Intra- and post-dialytic changes of haemoglobin concentrations in non-anaemic haemodialysis patients

Minutolo, Roberto; Nicola, Luca De; Bellizzi, Vincenzo; Iodice, Carmela; Rubino, Roberto; Aucella, Filippo; Stallone, C.; Nappi, Felice; Avella, F; Maione, Eleonora; Conte, Giuseppe; Iorio, Biagio Di

doi:10.1093/ndt/gfg387

Cited by 29 publications

(34 citation statements)

References 22 publications

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“…In the paper by Ozturk et al [15] cited earlier, ICF and ECF changes by bioimpedance were compared during dialysis using 0 or 200 mg/dL glucose dialysis solution, and the relative decreases in ICF and ECF were not different. Furthermore, our results are similar to those reported by Minutolo et al [18], who studied changes in hemoglobin and serum total protein as a result of ultrafiltration during dialysis, including the 2-h period after dialysis. In their patients, from whom they removed 4% body weight over a 4-h treatment, the serum total protein levels increased markedly during dialysis, more so in the group with higher predialysis hemoglobin values, but by 2 h after dialysis, the average ratio of serum total protein relative to the predialysis value was approximately 1.11, close to that found in the HEMO study patients.…”

Section: Discussionsupporting

confidence: 92%

“…In their patients, from whom they removed 4% body weight over a 4-h treatment, the serum total protein levels increased markedly during dialysis, more so in the group with higher predialysis hemoglobin values, but by 2 h after dialysis, the average ratio of serum total protein relative to the predialysis value was approximately 1.11, close to that found in the HEMO study patients. In that study, the dialysis solution glucose concentration used was 100 mg/dL (Minutolo et al [18], personal communication).…”

Section: Discussionmentioning

confidence: 99%

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Changes in Total Protein Concentration Due to Fluid Removal During and Shortly after Hemodialysis

Daugirdas¹

2018

Am J Nephrol

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Background: Changes in plasma volume during hemodialysis are complex and have been shown to depend on the rate of fluid removal and the degree of fluid overload. We examined changes in total protein concentration during and shortly after a dialysis treatment in archived data from the HEMO study. Methods: During follow-up months 4 and 36 of the HEMO study, additional blood samples were obtained during a typical dialysis session at 30 and 60 min after dialysis. In 315 studies from 282 patients where complete data were available, we calculated the concentration change in total protein and compared it to the modeled change in both total body water and extracellular fluid space as derived from 2-pool urea kinetic modeling. Results: The mean postdialysis modeled urea volume (V) was 31.1 ± 6.18 L. Mean fluid removal was 2.76 ± 1.27 kg, over a session length of 207 ± 28 min. The ratio of predialysis V to postdialysis V averaged 1.090 ± 0.040. The mean TP ratios (post/pre) at 0, 30, and 60 min postdialysis averaged 1.121 ± 0.070 (SD), 1.091 ± 0.090, and 1.091 ± 0.086. The dialysate to serum sodium gradient, studied in a different group of treatments where this information was available, had no impact on these findings, nor did the length of the interdialytic interval. Conclusions: On average, after equilibration, the change in plasma volume due to fluid removal is similar to the modeled change in total body water (urea space), irrespective of dialysate to serum sodium gradient. This supports previous observations that during dialysis with ultrafiltration, plasma volume contracts to a lesser degree than the interstitial volume and that some fluid may be removed from spaces other than the extracellular fluid.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Changes in Total Protein Concentration Due to Fluid Removal During and Shortly after Hemodialysis

Daugirdas¹

2018

Am J Nephrol

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“…The problem of adequate refilling is often addressed in clinical studies. 3,[6][7][8][9][10][11][12][13][14] Continuous on-line blood volume monitoring was applied by some authors to obtain qualitative characteristics of the process of refilling and its relation to hypotensive episodes. 3,[15][16][17][18][19][20][21] The quantitative analysis of the refilling process may be based on a two-compartment model to describe the rate of plasma refilling through the application of the Starling equation to the kinetics of plasma volume, V p , during dialysis session 22 :…”

mentioning

confidence: 99%

Kinetics of Plasma Refilling During Hemodialysis Sessions with Different Initial Fluid Status

Pietribiasi

Katzarski²,

Galach

et al. 2015

ASAIO Journal

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Removal of fluid excess from the plasma volume by ultrafiltration during hemodialysis (HD) is balanced by plasma refilling from the interstitium, driven mainly by the increase in plasma oncotic pressure. We calculated the plasma refilling coefficient (Kr, a parameter expressing the ratio of refilling rate to the increase in oncotic pressure) for nine patients, each undergoing two HD sessions differing by pretreatment fluid status and session time (shorter session, SH, 3.5 h, and longer session, LH, 4.5h). Relative blood volume change was measured online, and solute concentrations were measured regularly during the sessions. The volume of body compartments was measured by bioimpedance. The patients were more volume expanded before LH session (higher initial body mass and total body water). Oncotic pressure was similar for both sessions. The refilling rate, despite higher fluid overload in the LH sessions, was similar for both sessions. The final Kr values stabilized on similar levels (SH: 136.6 ± 55.6 ml/mm Hg/h and LH: 150.7 ± 73.6 ml/mm Hg/h) at similar times, notwithstanding the difference in initial fluid overload between the two groups, suggesting that Kr at dry weight is relatively insensitive to the initial fluid status of the patient.

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“…In addition to the above factors, intradialytic changes may also affect Hgb concentrations postdialysis. Most importantly is whether there is a true rise in Hgb or is it a component of disequilibrium as described by Minutolo et al 14 or whether the use of saline during the treatment, despite goal ultrafi ltration and attaining dry weight, affect Hgb. These issues need further evaluation, but do not minimize the observation that many patients do have a signifi cant rise in their Hgb post-dialysis and that the optimal Hgb/hematocrit for an individual patient is still not known.…”

Section: Discussionmentioning

confidence: 97%

Increase in post‐dialysis hemoglobin can be out of proportion and unrelated to ultrafiltration

Geller

Devita

Marku-Podvorica

et al. 2010

Dialysis & Transplantation

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OBJECTIVEThe objective of this study was to compare pre‐dialysis and post‐dialysis hemoglobin (Hgb) and ultrafiltration in hemodialysis patients. Factors influencing Hgb are not well understood.METHODSPre‐dialysis and post‐dialysis Hgb and weight were measured in 133 hemodialysis patients. Absolute and percentage change in Hgb (%ΔHgb) and percent change in body weight (%ΔBW) were determined for that treatment. Patients were divided into 2 groups, those with post‐dialysis Hgb < 13 g/dL (group 1) and those with post‐dialysis Hgb ≥13 g/dL (group 2); the differences in %ΔBW were compared between the 2 groups.RESULTSThe mean pre‐dialysis Hgb was 11.9 ± 1.4 g/dL, the mean post‐dialysis Hgb level was 12.8 ± 1.8 g/dL. The %ΔHgb was 3.9 ± 6.6 in group 1 and 10.8 ± 7.8 in group 2. The %ΔBW was 3.1 ± 1.4 in group 1 and 3.9 ± 1.7 in group 2 (p < .001 for all comparisons). We found that although both groups had a rise in Hgb level post‐dialysis, group 2 patients had a rise in %ΔHgb that was greater than the relatively small difference in %ΔBW between the 2 groups. In addition, we found only a modest correlation between %ΔBW and %ΔHgb in both groups. The r2 of 0.24 suggests that only 25% of the variability found in %ΔHgb can be related to %ΔBW.CONCLUSIONSPatients with post‐dialysis Hgb ≥13 g/dL had a greater increase in %ΔHgb that was out of proportion to %ΔBW. Factors other than %ΔBW may play a role in determining post‐dialysis Hgb.

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Intra- and post-dialytic changes of haemoglobin concentrations in non-anaemic haemodialysis patients

Cited by 29 publications

References 22 publications

Changes in Total Protein Concentration Due to Fluid Removal During and Shortly after Hemodialysis

Changes in Total Protein Concentration Due to Fluid Removal During and Shortly after Hemodialysis

Kinetics of Plasma Refilling During Hemodialysis Sessions with Different Initial Fluid Status

Increase in post‐dialysis hemoglobin can be out of proportion and unrelated to ultrafiltration

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