Changes in major blood components after adopting the supine position during haemodialysis

Inagaki, Hitoshi; Kuroda, Masahiro; Watanabe, Shiro; Hamazaki, Tomohito

doi:10.1093/ndt/16.4.798

Cited by 28 publications

(16 citation statements)

References 12 publications

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“…Postural changes have a profound effect on plasma volume in healthy subjects [16] and in HD patients [17]. Upon standing, the hematocrit increases because of a decrease in plasma volume due to a fluid shift from the circulation to the interstitial tissue of the dependent regions of the body.…”

Section: Problems With the Measurement Of Rbvmentioning

confidence: 99%

“…Resumption of the supine body position after standing facilitates mixing of blood between the circulatory compartments and leads to a rapid and marked temporary increase in hematocrit followed by a slow decrease [16]. Inagaki et al [17] found that hemodilution and, thus, the fluid flux from the interstitial tissue to the vascular space took more time (>30 min) in HD patients than healthy controls (<15 min). Many patients assume a supine or half-sitting position just before the start of HD (e.g.…”

Section: Problems With the Measurement Of Rbvmentioning

confidence: 99%

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Critical Evaluation of Blood Volume Measurements during Hemodialysis

Dasselaar¹,

Sande²,

Franssen³

2012

Blood Purif

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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.

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Section: Problems With the Measurement Of Rbvmentioning

confidence: 99%

Section: Problems With the Measurement Of Rbvmentioning

confidence: 99%

Critical Evaluation of Blood Volume Measurements during Hemodialysis

Dasselaar¹,

Sande²,

Franssen³

2012

Blood Purif

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“…The mean UF volume was 1.51 litres and the mean UF rate was 8.1 ml/kg/h. Patients maintained a standard semi-reclining posture throughout the study [11] . Haemodynamic monitoring of BP, RBV, ECF and CO was carried out throughout the study as described below.…”

Section: Study Protocolmentioning

confidence: 99%

Haemodynamic Effects of Food Intake during Haemodialysis

Sivalingam

Banerjee²,

Nevett³

et al. 2008

Blood Purif

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Background: There is some doubt whether food intake during haemodialysis (HD) is detrimental to haemodynamic stability. Methods: We studied 20 stable non-diabetic HD patients during a single session. A standard meal was given 45 min into dialysis. Relative blood volume (RBV), cardiac output (CO), systemic vascular resistance (SVR) and extracellular fluid (ECF) resistance were monitored continuously. Total protein and albumin were measured. Results: There was a significant reduction in RBV after food ingestion (maximum reduction 3.4 ± 1.1%; p < 0.001). There was no significant change in ECF resistance, heart rate, CO or SVR. Mean arterial pressure was significantly different from pre-food levels 30 min after food (p = 0.04). The rate of change of total protein and albumin concentration was significantly higher immediately after food ingestion. Conclusions: Food intake during HD caused significant reductions in RBV, possibly related to fluid shifts from intestinal microcirculation to interstitium. CO and SVR remained stable perhaps because of the opposing effects of food ingestion and UF.

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“…Patients were placed lying in a supine position in bed for > 20 min before the pre-dialysis sampling, and were not allowed to eat or drink until the post-dialysis sampling [11, 12]. Hematocrit (Ht), albumin (Alb), and sodium (Na) concentrations of the samples were measured.…”

Section: Methodsmentioning

confidence: 99%

Influence of Hemofiltration on Intradialytic Plasma Volume Decrease

Tanemoto

Tomita

Motoharu

et al. 2019

Kidney Blood Press Res

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Background/Aims: Compared with hemodialysis (HD), hemodiafiltration (HDF) reduces the frequency of episodes of intradialytic hypotension. Intradialytic plasma volume decrease (IPVD) induced by ultrafiltration is a leading cause of the episodes, and hemofiltration might have a preventive effect on IPVD. This study examined whether online HDF (ol-HDF) prevented IPVD compared with HD. Methods: Online HDF of pre-dilution mode (pre-ol-HDF) and post-dilution mode (post-ol-HDF) and HD were performed in 22 patients on maintenance dialysis. In each session, IPVD was calculated by using an intradialytic change in hematocrit, and IPVD in pre-ol-HDF and post-ol-HDF was compared with that in HD in a crossover manner. Results: While the ratios of intradialytic body weight loss to post-dialysis BW (IBWL/BW) in ol-HDF were generally smaller than those in HD, the levels of IPVD and IPVD/IBWL/BW were generally larger than those in HD; the IPVD levels were 0.108 ± 0.058, 0.113 ± 0.053, and 0.101 ± 0.057 (P = 0.67), and those of IPVD/IWL/BW were 2.21 ± 0.97, 2.32 ± 0.91, and 1.98 ± 1.14 (P = 0.21) in pre-ol-HDF, post-ol-HDF, and HD, respectively. Conclusion: Online mode hemofiltration, in either pre-dilution mode or post-dilution mode, performed in combination with hemodialysis has no preventive effect on IPVD.

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Changes in major blood components after adopting the supine position during haemodialysis

Abstract: This study suggests that the change from the upright to the supine positions during HD causes changes in blood components that are critical for quality control determinations.

Cited by 28 publications

References 12 publications

Critical Evaluation of Blood Volume Measurements during Hemodialysis

Critical Evaluation of Blood Volume Measurements during Hemodialysis

Haemodynamic Effects of Food Intake during Haemodialysis

Influence of Hemofiltration on Intradialytic Plasma Volume Decrease

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