Continuous Blood Volume Monitoring and “Dry Weight” Assessment

Lopot, František; Nyiomnaitham, V; Svárová,; Polakovič, Vladimír; Švára, František; Sulková, S

doi:10.1111/j.1755-6686.2007.tb00040.x

Cited by 9 publications

(7 citation statements)

References 14 publications

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“…Relative blood volume decreased as refilling fraction and post‐dialysis volume overload decreased (Figure ). This is in support of the concept that relative blood volume captures aspects of both intra‐ and extravascular volume status . There is, however, considerable scatter in these relationships, and the assessment of volume status based on RBV measurements alone remains to be difficult.…”

Section: Discussionsupporting

confidence: 60%

Vascular refilling is independent of volume overload in hemodialysis with moderate ultrafiltration requirements

Kron

Schneditz

Leimbach³

et al. 2016

Hemodialysis International

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Introduction Blood volume changes and vascular refilling during hemodialysis (HD) and ultrafiltration (UF) have been assumed to depend on volume overload (Vo ). It was the aim to study the magnitude of vascular refilling in stable HD patients with moderate volume expansion in everyday dialysis using novel technical approaches. Methods Patients were studied during routine dialysis and UF based on clinical dry weight assessment. Pre-dialysis Vo was independently measured by bioimpedance spectroscopy. Vascular refilling volume (Vref ) was calculated as: Vref = Vuf - ΔV, where ΔV is the absolute blood volume change determined by on-line dialysate dilution using a commercial on-line hemodiafiltration machine incorporating a relative blood volume monitor, and where Vuf is the prescribed UF volume. Findings Thirty patients (dry weight: 81.0 ± 17.8 kg) were studied. Pre-dialysis Vo was 2.46 ± 1.45 L. Vuf was 2.27 ± 0.71 L, specific UF rate was 6.45 ± 2.43 mL/kg/h, and since ΔV was 0.66 ± 0.31 L, Vref was determined as 1.61 ± 0.58 L, corresponding to a constant refilling fraction (Fref ) of 70.6 ± 10.6%. Vref strongly correlated with Vuf (r(2) = 0.82) but was independent of Vo and other volumes. Fref was also independent of Vo and other volumes normalized for various measures of body size. Discussion While vascular refilling and Fref is independent of Vo in treatments with moderate UF requirements, intravascular volume depletion increases with increasing UF requirements. The relationship between blood volume and Vo needs to be more closely examined in further studies to optimize volume control in everyday dialysis.

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Section: Discussionsupporting

confidence: 60%

Vascular refilling is independent of volume overload in hemodialysis with moderate ultrafiltration requirements

Kron

Schneditz

Leimbach³

et al. 2016

Hemodialysis International

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“…[15] The so-called critical blood volume decrease has been implemented into automatic blood volume control with improvement of hemodynamic stability. However, neither blood volume change monitoring nor biofeedback-based regulation of ultrafiltration brings any information about peripheral microcirculation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Skin Microcirculation during Hemodialysis

et al. 2010

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Background. Cardiovascular mortality in hemodialysis (HD) patients remains high despite improvements in HD technique such as dialysis adequacy, dialysis fluid purity, and membrane biocompatibility. Optimal fluid balance to maintain optimal hemodynamic stability during hemodialysis (HD) procedure is essential. At the present time, hemodynamic stability is conventionally assessed as stability of macrocirculation, especially as maintenance of systemic blood pressure with no attention paid to peripheral perfusion. Peripheral ischemic vascular disease represents a serious problem with high mortality and morbidity. We estimated skin microcirculation changes during HD using new device, Laser Doppler Line Scanner (Moor Instruments, Devon, UK). Aims. The aims were to introduce the novel method of detection of skin perfusion changes during hemodialysis and to evaluate possible relationship of these to ultrafiltration as well as to selected biochemical characteristics. Methods. In 36 hemodynamically stable patients, we performed paired measurements of skin blood flow in both hands before and during HD with registering the time of dialysis and the total ultrafiltration achieved. Results. We found a significant decrease in a majority of the evaluated areas. However, the skin blood flow change was not homogenous as it decreased more on the fingers. Conclusion.To our knowledge, this is the first study when the microcirculatory changes during hemodialysis are demonstrated and evaluated in large skin surface area, and showing not only a decrease in a majority of areas but also the heterogeneity of the changes.

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“…A constant or increasing RBV is widely interpreted as a sign that the rate of refilling of the vascular space from the interstitium matches or exceeds the rate of fluid removal, indicative of interstitial fluid overload, while reductions in RBV suggest that vascular refilling cannot compensate for fluid removal, indicative of reduced interstitial fluid volumes. When these principles are applied to real-time monitoring of RBV, often as part of a feedback controlled mechanism, reducing ultrafiltration rates in response to RBV reductions can reduce the number of hypotensive episodes (5). When applied to target weight management, RBV values that are relatively constant during a dialysis session are assumed to indicate that the patient is fluid overloaded, typically leading to reductions in target weight until there is an acceptable drop in RBV over a dialysis session (6).…”

Section: Introductionmentioning

confidence: 99%

Time to Reconsider the Role of Relative Blood Volume Monitoring for Fluid Management in Hemodialysis

et al. 2018

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Relative blood volume (RBV) monitoring during hemodialysis has been used to help guide fluid management for decades, although with little supporting evidence. The technique relies on the assumption that variation in RBV during fluid removal reflects the capacity for vascular refilling and that efficient refilling is related to fluid overload. This study investigated the relationship between RBV variation and bioimpedance-based fluid overload in 47 patients on stable hemodialysis. Mean treatment ultrafiltration volume (UFV) was 1.7 L and RBV reduction was 3.2%/hour. Relative blood volume slopes were grouped based on trajectory: flatline (no decrease), linear decrease, or linear decrease followed by flatline. Fluid overload was similar (p > 0.05) across groups pre-dialysis (1.0, 2.2, and 1.6 L, respectively) and post-dialysis (-0.8, -0.1, and -0.1 L), whereas UFV was higher in patients with a linear decrease (1.8, 2.5, and 1.6 L; p = 0.02). Specific ultrafiltration rate, but not fluid overload, was associated with RBV change over dialysis. At least half the patients in each group finished dialysis fluid depleted based on bioimpedance, suggesting that the link between refilling and fluid overload is not as straightforward as previously assumed. These results question the assumptions that the absence of an appreciable decrease in RBV indicates fluid overload, and a rapid fall suggests fluid depletion.

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Continuous Blood Volume Monitoring and “Dry Weight” Assessment

Cited by 9 publications

References 14 publications

Vascular refilling is independent of volume overload in hemodialysis with moderate ultrafiltration requirements

Vascular refilling is independent of volume overload in hemodialysis with moderate ultrafiltration requirements

Evaluation of Skin Microcirculation during Hemodialysis

Time to Reconsider the Role of Relative Blood Volume Monitoring for Fluid Management in Hemodialysis

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