Critical Evaluation of Blood Volume Measurements during Hemodialysis

Dasselaar, Judith J.; Sande, Frank M. van der; Franssen, Casper F. M.

doi:10.1159/000334142

Cited by 46 publications

(64 citation statements)

References 52 publications

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“…Unfortunately, available data precluded study of the effects of dialysis sodium concentration and dialysate temperature, both of which may also affect IDH (21). Furthermore, prior studies indicate that fluid status with respect to extracellular euvolemia may be an important determinant in IDH (22,23). In time, emerging technologies may enable real-time consideration of volume status to ameliorate IDH and downstream CV events.…”

Section: Discussionmentioning

confidence: 99%

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Intradialytic Hypotension and Risk of Cardiovascular Disease

Stefánsson

Brunelli

Cabrera

et al. 2014

Clinical Journal of the American Society of Nephrology

266

192

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Background and objectives Patients undergoing hemodialysis have an elevated risk of cardiovascular diseaserelated morbidity and mortality compared with the general population. Intradialytic hypotension (IDH) is estimated to occur during 20%-30% of hemodialysis sessions. To date, no large studies have examined whether IDH is associated with cardiovascular outcomes. This study determined the prevalence of IDH according to interdialytic weight gain (IDWG) and studied the association between IDH and outcomes for cardiovascular events and mortality to better understand its role.

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Section: Discussionmentioning

confidence: 99%

“…To date, analyses regarding the effect of such technologies have yielded mixed findings, possibly based on differences in protocolized responses to IDH. Further study is needed to optimally translate data on extracellular volume into clinical responses (23).…”

Section: Discussionmentioning

confidence: 99%

Intradialytic Hypotension and Risk of Cardiovascular Disease

Stefánsson

Brunelli

Cabrera

et al. 2014

Clinical Journal of the American Society of Nephrology

266

192

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“…FO is one of many factors influencing this relationship. It has often been reported that flat RBV curves are a sign of excessive FO [6,8,9,11]. According to Guyton and Hall [24], about two thirds of FO contribute to the interstitial space, and the remaining third contributes to the blood volume.…”

Section: Discussionmentioning

confidence: 99%

“…to reduce intradialytic morbid events by controlling the ultrafiltration rate (UFR). Recently however, its utility for fluid status assessment has come more into focus [8,9,10,11]. Some authors have proposed to categorize patients' fluid status by the shape of their intradialytic blood volume reduction or postdialytic volume rebound curves [12,13,14,15].…”

Section: Introductionmentioning

confidence: 99%

Sensitivity of Blood Volume Monitoring for Fluid Status Assessment in Hemodialysis Patients

et al. 2013

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Background/Aims: This study investigates the use of blood volume monitoring (BVM) markers for the assessment of fluid status. Methods: Predialysis fluid overload (FO) and BVM data were collected in 55 chronic hemodialysis patients in 317 treatments. Predialysis FO was measured using bioimpedance spectroscopy. The slope of the intravascular volume decrease over time normalized by ultrafiltration rate (Slope4h) was used as the primary BVM marker and compared against FO. Results: Average relative blood volume curves were well separated in different FO groups between 0 and 5 liters. Receiver-operating characteristics analysis revealed that the sensitivity of BVM was moderate in median FO ranges between 1 and 3 liters (AUC 0.60-0.65), slightly higher for volume depletion of FO <1 liter (AUC 0.7) and highest for excess fluid of FO >3 liters (AUC 0.85). Conclusion: Devices that monitor blood volume are well suited to detect high FO, but are not as sensitive at moderate or low levels of fluid status.

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“…These devices heighten the awareness and decision-making data that clinicians use to reduce volume-related hospitalization and urgent dialysis therapy (6).…”

Section: Opportunities and Challengesmentioning

confidence: 99%

The Journey to Full Health Care Responsibility for One ESCO Provider

Maddux

Ketchersid

2017

CJASN

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The Comprehensive ESRD Care (CEC) Model is designed to identify and evaluate new ways to improve care and reduce cost for Medicare beneficiaries with ESRD (1). With 24 Fresenius Medical Care North America (FMC) sites in the ESRD Seamless Care Organizations (ESCOs), we appreciate the opportunity to discuss our approach, opportunities, and challenges. This perspective aims to highlight early learnings from the ESCO program sponsored by the Center for Medicare and Medicaid Innovation (CMMI).The ESCO program shows three elements of valuebased health care on the basis of the work by Porter and Teisberg (2), namely quality of care, service delivery (including patient experience and engagement), and cost control. We believe that the ESCO program has the opportunity to lead to a payment model with long-term sustainable results. ESCOs in a NutshellAn ESCO is a partnership between a nephrology practice(s) and a dialysis organization. Medicare beneficiaries with ESRD are attributed to the ESCO on the basis of "first touch." First touch occurs when Medicare processes a claim submitted for outpatient dialysis by a dialysis clinic participating in an ESCO. The ESCO participants are responsible for the total Medicare Part A and B spending incurred by aligned beneficiaries. The CMMI establishes a historically based financial benchmark. If the cost of care for attributed beneficiaries is less than the benchmark, the ESCO participants have the opportunity to share savings with Medicare. If costs exceed the benchmark, the ESCO participants share the financial loss with Medicare. The amount of savings shared or the size of the check that the ESCO writes to Medicare is directly dependent on the ESCO's quality score. A higher score financially advantages the ESCO, whereas lower quality scores have the opposite effect. These reconciliations of the cost and clinical quality scores occur after the performance year. All ESCO participants are exposed to more than nominal financial risk.Today, there are 37 ESCOs participating in the Comprehensive ESRD Care Model. FMC partners with over 800 nephrology providers in 20 states and the District of Columbia to manage an ESCO population of patients clinically similar to the overall FMC patient population. Approach to Clinical Care within an ESCOClinical care within an ESCO assumes broad care coordination responsibility for all clinical conditions of a patient. Patients with ESRD have high resource utilization with respect to cardiac and vascular disease, infections, behavioral health, nutrition, and endocrine care. Common sites of service include ambulatory, home, emergency department, hospital, and dialysis facility. The approach taken leverages both site of service and clinical condition competence around three themes: medical management, care navigation, and financial stewardship.Medical management focuses on ESCO quality measures (3) and daily care. This uses algorithms to address dialysis treatment prescription, anemia management, and bone and mineral metabolism but also includes logistic as...

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Critical Evaluation of Blood Volume Measurements during Hemodialysis

Cited by 46 publications

References 52 publications

Intradialytic Hypotension and Risk of Cardiovascular Disease

Intradialytic Hypotension and Risk of Cardiovascular Disease

Sensitivity of Blood Volume Monitoring for Fluid Status Assessment in Hemodialysis Patients

The Journey to Full Health Care Responsibility for One ESCO Provider

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