Hematocrit as an Indicator of Blood Volume and a Predictor of Intradialytic Morbid Events

Steuer, Robert R.; Leypoldt, John K.; Cheung, Alfred K.; Harris, David; Conis, J. M.

doi:10.1097/00002480-199407000-00087

Cited by 100 publications

(60 citation statements)

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“…Alternatively, excessive ultrafiltration can be detected as rapid increments in the hematocrit. By serially measuring hematocrit in the blood tubing using an external optical sensor, CritLine detects intravascular volume changes that occur with ultrafiltration or fluid administration during hemodialysis (6,7). Therefore, it is proposed that intravascular volume monitoring using Crit-Line may serve as a prospective management tool for fluid removal and be superior to clinical judgment (7)(8)(9)(10)(11).…”

Section: Study Rationale Design Monitoring and Interventionsmentioning

confidence: 99%

“…Crit-Line noninvasively monitors hematocrits by optical transmission (6). In smaller, uncontrolled studies, continuous hematocrit monitoring with Crit-Line correlated with intradialytic blood volume changes, and certain aspects of monitoring predicted intradialytic morbidity (7,8). Prompted by such findings, the Crit-Line Intradialytic Monitoring Benefit (CLIMB) Study tested the hypothesis that the availability of hematocrit-based intradialytic monitoring using Crit-Line would decrease morbidity associated with ultrafiltration in comparison with patient management using conventional clinical criteria such as symptoms, BP, weight, and physical examination.…”

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confidence: 99%

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Intradialytic Blood Volume Monitoring in Ambulatory Hemodialysis Patients

Reddan

Szczech

Hasselblad

et al. 2005

Journal of the American Society of Nephrology

183

168

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Complications related to inadequate volume management are common during hemodialysis. This trial tested the hypothesis that availability of an intradialytic blood volume monitoring (IBVM) device improves fluid removal, reducing morbidity. A six-center, randomized trial with 6 mo of intervention comparing IBVM using Crit-Line versus conventional clinical monitoring was conducted. The average rate of non-access-related hospitalizations was compared across treatment groups using Poisson regression. Mortality analysis used the Kaplan Meier method. A total of 227 patients were randomized to Crit-Line, and 216 were randomized to conventional monitoring. Both groups had similar baseline characteristics. During the study, no differences in weight, BP, or number of dialysis-related complications were observed. There were 120 and 81 non-access-related hospitalizations in the Crit-Line and conventional monitoring groups. The adjusted risk ratio for non-access-related and access-related hospitalization was 1.61 (95% confidence interval 1.15 to 2.25; P ‫؍‬ 0.01) and 1.52 (95% confidence interval 1.02 to 2.28; P ‫؍‬ 0.04) for the Crit-Line monitoring group. Mortality was 8.7% in the Crit-Line monitoring group and 3.3% in the conventional group (P ‫؍‬ 0.021). Standardized mortality ratios comparing the Crit-Line and conventional monitoring groups to the prevalent hemodialysis population were 0.77 (NS) and 0.26 (P < 0.001). Hospitalization rates were 1.51 and 1.03 events/yr in the Crit-Line and standard monitoring groups, compared with 2.01 for the prevalent hemodialysis population. IBVM was associated with higher nonvascular and vascular access-related hospitalizations and mortality compared with conventional monitoring. The atypically low hospitalization and mortality rates for the conventional monitoring group suggest that these findings should be generalized to the US hemodialysis population with caution.

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Section: Study Rationale Design Monitoring and Interventionsmentioning

confidence: 99%

mentioning

confidence: 99%

Intradialytic Blood Volume Monitoring in Ambulatory Hemodialysis Patients

Reddan

Szczech

Hasselblad

et al. 2005

Journal of the American Society of Nephrology

183

168

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“…Because the hematocrit is an indicator of blood volume [28,29], the fluid overload and hemodilution status of the early-dialysis group - in which none were patients with traumatic hypovolemic shock - was partially supported by a reduced urine output and lower serum creatinine before ECMO.…”

Section: Discussionmentioning

confidence: 99%

Early Continuous Renal Replacement Therapy in Cardiogenic Shock Patients with Severe Acute Kidney Injury Undergoing Extracorporeal Membrane Oxygenation

Lin¹,

Lin²,

Lin

et al. 2014

Cardiorenal Med

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Background: Continuous renal replacement therapy (CRRT) may benefit patients requiring extracorporeal membrane oxygenation (ECMO). However, the clinical benefits and timing of CRRT have not been fully elucidated for these patients. Methods: This study was conducted retrospectively at the Taipei Medical University Hospital between January 2008 and December 2010. We included patients who had Acute Kidney Injury Network (AKIN) stage 3 disease at the initiation of ECMO and subsequently underwent CRRT. We excluded patients aged <18 years or those who were chronic dialysis patients. Early dialysis was defined as receiving CRRT <24 h after the initiation of ECMO. The primary outcome was mortality before weaning from ECMO. Results: The median age of the 15 patients included in the study was 72 years. The median interval between ECMO and CRRT was 16 h. No significant difference in survival was observed between the early- and late-dialysis patients (p = 0.58, log-rank test). However, a trend toward a shorter mean duration of ECMO therapy was observed in the early-dialysis patients (124 vs. 169 h, p = 0.16). The median follow-up glomerular filtration rate for the survivors was 38.9 ml/min/1.73 m². Conclusion: No survival benefit is conferred by the use of CRRT within 24 h after initiating ECMO in patients with severe acute kidney injury according to AKIN criteria. © 2014 S. Karger AG, Basel

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“…Intradialytic muscle cramping, usually of the lower extremities, occurs commonly in patients on maintenance hemodialysis [6,7], and is an important cause of early termination of dialysis sessions [8]. While the etiology of intradialytic cramps is multifactorial, impaired hemodynamics may be an important contributory component [6,7,9].…”

Section: Introductionmentioning

confidence: 99%

“…While the etiology of intradialytic cramps is multifactorial, impaired hemodynamics may be an important contributory component [6,7,9]. Recently Michener et al [10] suggested that patients with PAD may be predisposed to intradialytic cramps resulting from the incremental hemodynamic compromise associated with volume removal during dialysis.…”

Section: Introductionmentioning

confidence: 99%

Peripheral Arterial Disease Is Not Associated with an Increased Prevalence of Intradialytic Cramps in Patients on Maintenance Hemodialysis

Brass

Adler²,

Sietsema³

et al. 2002

Am J Nephrol

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Background/Aims: Peripheral arterial disease (PAD) has been suggested as a contributing factor to the development of intradialytic muscle cramps in patients on maintenance hemodialysis. Methods: To test this hypothesis, 122 patients from two dialysis centers were studied. The presence of PAD was determined by measurement of the ankle-brachial index (ABI) in the lower extremities of patients pre- and postdialysis. The experience of intradialytic cramps was assessed using patient history and review of medical records. Results: PAD defined as a predialysis ABI ≤0.90 had an overall prevalence of 16.4% among patients studied. The prevalence of PAD was age-dependent, reaching 37.5% in patients 80–89 years old. Intradialytic muscle cramps were common, with 52.1% of patients reporting cramps within the previous two months, but there was no relationship between cramps during dialysis and PAD (p > 0.05). Conclusions: PAD was common in hemodialysis patients, but there was no association between the presence of PAD and the prevalence of intradialytic muscle cramps.

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Hematocrit as an Indicator of Blood Volume and a Predictor of Intradialytic Morbid Events

Cited by 100 publications

References 0 publications

Intradialytic Blood Volume Monitoring in Ambulatory Hemodialysis Patients

Intradialytic Blood Volume Monitoring in Ambulatory Hemodialysis Patients

Early Continuous Renal Replacement Therapy in Cardiogenic Shock Patients with Severe Acute Kidney Injury Undergoing Extracorporeal Membrane Oxygenation

Peripheral Arterial Disease Is Not Associated with an Increased Prevalence of Intradialytic Cramps in Patients on Maintenance Hemodialysis

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