scholarly journals Relative blood volume changes during haemodialysis estimated from haemoconcentration markers

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
L. Pstras ◽  
J. Waniewski ◽  
A. Wojcik-Zaluska ◽  
W. Zaluska
Keyword(s):  
Blood Volume ◽  
Protein Concentration ◽  
Fluid Management ◽  
Blood Protein ◽  
Dialysis Session ◽  
Total Blood ◽  
Online Measurements ◽  
Exact Moment ◽  
The Moment ◽  
Relative Blood Volume

Abstract Relative blood volume (RBV) monitoring is frequently used in haemodialysis patients to help guide fluid management and improve cardiovascular stability. RBV changes are typically estimated based on online measurements of certain haemoconcentration markers, such as haematocrit (HCT), haemoglobin (HGB) or total blood protein concentration (TBP). The beginning of a haemodialysis procedure, i.e. filling the extracorporeal circuit with the patient’s blood (with the priming saline being infused to the patient or discarded) may be associated with relatively dynamic changes in the circulation, and hence the observed RBV changes may depend on the exact moment of starting the measurements. The aim of this study was to use a mathematical model to assess this issue quantitatively. The model-based simulations indicate that when the priming saline is not discarded but infused to the patient, a few-minute difference in the moment of starting RBV tracking through measurements of HCT, HGB or TBP may substantially affect the RBV changes observed throughout the dialysis session, especially with large priming volumes. A possible overestimation of the actual RBV changes is the highest when the measurements are started within a couple of minutes after the infusion of priming saline is completed.

Designing Robust Ultrafiltration Rate Profiles Based on Identifying Fluid Volume Model Parameters During Hemodialysis

2017 ◽  
Author(s):  
Rammah M. Abohtyra ◽  
C. V. Hollot ◽  
J. Horowitz ◽  
M. G. Germain ◽  
Y. Chait
Keyword(s):  
Blood Volume ◽  
Fluid Management ◽  
Adverse Outcomes ◽  
Fluid Volume ◽  
Model Parameters ◽  
Intradialytic Hypotension ◽  
Ultrafiltration Rate ◽  
Volume Model ◽  
Rate Profile ◽  
Relative Blood Volume

Chronic dialysis is a necessary treatment for end-stage kidney disease (ESKD) patients in order to increase life span, with hemodialysis (HD) being the dominant modality. Despite significant advances in HD technology, only half of ESKD patients treated with this modality survive more than 3 years. Fluid management remains one of the most challenging aspects of HD care, with serious implications for morbidity and mortality. Ultrafiltration has been associated with intradialytic hypotension, also associated with adverse outcomes. Therefore, removing a specified fluid volume to achieve an adequate balance without negative outcomes remains a critical challenge to improving patient outcomes. Therefore, it has been suggested that in addition to blood pressure information, routine HD treatments should include blood volume monitoring. Sensors integrated in dialysis machines are able to track the concentration of various blood components, such as hematocrit, with high accuracy and resolution and to derive a relative blood volume (RBV) changes. In this paper, we propose a novel algorithm to design an optimal, robust ultrafiltration rate profile based on identifying the parameters of a fluid volume model of an individual patient during HD and RBV sensor. Our design achieves, if exists, an optimal ultrafiltration profile for the identified nominal model under maximum ultrafiltration and hematocrit constraints, and guarantees that these constraints are satisfied over a pre-defined set of parameter uncertainty. We demonstrate the performance of our algorithm through a combination of clinical data and simulations.

scholarly journals Hemodialysis crossover study using a relative blood volume change-guided ultrafiltration control compared with standard hemodialysis: the BV-UFC study

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Susumu Ookawara ◽  
Kiyonori Ito ◽  
Takayuki Uchida ◽  
Keito Tokuyama ◽  
Satoshi Kiryu ◽  
...  
Keyword(s):  
Crossover Study ◽  
Blood Volume ◽  
Primary Outcome ◽  
Fluid Management ◽  
Feedback System ◽  
Intradialytic Hypotension ◽  
Hemodynamic Stability ◽  
Automatic Feedback ◽  
Limited Application ◽  
Relative Blood Volume

Abstract Background It has been difficult to sufficiently achieve body-fluid management using blood volume (BV) monitor during hemodialysis (HD) with constant ultrafiltration (UF) rate. Recently, a relative BV change-guided UF control (BV-UFC) system was developed by combining the concepts of an automatic feedback system that could control the UF rate and profile with real- time monitoring of relative changes in BV (%ΔBV). However, this system has limited application in the clinical setting. Therefore, in this study, we aimed to perform the crossover study on HD with BV-UFC compared to standard HD in terms of hemodynamic stability during HD. Methods Forty-eight patients entered an 8-week crossover period of standard HD or HD with BV-UFC. Prevalence of intradialytic hypotension (IDH) as a primary outcome and changes in blood pressure (BP), differences in %ΔBV, and achievement of the target ultrafiltration volume as secondary outcomes were compared. IDH was defined as a reduction in systolic BP ≥20 mmHg from the baseline value at 10 min after HD initiation. Results No significant differences were found in the prevalence of IDH, frequency of intervention for symptomatic IDH, and achievement of the target ultrafiltration volume between the groups. The %ΔBV was significantly fewer (-12.1 ± 4.8% vs. -14.4 ± 5.2%, p <0.001) in the HD with BV-UFC than that in the standard HD. Conclusions HD with BV-UFC did not reduce the prevalence of IDH compared with standard HD. The relief of a relative BV reduction at the end of HD may be beneficial in patients undergoing HD with BV-UFC. Trial Registration UMIN, UMIN000024670. Registered on December 1, 2016.

scholarly journals Relative Blood Volume Changes Underestimate Total Blood Volume Changes during Hemodialysis

2007 ◽  
Vol 2 (4) ◽  
pp. 669-674 ◽  
Author(s):  
Judith J. Dasselaar ◽  
Marjolijn N. Lub-de Hooge ◽  
Jan Pruim ◽  
Hugo Nijnuis ◽  
Anneke Wiersum ◽  
...  
Keyword(s):  
Blood Volume ◽  
Total Blood Volume ◽  
Volume Changes ◽  
Total Blood ◽  
Relative Blood Volume

scholarly journals Influence of multicomponent bacterial symbiotic substance on productive indices of pigs and metabolism

2019 ◽  
Vol 80 (4) ◽  
pp. 190-198
Author(s):  
S. O. Bibikov ◽  
S. O. Shapovalov ◽  
E. V. Kornilova ◽  
S. B. Vorozheykin ◽  
A. P. Sanzheev ◽  
...  
Keyword(s):  
White Blood Cells ◽  
Bifidobacterium Bifidum ◽  
Lactobacillus Bulgaricus ◽  
Blood Protein ◽  
Control Group ◽  
Chemical Research ◽  
Total Blood ◽  
Average Mass ◽  
Feed Digestibility ◽  
The Moment

Bacteria and bifidogenic drugs became more popular for animal’s treatment. The results of studying bacterial polycomponent symbiotic substance (PCBSS) effect on productive indicators of pigs with intensive cultivation technology was presented. Zootechnical, clinical, hematological, morphological, physico-chemical, research methods were used in experimental part. The effect of three and four course treatment with polycomponent bacterial symbiotic substance (PCBSS) was established. The lyophilized cells of lacto- and bifidobacteria Bifidobacterium bifidum and Lactobacillus bulgaricus was included in this drug. Due to this treatment the reduction of endogenous intoxication by metabolites of various genesis and normalization of the activity of marker transaminases, protein metabolism, activation of energy processes, increase digestibility of feed and increase animals mass were observed. To the moment of animals butchering the average mass of animals after 3 and 4 courses PKBSS exceeded the weight of animals in the control group by 7 kg (5.2%) and 10.7 (7.9%), respectively. The digestibility of dry matter feed by 3% was increased by PCBSS addition to the animals diet. The safety of pigs in the experimental groups was higher compared with the control by 3.4-17.5%. Due to the digestion of crude protein the digestion of organic matter was increased in experimental pigs groups. By leukocyte analysis in blood it was shown that use of PCBSS had a stimulating effect on the formation of white blood cells. At the end of the experiment it was found that for animals of the experimental groups the level of total blood protein was higher than in the control group by 0.66% and by 3.77%. Decreasing in the activity of marker transaminases: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, lactate dehydrogenase (LDH) was observed in experimental groups. The intestinal microbiota with its exogenous correction by PCBSS regulates the physiological processes of the animal, and this was confirmed by an increasing of animals body weight and changes in the biochemical reactions, by decreasing in mortality and by increasing in feed digestibility.

FC 095INCREASED VASCULAR REFILLING BY FEEDBACK-CONTROLLED ULTRAFILTRATION PROFILE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Susanne Kron ◽  
Til Leimbach ◽  
Joachim Kron
Keyword(s):  
Clinical Practice ◽  
Blood Volume ◽  
Venous Blood ◽  
Control Program ◽  
Wilcoxon Test ◽  
Dialysis Session ◽  
Bolus Administration ◽  
Before And After ◽  
On Line ◽  
Relative Blood Volume

Abstract Background and Aims Refilling volume has not been a measurable parameter in clinical practice so far, as knowing the absolute blood volume (BV) is a prerequisite. Recently, we developed a method to determine absolute BV, thus enabling quantification and comparison of the refilling volume under various conditions. In this study, we evaluated refilling with a constant UF rate and with a feedback-controlled UF profile. Method Forty dialysis patients were included and studied during their routine dialysis sessions. Absolute BV was determined by indicator dilution. Immediately at the beginning of the dialysis session (before UF was started), an on-line infusate bolus of 240 mL was injected into the venous blood line by pressing a button on the keypad of the dialysis machine 5008 (FMC). The resulting increase in relative blood volume before and after bolus administration (RBVpost-RBVpre) was used to calculate absolute BV: absolute BV (in mL) = bolus volume (240 mL) x 100 / increase in RBV (in %) Absolute BV at the end of dialysis was calculated as: absolute BVend = absolute BVbeginning x RBVend in % / 100 Refilling volume was calculated as: refilling volume = UF volume – (absolute BV beginning – absolute BV end) The refilling fraction is given as: Refilling fraction = refilling volume / UF volume UF was either set as constant UF rate or as UF profile. In contrast to the constant UF rate, the UF program integrated in the dialysis machine 5008 initially starts with twice the average UF rate. If half of the prescribed UF target is reached, the control program keeps UF and refilling in balance. Results Refilling data of 40 dialysis sessions with constant UF were compared to 40 sessions with the feedback-controlled UF profile. Refilling volumes were 1.72 ± 0.76 l during the profiled sessions and 1.60 ± 0.64 l in sessions with constant UF rate (p &lt; 0.001, Wilcoxon test). UF volumes were similar in both treatments (2.20 ± 0.90 and 2.26 ± 0.81 L, respectively). There was a strong correlation between refilling volume and UF volume in both treatments (r = 0.98 with profile, and r = 0.92 with constant UF rate, respectively). The refilling fraction was significantly higher (p &lt; 0.001, t-test) with the feedback-controlled UF profile (77.2 ± 8.5%) than with a constant UF rate (70.4 ± 9.9%). In one patient there was a higher refilling fraction with constant UF rate (p &lt; 0.0001). Symptomatic hypotension occurred in 3 patients, all in sessions with constant UF rate. Refilling was not lower in these 3 cases. Conclusion Refilling volume predominantly depended on UF volume. The refilling was improved by a high UF rate at the beginning of dialysis. This confirms previous data that initially high UF rates induce the refilling sooner, and, therefore, the refilling volume is higher with the same UF. An increased UF rate at the beginning can improve volume management in haemodialysis patients. With a UF profile, more volume can be removed while maintaining a stable absolute BV which may prevent hypotension in some cases. We therefore recommend that such UF profiles should be used more often in routine clinical practice. However, with every litre of UF volume, BV is reduced by more than 200 ml, at a constant UF rate even by approximately 300 ml. This must be taken into account when prescribing the UF volume.

Normal Values of Hemoglobin Mass and Blood Volume in Young, Active Women and Men

2019 ◽  
Vol 40 (04) ◽  
pp. 236-244 ◽  
Author(s):  
Roberto Falz ◽  
Sven Fikenzer ◽  
Stephan Hoppe ◽  
Martin Busse
Keyword(s):  
Lean Body Mass ◽  
Blood Volume ◽  
Body Mass ◽  
Normal Values ◽  
Fluid Management ◽  
Impedance Analysis ◽  
Total Blood ◽  
Entire Study ◽  
Young Subjects ◽  
Hemoglobin Mass

AbstractHemoglobin mass (Hbmass) and total blood volume (BV) determine the oxygen content in the blood. Varying anthropometric values are used to standardize blood volume and Hbmass. The aim of this study was to create normal values and to evaluate an anthropometric reference for Hbmass and BV. One hundred healthy young subjects participated in this study (50 women: 20.9±2.0 yr; 50 men: 23.2±2.9 yr). The Hbmass was measured twice by using a CO rebreathing method. The BV was calculated from the Hbmass, Hb concentration and hematocrit values. The lean body mass (LBM) was measured by a bio-impedance analysis. Women had a significant lower Hbmass per kg LBM compared with that of men (13.6±1.3 g vs. 16.1±1.7 g; p<0.0001). The BV per kg LBM tended to be lower in women than in men (105.3±8.4 ml vs. 108.7±9.0 ml; p=0.0548). LBM had the best correlation with Hbmass (r=0.9274) and BV (0.9233) when considering the entire study group. Normal values of Hbmass and BV could be potentially useful for fluid management and contribute to the diagnosis of blood disorders. For normalization and assessment of measured BV and Hbmass, lean body mass should be prioritized in future studies instead of body weight or body surface area.

Sign in / Sign up

Export Citation Format

Share Document