Assessment of dry weight by monitoring changes in blood volume during hemodialysis using Crit-Line

Rodriguez, Hector J.; R, Domenici; Diroll, Anne; Goykhman, Irina

doi:10.1111/j.1523-1755.2005.00467.x

Cited by 84 publications

(78 citation statements)

References 24 publications

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“…A technique that may help attain better control of volume status is continuous noninvasive monitoring of the hematocrit (NIVM). NIVM has been proposed as a more accurate method of estimating the dry weight in both adults and children (11)(12)(13)(14). An NIVM-directed ultrafiltration (UF) algorithm was believed to reduce the hospitalization rate for severe fluid overload in a pediatric HD population at a single center, although the patients studied had already been receiving NIVM before the algorithm was introduced in that dialysis unit (15).…”

mentioning

confidence: 99%

A Standard, Noninvasive Monitoring of Hematocrit Algorithm Improves Blood Pressure Control in Pediatric Hemodialysis Patients

Patel¹,

Goldstein²,

Mahan³

et al. 2007

Clinical Journal of the American Society of Nephrology

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Accurate dry weight assessment is difficult in pediatric hemodialysis patients but is essential to prevent chronic fluid overload, hypertension, and cardiovascular morbidity. A noninvasive monitoring (NIVM) of hematocrit-guided ultrafiltration algorithm was studied prospectively in 20 pediatric hemodialysis patients. The algorithm targeted the first 50% of total goal ultrafiltration to be removed during the first hour of dialysis with a maximum blood volume change of 8 to 12% per hour. The second 50% was removed during the remaining treatment time with a maximum blood volume change of 5% per hour. Data that were collected at baseline and 6 mo included weight, BP, number of antihypertensive medications, 24-h ambulatory BP monitoring (ABPM), echocardiogram, and ultrafiltration-associated symptoms. Sixteen of 20 enrolled patients completed the study. No difference was seen between baseline and 6-mo weight, predialysis casual BP, nighttime ABPM, or left ventricular mass index. There was a decrease in postdialysis casual systolic BP, daytime ABPM, number of antihypertensive medications prescribed, and rate of intradialytic events related to ultrafiltration (all P < 0.05). Adoption of a standardized NIVM-guided algorithm led to (1) improved ABPM profiles, (2) decreased antihypertensive medication burden, and (3) decreased ultrafiltration-associated symptoms. Wider use of NIVM-guided ultrafiltration may decrease cardiovascular morbidity in pediatric hemodialysis patients.

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confidence: 99%

A Standard, Noninvasive Monitoring of Hematocrit Algorithm Improves Blood Pressure Control in Pediatric Hemodialysis Patients

Patel¹,

Goldstein²,

Mahan³

et al. 2007

Clinical Journal of the American Society of Nephrology

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“…Rodriguez et al (78) demonstrated that in patients in whom BVM remained stable, more fluid could be removed during a dialysis session than in patients with steep decrease of BV; however, this study reflects only the clinical reality that some patients do and others do not tolerate ultrafiltration and that the latter tend to end up fluid overloaded. Tools allowing BVM have been included in several dialysis monitors and coupled online with biofeedback systems to devices, thereby modifying elements of the dialysis strategy.…”

Section: Assessment Of Fluid Status and Body Compositionmentioning

confidence: 43%

Did 20 Years of Technological Innovations in Hemodialysis Contribute to Better Patient Outcomes?

Lameire¹,

Biesen²,

Vanholder³

2009

Clinical Journal of the American Society of Nephrology

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During the past two decades, impressive technological innovations have been introduced in the field of hemodialysis. This review analyzes whether these have been translated into better patient survival. The potential impacts of an increase in dialysis dosage, the preference of high-flux versus low-flux membranes, the choice between convection and diffusion as dialysis strategy, the chemical composition and biologic purity of dialysate, the effect of sodium, potassium, volume profiling, and the intradialytic volume monitoring aiming at improving hemodynamic stability are explored. Studies in which the dialysis dosage was increased were not associated with increased patient survival, whereas the superiority of high-flux over low-flux membranes is not convincingly demonstrated. Although strict evidence is lacking, observational data suggest an advantage of convective over pure diffusive strategies. Longer duration of the dialysis sessions and/or higher frequency of dialysis is probably beneficial, but the results of powerful randomized, controlled trials should be awaited. Sodium profiling has more disadvantages than advantages, whereas potassium profiling mainly in arrhythmia-prone patients with ventricular hypertrophy should be considered. Intradialytic blood volume monitoring has reduced intradialytic hypotension episodes, but hard evidence for improving patient survival is lacking. Overall, the major technological advances in dialysis have not yet been translated into longer patient survival. Optimal predialysis care in preventing the cardiovascular damage that accumulates before the start of dialysis and timely creation of an arteriovenous fistula as vascular access is a more effective and more economic strategy in the long-term outcome of the dialysis patient.

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“…Studies among hemodialysis patients in adults and children suggest that managing intradialytic RPV may reduce the number of hospital admissions due to fluid overload (14,19), improve BP control, and decrease hypotension-associated dialysis symptoms (20). It is possible that the latter benefit is, in part, related to diminished use of antihypertensive medication.…”

Section: Dry-weight and Outcomesmentioning

confidence: 99%

“…Thus, RPV slope monitoring may be useful to assess dry-weight among hypertensive hemodialysis patients. RPV monitoring, combined with clinical assessment of intradialytic hypovolemia and postdialytic fatigue, can help assess patient dry-weight and optimize volume status while reducing dialysis-associated morbidity (14). Wabel et al (15) measured body composition through body impedance analysis and predialysis systolic BP among 500 patients from eight dialysis centers in Europe.…”

Section: Newer Developments In the Assessment Of Dry-weightmentioning

confidence: 99%

Dry-Weight

Agarwal

Weir

2010

Clinical Journal of the American Society of Nephrology

145

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Background and objectives: Achieving and maintaining dry-weight appears to be an effective but forgotten strategy in controlling and maintaining normotension among hypertensive patients on hemodialysis.Methods: Qualitative review of literature to define dry-weight and its utility in achieving blood pressure control. Results: The concept of dry-weight has evolved over time and its definition has changed. One such definition defines dry-weight as the lowest tolerated postdialysis weight achieved via gradual change in postdialysis weight at which there are minimal signs or symptoms of hypovolemia or hypervolemia. Although clinical examination does not perform well in detecting latent increase in dry-weight, several technologies such as relative plasma volume monitoring and body impedance analysis are emerging that may help in assessing dry-weight in the future. Sodium restriction is a modifiable risk factor that can lead to better blood pressure (BP) control. However, dietary sodium restriction requires lifestyle modifications that are difficult to implement and even harder to sustain over the long term. Restricting dialysate sodium is a simpler but underexplored strategy that can reduce thirst, limit interdialytic weight gain, and assist the achievement of dry-weight. Achievement of dry-weight can improve interdialytic BP, reduce pulse pressure, and limit hospitalizations.Conclusions: Avoiding medication-directed control of BP may enhance the opportunity to probe dry-weight, facilitate removal of volume, and limit the risk for pressure-volume overload, which may be a significant concern leading to myocardial remodeling in the hemodialysis patient. Probing dry-weight among patients with ESRD has the potential to improve dismal cardiovascular outcomes.

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Assessment of dry weight by monitoring changes in blood volume during hemodialysis using Crit-Line

Cited by 84 publications

References 24 publications

A Standard, Noninvasive Monitoring of Hematocrit Algorithm Improves Blood Pressure Control in Pediatric Hemodialysis Patients

A Standard, Noninvasive Monitoring of Hematocrit Algorithm Improves Blood Pressure Control in Pediatric Hemodialysis Patients

Did 20 Years of Technological Innovations in Hemodialysis Contribute to Better Patient Outcomes?

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