Blood volume monitoring and control

Santoro, Antonio; Mancini, Elena; Paolini, Francesco; Zucchelli, P

doi:10.1093/ndt/11.supp2.42

Cited by 41 publications

(44 citation statements)

References 6 publications

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“…⌬RBV were measured with Hemoscan (Gambro-Hospal). In addition, we assessed ⌬RBV from changes in Ht (⌬RBV-Ht) in afferent blood because this method is considered to be the reference method for determining ⌬RBV during HD (5,22).…”

Section: Study Protocolmentioning

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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Section: Study Protocolmentioning

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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“…In a randomized trial, it was found that probing dry weight leads to steepened RPV slopes (21). Data on intraindividual (17,18) and interindividual variability (18,20) of relative blood volume monitoring are limited.…”

Section: Discussionmentioning

confidence: 99%

“…RPV slopes associate with all-cause mortality, even after accounting for interdialytic ambulatory BP and interdialytic weight gain (4). However, reproducibility of RPV within individuals remains unknown (15)(16)(17)(18)(19)(20)(21). Gauging reproducibility is important, and therefore, the reliability of this test can be ascertained.…”

Section: Introductionmentioning

confidence: 99%

Determinants and Short-Term Reproducibility of Relative Plasma Volume Slopes during Hemodialysis

Anand

Sinha

Agarwal

2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Hypervolemia is a major cause of morbidity, in part because of the lack of well characterized diagnostic tests. The hypothesis was that relative plasma volume (RPV) slopes are influenced by ultrafiltration rate, directly associate with improvement in arterial oxygen saturation, and are reproducible.Design, setting, participants, & measurements RPV slopes were measured on three consecutive hemodialysis sessions. Various relationships were tested using mixed models. Reproducibility was assessed by the intraclass correlation coefficient.Results RPV slopes averaged 1.3761.45% per hour. The mean RPV slopes were steeper on the first dialysis of the week, which correlated with a higher ultrafiltration rate; RPV slope and ultrafiltration rate were directly related. Increasing ultrafiltration rate quartiles were associated with similar change in RPV in the first 1 hour of dialysis but steeper changes in RPV subsequently. A direct relationship emerged between increasing RPV slopes and increasing arterial oxygen saturation slopes. The intraclass correlation coefficient for the relative plasma volume slope was 0.77.Conclusions Although ultrafiltration rate is a major determinant of RPV slope, similar ultrafiltration rates are associated with varying RPV between individuals. Because RPV is associated with little change by ultrafiltration rate during the first 1 hour of dialysis, probing dry weight during the earlier part of dialysis may be safer. RPV slopes are physiologically meaningful, because they are associated with parallel changes in arterial oxygenation saturation slopes. RPV slopes are reproducible, and therefore, RPV may serve as a useful marker to judge changes in volume status within an individual.

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“…Pressure gradients thus created drive the water back into the vascular space until a new equilibrium is reached. As UF and water withdrawal from the intravascular space continue, the new disequilibrium thereby generated has to be once again balanced, and so on until the end of the session (Santoro et al, 1996). Several factors can influence rate of plasma refilling by acting on these forces: hydration status, plasma osmolality, and plasma protein concentration.…”

Section: Concept Of Plasma Refillingmentioning

confidence: 99%