On-Line Dialysate Infusion to Estimate Absolute Blood Volume in Dialysis Patients

Schneditz, Daniel; Schilcher, Gernot; Ribitsch, Werner; Krisper, Peter; Haditsch, Bernd; Kron, Joachim

doi:10.1097/mat.0000000000000086

Cited by 30 publications

(69 citation statements)

References 28 publications

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“…1) or in a more technical companion paper [13]. Transferring the accuracy of our in vitro data to the clinical setting, this corresponds to a resolution of less than ± 1 ml/kg of specific blood volume.…”

Section: Discussionmentioning

confidence: 99%

“…Analysis of continuous data has the potential to provide both flexibility and accuracy for the period of measurement [13]. This could easily be installed by a software modification.…”

Section: Discussionmentioning

confidence: 99%

“…In comparison with saline, dialysate has the important advantage that it is a balanced solution and available at the proper temperature and osmotic concentration during dialysis, that it can be precisely delivered without the manipulation of blood lines and solutions using the intrinsic volume balance system [13] when activating the emergency function of the dialysis machines, and that does not infer additional costs. …”

Section: Discussionmentioning

confidence: 99%

“…In a parallel study done in five patients using dialysate dilution and analysis of continuously recorded BVM data, the initial specific blood volume was 77.9 ± 12.9 ml/kg [13]. …”

Section: Discussionmentioning

confidence: 99%

“…Suffering many limitations [10,] this approach has not been transferred into clinical practice. Later, the controlled infusion of ultra-pure dialysate during online hemodiafiltration has been suggested as an alternative [11,12,13]. …”

Section: Introductionmentioning

confidence: 99%

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A Simple and Feasible Method to Determine Absolute Blood Volume in Hemodialysis Patients in Clinical Practice

Kron¹,

Schneditz

Leimbach³

et al. 2014

Blood Purif

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Background: We developed a simple method to determine the absolute blood volume (V) during hemodialysis in everyday clinical practice and examined its relationship with volume overload, clinical relevance, and accuracy. Methods: The increase in relative blood volume (RBV_post - RBV_pre) measured before and after infusion of 240 ml of ultra-pure dialysate using the bolus function of a commercial online hemodiafiltration machine incorporating a relative blood volume monitor was applied to determine absolute blood volume. The specific blood volume (V_s, blood volume per kg body mass at dry weight, in ml/kg) was compared to volume status as assessed by bioimpedance analysis and clinical criteria. Results: The blood volume measured in 30 stable hemodialysis patients was 6.51 ± 1.70 l at the beginning, corresponding to a specific blood volume of 80.1 ± 12.8 ml/kg, and dropped to 5.84 ± 1.61 l or 72.0 ± 12.1 ml/kg at the end of the dialysis session, respectively. Specific blood volume correlated with volume status assessed both clinically and by bioimpedance analysis. Intradialytic morbid events occurred only in treatments where specific blood volume fell below 65 ml/kg. The reproducibility of the technique was better than 4% and the in vitro accuracy corresponds to a resolution in V_s of better than 1 ml/kg. Conclusion: Absolute blood volume can be easily measured at the beginning of the dialysis session using the current dialysis technology. Information about V and V_s could be a promising tool to avoid intradialytic morbid events. This technique could be completely automated without altering the hardware of currently available online dialysis devices. Therefore, it is recommended that this technique be integrated into all hemodiafiltration machines.

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Section: Discussionmentioning

confidence: 99%

“…Analysis of continuous data has the potential to provide both flexibility and accuracy for the period of measurement [13]. This could easily be installed by a software modification.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…In a parallel study done in five patients using dialysate dilution and analysis of continuously recorded BVM data, the initial specific blood volume was 77.9 ± 12.9 ml/kg [13]. …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Simple and Feasible Method to Determine Absolute Blood Volume in Hemodialysis Patients in Clinical Practice

Kron¹,

Schneditz

Leimbach³

et al. 2014

Blood Purif

Self Cite

View full text Add to dashboard Cite

show abstract

Estimation of absolute blood volume in hemodialysis patients: A numerical algorithm for assessing blood volume increase after dialysate bolus infusion

Pstras,

Krenn,

Waniewski

et al. 2024

Biomedical Signal Processing and Control

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Vascular refilling coefficient is not a good marker of whole-body capillary hydraulic conductivity in hemodialysis patients: insights from a simulation study

Pstras

Waniewski

Lindholm

2022

Sci Rep

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Refilling of the vascular space through absorption of interstitial fluid by micro vessels is a crucial mechanism for maintaining hemodynamic stability during hemodialysis (HD) and allowing excess fluid to be removed from body tissues. The rate of vascular refilling depends on the imbalance between the Starling forces acting across the capillary walls as well as on their hydraulic conductivity and total surface area. Various approaches have been proposed to assess the vascular refilling process during HD, including the so-called refilling coefficient (Kr) that describes the rate of vascular refilling per changes in plasma oncotic pressure, assuming that other Starling forces and the flow of lymph remain constant during HD. Several studies have shown that Kr decreases exponentially during HD, which was attributed to a dialysis-induced decrease in the whole-body capillary hydraulic conductivity (LpS). Here, we employ a lumped-parameter mathematical model of the cardiovascular system and water and solute transport between the main body fluid compartments to assess the impact of all Starling forces and the flow of lymph on vascular refilling during HD in order to explain the reasons behind the observed intradialytic decrease in Kr. We simulated several HD sessions in a virtual patient with different blood priming procedures, ultrafiltration rates, session durations, and constant or variable levels of LpS. We show that the intradialytic decrease in Kr is not associated with a possible reduction of LpS but results from the inherent assumption that plasma oncotic pressure is the only variable Starling force during HD, whereas in fact other Starling forces, in particular the oncotic pressure of the interstitial fluid, have an important impact on the transcapillary fluid exchange during HD. We conclude that Kr is not a good marker of LpS and should not be used to guide fluid removal during HD or to assess the fluid status of dialysis patients.

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On-Line Dialysate Infusion to Estimate Absolute Blood Volume in Dialysis Patients

Cited by 30 publications

References 28 publications

A Simple and Feasible Method to Determine Absolute Blood Volume in Hemodialysis Patients in Clinical Practice

A Simple and Feasible Method to Determine Absolute Blood Volume in Hemodialysis Patients in Clinical Practice

Estimation of absolute blood volume in hemodialysis patients: A numerical algorithm for assessing blood volume increase after dialysate bolus infusion

Vascular refilling coefficient is not a good marker of whole-body capillary hydraulic conductivity in hemodialysis patients: insights from a simulation study

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