Preserving Central Blood Volume: Changes in Body Fluid Compartments During Hemodialysis

Shulman, Tanya; Heidenheim, A. Paul; Kianfar, C; Shulman, Steven; Lindsay, Robert M.

doi:10.1097/00002480-200111000-00009

Cited by 60 publications

(50 citation statements)

References 13 publications

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“…Bioimpedance analysis has been used as a tool for body composition/body fat analysis [4][5][6][7][8][9] and in the assessment of fluid imbalance in hemodialysis patients [10][11][12][13]. It has not yet been applied to the prosthetics field.…”

Section: Electrical Bioimpedancementioning

confidence: 99%

“…Segmental bioimpedance analysis has been used successfully to determine changes in V ECF with respect to body position [12,[22][23]. R ECF increased and V ECF decreased in the legs when subjects changed body position from sitting to supine to supine with elevated legs, indicating that fluid was redistributed from the legs into the trunk during supine positioning and leg elevation [22].…”

Section: (1)mentioning

confidence: 99%

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Assessment of residual-limb volume change using bioimpedence

Sanders

Rogers

Abrahamson

2007

JRRD

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Abstract-We investigated electrical bioimpedance as a potential measurement modality to assess residual-limb volume change in lower-limb amputees. Four strip electrodes were positioned across the anterior lateral to posterior lateral aspects of the proximal lower leg or residual limb such that the outer pair applied current and the inner pair sensed voltage. A commercial bioimpedance analyzer supplied current at 50 frequencies between 5 kHz and 1 MHz and then used a wellvalidated model to determine fluid resistance. From these data, extracellular fluid volume (V ECF ) could be estimated. Bench test evaluation showed the instrument to have a root-meansquare error of less than 0.014% over a 1 h interval. Tests of subjects who had been transtibial amputees for at least 2 yr showed V ECF changes from postural adjustments well outside the instrument error and normal minute-to-minute biological variability. The rate of V ECF change while standing with the prosthesis donned was greater for diabetic subjects than for nondiabetic subjects. Bioimpedance analysis may have use in prosthetics research, where comparing residual-limb volume at different time points or under different treatment conditions is of interest.

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Section: Electrical Bioimpedancementioning

confidence: 99%

Section: (1)mentioning

confidence: 99%

Assessment of residual-limb volume change using bioimpedence

Sanders

Rogers

Abrahamson

2007

JRRD

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“…5 During dialysis, plasma refilling is more dynamic from the leg in comparison with the trunk or arms, suggesting that the calf could be used as a window to monitor intradialytic changes in whole-body extracellular fluid volume. 6 The use of a higher dialysate sodium concentration (Ͼ140 mEq/L) is an effective means to ensure adequate vascular refilling and has proved to be among the most efficacious and best tolerated therapies for episodic hypotension. Sodium modeling is a technique in which the dialysate sodium concentration is varied during the course of the procedure.…”

mentioning

confidence: 99%

Recent Advances in the Prevention and Management of Intradialytic Hypotension

Palmer

Henrich

2008

Journal of the American Society of Nephrology

158

124

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A symptomatic reduction in BP during or immediately after dialysis occurs in approximately 20 to 30% of dialysis sessions. The treatment includes stopping or slowing the rate of ultrafiltration, placing the patient in the Trendelenburg position, decreasing the blood flow rate, and restoring intravascular volume. Such episodes predispose the patient to leave the dialysis unit volume overloaded and if repetitive can lead to inadequate clearance. Intradialytic hypotension and orthostatic hypotension after the procedure are significant and independent risk factors affecting mortality in dialysis patients. 1 This clinical commentary focuses on recent advances in the prevention and management of intradialytic hypotension.Dialysis hypotension is the result of an inadequate cardiovascular response to the reduction in blood volume that occurs when a large volume of water is removed during a short period of time. In a typical dialysis procedure, an ultrafiltrate volume that is equal to or greater that the entire plasma volume is often removed.Despite the large ultrafiltrate volume, plasma volume typically decreases by only approximately 10 to 20%. This ability to maintain plasma volume during ultrafiltration requires mobilization of fluid from the interstitial into the intravascular space. Vascular refilling is influenced by both patient-specific and treatment-related factors that dictate the distribution of water between the body fluid compartments.The amount of interstitial fluid available for vascular refilling is influenced by the dry weight set for the patient. When the volume of interstitial fluid is small, any ultrafiltrate volume will more likely be associated with hemodynamic instability. This explains the development of hypotension when patients undergo dialysis below their true dry weight. By contrast, increased amounts of interstitial fluid will expand the volume of fluid accessible for refilling of the intravascular space and, therefore, decrease the likelihood of hypotension. In most patients, a dry weight that minimizes the amount of interstitial fluid present is selected because chronic volume overload has long-term deleterious effects on the cardiovascular system.The determination of dry weight is largely assessed empirically by trial and error. The dry weight is set at the weight below which unacceptable symptoms, such as cramping, nausea, and vomiting, or hypotension occur. The dry weight is highly variable in many patients and can fluctuate with intercurrent illnesses (e.g., diarrhea, infection) and with changes in hematocrit (as with erythropoietin). A number of methods have been proposed to define more objectively the dry weight of the patient (Table 1). Comparative studies have generally favored methods based on bioimpedance measurements, which provide an assessment of extracellular and intracellular volume and total body water. 2-4 A variant of this technique in which continuous intradialytic measurements are confined to the calf shows particular promise because the relative volume of excess extrac...

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“…One of the goals is to improve predictive equations and to identify the effect of different parameters on the measures obtained [19,20]. In dialysis for example, it has been shown that fluid is removed predominantly from the extracellular and peripheral (arms, legs) compartments [21]. Thus, different biofluid models have been proposed to describe the whole body or individual organs.…”

Section: Usefulness Of Bioimpedance For the Kidney Disease Patientmentioning

confidence: 99%