Computational analysis of blood volume curves and risk of intradialytic morbid events in hemodialysis

Beige, Joachim; Sone, Jeremiah; Sharma, Arya M.; Rudwaleit, Martín; Offermann, G.; Distler, A.; Preuschof, Lothar

doi:10.1046/j.1523-1755.2000.00343.x

Cited by 21 publications

(12 citation statements)

References 8 publications

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“…Beige and co-workers suggested a different approach based on a single RBV-derived value (4). Instead of a simple RBV crit they evaluate RBV variability during HD.…”

Section: The Alert Rbv Value-based Approachesmentioning

confidence: 99%

Continuous Blood Volume Monitoring and “Dry Weight” Assessment

Lopot

Nyiomnaitham

Svárová

et al. 2007

Journal of Renal Care

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There are two distinct facets of adequate fluid balance control in haemodialysis patients--estimation of dry weight (DW) as the target and adequate ultrafiltration (UF) strategy, i.e. the way to reach the target in a possibly symptom-free way. The article reviews the continuous blood volume monitoring (CBVM) based procedures to deal with the former facet-DW determination. The existing approaches are divided in three groups--methods defining certain alert value of relative blood volume (RBV) reduction, methods working with RBV response to constant UF rate, and methods evaluating dynamics of RBV response to UF pulse or chain of UF pulses. While the first and the third approaches are relatively easy to automate, the second group of methods are suitable mainly for observational evaluations only. All the discussed methods, without exception, need large-scale verification, as they all were evaluated in the majority by their authors only and on small patient cohorts.

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“…Beige and co-workers suggested a different approach based on a single RBV-derived value (4). Instead of a simple RBV crit they evaluate RBV variability during HD.…”

Section: The Alert Rbv Value-based Approachesmentioning

confidence: 99%

Continuous Blood Volume Monitoring and “Dry Weight” Assessment

Lopot

Nyiomnaitham

Svárová

et al. 2007

Journal of Renal Care

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“…Kim et al showed that if RBV fell below a given threshold, arterial hypotension appeared [3]. Larger observational studies failed to corroborate this idea of a critical level of RBV reduction but found that irregularity of the RBV course, gradient of the RBV curve and the switching from an exponential to a linear RBV reduction were the most powerful predictors of intradialytic hypotension [4][5][6]. The only study in paediatrics, by Jain et al, demonstrated a relationship between RBV and intradialytic events and defined a safe ultrafiltration rate of <8% RBV per hour in the first 90 min and <4% thereafter, with no more than a 12% absolute RBV reduction per dialysis session [7].…”

Section: Introductionmentioning

confidence: 99%

Blood-volume monitoring in paediatric haemodialysis

et al. 2008

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A correlation between relative blood volume (RBV) reduction and adverse intradialytic events has been reported in children. Our aim was to determine whether the shape of the RBV curve and the RBV thresholds discriminated between haemodialysis treatments where patients developed complications and those where they did not. We retrospectively reviewed blood volume records (n = 74), using the Fresenius module. "Treatment complications" were defined as hypotension and/or intradialytic symptoms requiring nursing intervention. Treatments with complications were significantly associated with changes in heart rate (P = 0.05) and steeper decline of the RBV curve in the first hour (P = 0.01), but the final RBV measurement was not predictive (P = 0.27). When receiver operator characteristic (ROC) analyses were used, cut-off RBV thresholds of 88% at the end of the first hour, 84% at the end of the second hour, and 82% at the end of the third hour of dialysis, were able to discriminate between treatments with and without complications, but no RBV values at the end of the fourth hour of dialysis were discriminatory. The RBV curve differed in polyuric patients, such that complications occurred at lower RBV thresholds than in oliguric patients. Evolution of tachycardia and a steeper RBV fall in the first hour of dialysis predicted the occurrence of treatment complications.

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“…Since there are no data from the literature to support a strict threshold valid for all patients, this threshold value has to be chosen by the operator, based on his experience with the patient's individual needs. This concept is simple but may overlook that not only the minimal BV, but also the change of the BV slope over time may play a role for induction of hypotension [50]. Therefore, the concept of ideal BV curves over time may appear more sophisticated and could prove to be superior to that of a fixed minimal value for BV during dialysis.…”

Section: Manual and Automatic Feedback Control Of Bv Changesmentioning

confidence: 99%

Rationale for the Use of Blood Volume and Temperature Control Devices during Hemodialysis

Donauer

Böhler

2003

Kidney Blood Press Res

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Despite substantial progress in blood purification techniques over the last three decades, treatment-related hypotensive episodes remain one of the major problems in hemodialysis therapy. There are two main reasons for hypotension occurring during dialysis treatments. First, hypovolemia is frequently induced by rapid fluid removal from the blood compartment which is in excess of refilling of fluids from the interstitial space. Second, many patients fail to support blood pressure by adequate vasoconstriction or increased heart rate as a response to hypovolemia. The capacity to respond adequately to volume contraction may be reduced due to patient- or treatment-related factors, among which heat accumulation within the body plays a major role. Recently, two newer technical developments became commercially available for use in hemodialysis therapy: devices for blood volume and blood temperature control were designed to reduce the incidence of intradialytic hypotension. Although blood volume and temperature measurements are easy to perform today, there is some uncertainty in the dialysis community how and when their use may be helpful and in which patients it is indicated. This review critically discusses the application of blood volume- and temperature-measuring devices with regard to their usefulness in the clinical setting.

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Computational analysis of blood volume curves and risk of intradialytic morbid events in hemodialysis

Abstract: Using these kind of index thresholds and online analysis of BV curves, automatic management of ultrafiltration by BV dynamics could be a promising concept to avoid intradialytic morbidity.

Cited by 21 publications

References 8 publications

Continuous Blood Volume Monitoring and “Dry Weight” Assessment

Continuous Blood Volume Monitoring and “Dry Weight” Assessment

Blood-volume monitoring in paediatric haemodialysis

Rationale for the Use of Blood Volume and Temperature Control Devices during Hemodialysis

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