Plasma volume recovery after ultrafiltration in patients with chronic renal failure

Koomans, H. A.; Geers, Anton B.; Mees, E. J. Dorhout

doi:10.1038/ki.1984.227

Cited by 139 publications

(99 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In that previous study the refilling fraction appeared to be relatively uniform amounting to about 70% of the total UF volume and was independent of the fluid overload [12]. This finding was different from studies where vascular refilling increased especially with severe volume expansion [4,16,17], but it is in line with the refilling fraction of 74 ± 9% identified in nine dialysis patients using a mathematical model [18]. This is discussed in detail elsewhere [12].…”

Section: Discussioncontrasting

confidence: 54%

Vascular Refilling Is Not Reduced in Dialysis Sessions with Morbid Events

Kron

Schneditz²,

Leimbach³

et al. 2017

Blood Purif

View full text Add to dashboard Cite

Background: It is commonly believed that insufficient vascular refilling leads to hypovolemia during hemodialysis and contributes to intradialytic morbid events (IME). But data of refilling volumes at the time of IME are lacking. Methods: We compared the vascular refilling in 10 patients with IME with 14 stable patients with normal blood volume at the dialysis end (66-80 mL/kg). Results: The refilling characteristics in patients with IME did not differ from those in stable patients. The refilling fraction (refilling/ultrafiltration [UF] ratio) was 73.8 ± 9.4% in patients with IME, and 70.2 ± 6.4% in patients with normal blood volume at the end of the treatment. Refilling volume strongly correlated with UF volume in both patient groups (r² = 0.93 and r² = 0.81, respectively). Conclusion: IME are associated with a specific blood volume below 65 mL/kg. Vascular refilling is a constant fraction of UF in stable as well as in symptomatic dialysis sessions.

show abstract

Section: Discussioncontrasting

confidence: 54%

Vascular Refilling Is Not Reduced in Dialysis Sessions with Morbid Events

Kron

Schneditz²,

Leimbach³

et al. 2017

Blood Purif

View full text Add to dashboard Cite

show abstract

“…The hydration status itself also strongly influences the RBV course during HD: the less overhydrated the patient, the more pronounced the RBV decrease per unit of ultrafiltration volume due to a lower refill rate when the patient is closer to dry weight [11,12]. …”

Section: Problems With the Measurement Of Rbvmentioning

confidence: 99%

Critical Evaluation of Blood Volume Measurements during Hemodialysis

Dasselaar¹,

Sande²,

Franssen³

2012

Blood Purif

View full text Add to dashboard Cite

Devices that continuously measure relative blood volume (RBV) changes during hemodialysis (HD) are increasingly used for the prevention of dialysis hypotension and fine-tuning of dry weight. However, RBV measurements are subject to various limitations. First, RBV devices provide information on relative blood volume changes but not on absolute blood volume. Since blood volume varies with the hydration status, identical reductions of RBV may result in very different absolute blood volumes at the end of HD. Second, RBV changes underestimate the change of total blood volume due to translocation of lower-hematocrit blood from the microcirculation to the central circulation. Third, changes in posture before and during HD, food intake, exercise, and administration of intravenous fluids may influence the validity of the RBV measurement. Fourth, results obtained by various RBV devices show large interdevice differences. Finally, although a fall in blood volume is an important factor in dialysis hypotension, frank dialysis hypotension only occurs when the cardiovascular compensatory mechanisms can no longer compensate for the reduction in blood volume. Therefore, the dialysis staff should not exclusively focus on RBV, but also search for opportunities in the dialysis prescription to facilitate cardiovascular compensatory mechanisms, e.g. by lowering dialysate temperature. In the opinion of the authors, routine RBV monitoring should be used with caution until the major conceptual and methodological problems that are inherent to the indirect RBV estimation are clarified.

show abstract

“…In older patients low predialysis plasma volume, and compensatory responses such as sympathetic stimulation, which could lead to increased cardiac output and peripheral vascular resistance, and venous compliance, which facilitate movement of fluid from interstitial to intravascular compartment, are impaired [19]. Therefore, independent of the ultrafiltration rate old age was associated with increased risk of hemodynamic complications in our study.…”

Section: Discussionmentioning

confidence: 73%

Hospitalization for Initiation of Maintenance Hemodialysis

Agraharkar¹,

Martinez²,

Kuo³

et al. 2004

Nephron Clin Pract

View full text Add to dashboard Cite

Background: Recent data on complications of hemodialysis (HD) is lacking. With advancement in dialysis technology the incidence of complications such as dialysis disequilibrium syndrome (DDS) has decreased. Notwithstanding these improvements many patients with end-stage renal disease (ESRD) continue to be hospitalized solely for initiation of hemodialysis. This study was undertaken to assess if such admissions are justified and also to determine incidence and predictors of complications of HD during initiation. Methods: Medical records of adult patients (>18 years) initiated on maintenance hemodialysis from January 1st, 1998 through December 31st, 2000 at our institution were reviewed. The demographics of the patients, cause of renal failure, creatinine clearance, type of vascular access, comorbidities, serum chemistries, ultrafiltration (UF) rate and indications for initiating dialysis were noted. Intradialytic complications were retrieved from the dialysis flow sheets. Results: Of the 240 patients reviewed, 18.3% developed complications during initiation of dialysis, and none was severe. Hypotension and leg cramps were the most frequent complications. The patients who developed hypotension and cramps were significantly older than those with no complications, 57.7 ± 14.9 (mean ± SD) years versus 52.3 ± 14.8 years, respectively (p = 0.02). The increment of age significantly influenced the complication rate [odds ratio (OR): 1.03, 95% confidence interval (CI) 1.01–1.05 (p = 0.03)], and so did hematocrit (HCT) (OR: 1.07, 95% CI 1.01–1.13). Multivariate analysis using age and hematocrit as continuous variables revealed that the older patients with anemia had a significantly higher risk of developing HD related complications than younger patients with anemia (OR: 1.05, 95% CI 1.01–1.09 at HCT of 24%, and OR: 1.03, 95% CI 1.00–1.06 at HCT 27%). When patients were stratified by hematocrit level, older patients with hematocrit <27% had higher risk of complications and the risk increased with increasing age [complication rate (HCT <27%): age <40 = 0%, age 40–64 = 11.7%, age >65 = 25%, p < 0.016]. Conclusion: Although very few, hypotension and muscle cramps were the main complications during initiation of HD. Older patients with anemia are prone for these complications although no physician intervention was necessary. Hospitalization solely for initiation of maintenance dialysis is not necessary and the additional cost from such admissions cannot be justified.

show abstract

Plasma volume recovery after ultrafiltration in patients with chronic renal failure

Cited by 139 publications

References 20 publications

Vascular Refilling Is Not Reduced in Dialysis Sessions with Morbid Events

Vascular Refilling Is Not Reduced in Dialysis Sessions with Morbid Events

Critical Evaluation of Blood Volume Measurements during Hemodialysis

Hospitalization for Initiation of Maintenance Hemodialysis

Contact Info

Product

Resources

About