The Evaluation of Filtration Coefficients of Microvasculature for the Assessment of Fluid Status in Hemodialysis Patients

Yashiro, Masatomo; Ochiai, Miyuki; Fujisawa, Nao; Kadoya, Yuko; Kamata, Tadashi

doi:10.5301/ijao.5000167

Cited by 7 publications

(10 citation statements)

References 21 publications

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“…19,23 It was shown that the end-of-session value of a time-dependent L p might be a useful indicator in assessment of the fluid status of HD patients. 25 The purpose of our study was to investigate the kinetics of the refilling process by assessing Kr for two standard HD sessions with: 1) shorter predialytic interval before the dialysis session and shorter session duration (SH), and 2) longer predialytic interval before the session and longer session duration (lH), in each of nine clinically stable HD patients. According to the design of the study, we investigated if and how the difference in fluid overload (FO) between sessions was reflected in the magnitude and kinetic behavior of the refilling coefficient.…”

mentioning

confidence: 99%

Kinetics of Plasma Refilling During Hemodialysis Sessions with Different Initial Fluid Status

Pietribiasi

Katzarski²,

Galach

et al. 2015

ASAIO Journal

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Removal of fluid excess from the plasma volume by ultrafiltration during hemodialysis (HD) is balanced by plasma refilling from the interstitium, driven mainly by the increase in plasma oncotic pressure. We calculated the plasma refilling coefficient (Kr, a parameter expressing the ratio of refilling rate to the increase in oncotic pressure) for nine patients, each undergoing two HD sessions differing by pretreatment fluid status and session time (shorter session, SH, 3.5 h, and longer session, LH, 4.5h). Relative blood volume change was measured online, and solute concentrations were measured regularly during the sessions. The volume of body compartments was measured by bioimpedance. The patients were more volume expanded before LH session (higher initial body mass and total body water). Oncotic pressure was similar for both sessions. The refilling rate, despite higher fluid overload in the LH sessions, was similar for both sessions. The final Kr values stabilized on similar levels (SH: 136.6 ± 55.6 ml/mm Hg/h and LH: 150.7 ± 73.6 ml/mm Hg/h) at similar times, notwithstanding the difference in initial fluid overload between the two groups, suggesting that Kr at dry weight is relatively insensitive to the initial fluid status of the patient.

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confidence: 99%

Kinetics of Plasma Refilling During Hemodialysis Sessions with Different Initial Fluid Status

Pietribiasi

Katzarski²,

Galach

et al. 2015

ASAIO Journal

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“…Apart from blood volume and extracellular fluid volume, other physiological parameters relating to the blood volume refilling rate are whole body capillary surface area and its functional correlate, whole body filtration coefficient (26,(32)(33)(34)(35)(36). Lymphatic flow rate may also be important (37).…”

Section: Other Mechanistic Factorsmentioning

confidence: 99%

Hemodialysis Ultrafiltration Rate Targets Should Be Scaled to Body Surface Area Rather than to Body Weight

Daugirdas

Schneditz

2017

Seminars in Dialysis

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The association between higher ultrafiltration rates and poor outcomes in hemodialysis patients has received increased attention, to the point that various regulatory entities are considering adding ultrafiltration rate as a quality measure to be monitored and controlled. Most of the discussion to date has focused on ultrafiltration rate scaled to body weight, or more correctly, body mass (ml/hour per kg). One outcome study suggests that ultrafiltration rate might best be not scaled at all to body size, as modestly higher ultrafiltration rate in very small-size patients may be associated with some survival benefit, probably via increased dietary intake. Outcomes studies also suggest that the risk of exceeding a weight-scaled ultrafiltration target may be magnified in very large patients, and that body weight-scaled ultrafiltration targets in such patients should be set a lower level. Here, we present an analysis, based on physiological hemodynamic arguments, that it would be better to scale ultrafiltration rate to body surface area rather than to body mass. Whatever ultrafiltration rate is scaled to, attempts to restrict ultrafiltration rate by limiting interdialytic weight gain in small, possibly malnourished patients, should be done cautiously, to prevent an inadvertent lowering of intake of calories and dietary protein.

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“…AdjLpst was calculated by the method that we reported previously (4,6). The detailed method to calculate AdjLpst is shown in these reports.…”

Section: Measurementsmentioning

confidence: 99%

“…On the other hand, there was no significant difference between the agreement of AdjLpst with ANP and that of ExF/DW with it. Patient 4, for whom three out of a total of seven measurements were located in quadrant D, suffered from (3,4,5,6,8,9), significant positive correlations of the two markers are found. In nine patients (2,3,5,7,8,9,10,11,12), equal to or more than 80.0% of evaluations by AdjLpst and those by ExF/DW agreed.…”

mentioning

confidence: 90%

“…Macheck et al described a method to guide optimization of fluid status by utilizing ExF (3). We reported the usefulness of adjusted filtration coefficients of microvasculature (AdjLpst) for evaluation of the fluid status (4). AdjLpst is the hydraulic permeability of microvasculature adjusted for ultrafiltration rate (UFR) and was shown to have a significant positive correlation with ExF divided by dry weight (ExF/DW).…”

Section: Introductionmentioning

confidence: 99%

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Patient‐Specific Relationship Between Hydraulic Permeability of Microvasculature and the Extent of Burden of Excess Fluid in Hemodialysis Patients

et al. 2016

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We have reported a significant correlation between hydraulic permeability of microvasculature adjusted with ultrafiltration rate (AdjLpst) and excess fluid divided by dry weight (ExF/DW) in a cross-sectional study of hemodialysis patients. We aimed to study longitudinally whether a similar relationship between them exists in each patient. Twelve hemodialysis (HD) patients in whom AdjLpst and ExF/DW had been measured more than four times (total of 85 measurements) were enrolled. AdjLpst was calculated by monitoring blood volume during HD. ExF was calculated from the fluid volume measured via bioimpedance spectroscopy. The borders of overhydration were 1.66 mL/mm Hg per min for AdjLpst and a positive value for ExF/DW. There was a significant correlation between AdjLpst and ExF/DW (r = 0.517). When the 85 measurements were classified into four quadrants according to ExF/DW and AdjLpst, the evaluations of fluid status agreed in 66 measurements. In six patients, significant positive correlations were found. In nine patients, equal to or more than 80.0% of evaluations by AdjLpst and those by ExF/DW agreed. In only one patient was there neither significant correlation nor agreement. AdjLpst of two patients suffering from chronic heart failure and microscopic polyangiitis was reduced compared with that of others loaded with the same extent of excess fluid. We concluded that there was a significant correlation between AdjLpst and ExF/DW and high agreement between evaluation by AdjLpst and evaluation by ExF/DW in the majority of patients. However, the relationship between them was patient-specific to some extent.

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The Evaluation of Filtration Coefficients of Microvasculature for the Assessment of Fluid Status in Hemodialysis Patients

Abstract: AdjLpst can detect patients of the EX group more accurately than other tests. Because AdjLpst is related to plasma refilling, it may indicate removable fluid overload. AdjLpst in conjunction with BIS may contribute to more adequate fluid management.

Cited by 7 publications

References 21 publications

Kinetics of Plasma Refilling During Hemodialysis Sessions with Different Initial Fluid Status

Kinetics of Plasma Refilling During Hemodialysis Sessions with Different Initial Fluid Status

Hemodialysis Ultrafiltration Rate Targets Should Be Scaled to Body Surface Area Rather than to Body Weight

Patient‐Specific Relationship Between Hydraulic Permeability of Microvasculature and the Extent of Burden of Excess Fluid in Hemodialysis Patients

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