blood volume monitor (BVM) in the management of renal anemia and its ability to avoid the variability of hematocrit (Hct) and hemoglobin values (Hb) depending on plasma volume through a simple method of monitoring the total hemoglobin mass (MtHb). Methods Predialysis blood samples for measurement were drawn at both the midweek treatment and the beginning‐of‐the‐dialysis‐week treatment in 30 patients. The MtHb was calculated as MtHb = Vb × Hb, where Vb is the absolute blood volume determined by online dialysate dilution using an online hemodiafiltration machine incorporating a relative BVM. Findings The MtHb and the total red cell volume (VRBC) as measured with the bolus method at the starting of the treatment were 540 ± 148 grams and 1544 ± 339 mL, respectively. There were significant differences between the Hb levels and between the hematocrit levels according to the time of dialysis. However, the MtHb remained constant. There was also an excellent correlation between the Hb measurements by the BVM and the blood sampling method (R = 0.89, P value <0.001). Conclusion Our study suggests that BVM could be very useful in the management of anemia in dialysis by computing the total Hb mass in clinical practice and may support better and more appropriate assessments of the factors influencing circulating Hb.

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“…Oberhalb von 65 ml/kg wurden bei kei-nem Patienten intradialytische Komplikationen beobachtet. Andererseits blieben nur 4 von 19 Patienten bei einem Blutvolumen von unter 65 ml/kg stabil [17]. Somit scheint ein absolutes Blutvolumen von etwa 65 ml/kg eine kritische Grenze für das Auftreten von volumenbedingten Komplikationen während der Dialyse darzustellen [16,17].…”

Section: Absolutes Blutvolumen Und Komplikationenunclassified

Blutvolumenmonitoring bei Hämodialysepatienten

2020

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ZUSAMMENFASSUNGModerne Dialysegeräte verfügen heute über Monitore zur kontinuierlichen Messung der Veränderung des relativen Blutvolumens. Leider liefert dieses Monitoring nur Informationen über das relative, nicht aber über das absolute Blutvolumen. So kann trotz einer identischen Abnahme des relativen Blutvolumens ein sehr unterschiedliches absolutes Blutvolumen vorliegen. Diese Art des Blutvolumenmonitorings hat die Erwartungen nur unzureichend erfüllt. In diesem Artikel wird eine neue Methode vorgestellt, mit der das absolute Blutvolumen mit den gegenwärtig vorhandenen Dialysegeräten bestimmt werden kann. Allein mit einer Software-Modifikation ließe sich erreichen, dass künftig alle Dialysebehandlungen an einem einzustellenden Zielblutvolumen enden.

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Adjustment of target weight based on absolute blood volume reduces the frequency of intradialytic morbid events

Abstract: Adjustment of target weight based on information of Vs, Vo, and IME appears as a feasible approach to reduce the frequency of IME.

Cited by 22 publications

References 32 publications

Body Fluids in End-Stage Renal Disease: Statics and Dynamics

Body Fluids in End-Stage Renal Disease: Statics and Dynamics

Utility of a blood volume monitor in the management of anemia in dialysis by computing the total hemoglobin mass

Blutvolumenmonitoring bei Hämodialysepatienten

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