Reducing symptoms during hemodialysis by continuously monitoring the hematocrit

Steuer, Robert R.; Leypoldt, John K.; Cheung, Alfred K.; Senekjian, H. O.; Conis, J. M.

doi:10.1016/s0272-6386(96)90163-8

Cited by 106 publications

(79 citation statements)

References 12 publications

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“…This study confirms previous findings of a reduction in the number of intradialytic symptoms related to UF in both children and adults using NIVM (18,27). In a pediatric study by Jain et al (18), the data were more convincing in children who weighed Ͻ35 kg.…”

Section: Discussionsupporting

confidence: 90%

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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Section: Discussionsupporting

confidence: 90%

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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“…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.…”

mentioning

confidence: 99%

Intradialytic Blood Volume Monitoring in Ambulatory Hemodialysis Patients

Reddan

Szczech

Hasselblad

et al. 2005

Journal of the American Society of Nephrology

181

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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“…Continuous registration of ⌬RBV during HD with ultrafiltration (UF) is advocated as a tool to maintain an adequate volume of the intravascular compartment to avoid HD hypotension (1)(2)(3). However, the use of ⌬RBV measurements in clinical practice depends on its accuracy in reflecting the change in whole-body blood volume or total blood volume (⌬TBV).…”

mentioning

confidence: 99%

Relative Blood Volume Changes Underestimate Total Blood Volume Changes during Hemodialysis

Dasselaar

Hooge

Pruim

et al. 2007

Clinical Journal of the American Society of Nephrology

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Background: Measurements of relative blood volume changes (⌬RBV) during hemodialysis (HD) are based on hemoconcentration and assume uniform mixing of erythrocytes and plasma throughout the circulation. However, whole-body hematocrit (Ht) is lower than systemic Ht. During HD, a change in the ratio between whole-body to systemic Ht (F cell ratio) is likely to occur as a result of a net shift of low Ht blood from the microcirculation to the macrocirculation. Hence, ⌬RBV may differ significantly from total blood volume changes (⌬TBV). Therefore, this study compared ⌬RBV and ⌬TBV during HD.Design, setting, participants, and measurements: Plasma and erythrocyte volumes were measured using 125 I-and 123 Iradioiodinated albumin and 51 Cr-labeled erythrocytes, respectively. After validation of the standardized method in two patients on a nondialysis day, seven patients completed the protocol during HD.125 I-albumin and 51 Cr-labeled erythrocytes were administered 20 min before the start of HD.123 I-albumin was administered at 160 min into the HD session to quantify and correct for 125 I-albumin leakage. ⌬RBV was measured continuously throughout HD. The F cell ratio was derived from whole-body and systemic Ht.Results: Total ultrafiltration volume was 2450 ؎ 770 ml. TBV declined from 5905 ؎ 824 to 4877 ؎ 722 ml during HD. Thus, TBV declined 17.3 ؎ 4.4%, whereas the RBV decline was only 8.2 ؎ 3.7% (P ‫؍‬ 0.001). The F cell ratio increased from 0.896 ؎ 0.036 to 0.993 ؎ 0.049 during HD (P ‫؍‬ 0.002).Conclusions: ⌬RBV significantly underestimates ⌬TBV during HD. The rise in F cell ratio strongly suggests that during HD, blood translocates from the microcirculation to the macrocirculation, probably as a cardiovascular compensatory mechanism in response to hypovolemia.

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Reducing symptoms during hemodialysis by continuously monitoring the hematocrit

Cited by 106 publications

References 12 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

Intradialytic Blood Volume Monitoring in Ambulatory Hemodialysis Patients

Relative Blood Volume Changes Underestimate Total Blood Volume Changes during Hemodialysis

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