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 < 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 < 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 < 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.

P1090DETERMINATION OF ABSOLUTE BLOOD VOLUME USING ONLINE DIALYSATE DILUTION: WHEN SHOULD BE MEASURED?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Susanne Kron ◽  
Daniel Schneditz ◽  
Til Leimbach ◽  
Joachim Kron
Keyword(s):  
Blood Volume ◽  
Venous Blood ◽  
Dry Weight ◽  
Time Frame ◽  
Colloid Osmotic Pressure ◽  
Study Patient ◽  
Dialysis Session ◽  
Bolus Volume ◽  
Simple Method ◽  
On Line

Abstract Background and Aims Current on-line haemodiafiltration (HDF) machines equipped with a blood volume monitor (BVM) and an on-line bolus function have the potential for measuring absolute blood volume (aBV). Recently, we developed a simple method to determine absolute BV in everyday dialysis sessions. The aim of the present study was to evaluate the reproducibility of measurements. Method Intra-individual reproducibility was studied in 10 patients during a single dialysis session by 4 measurements of absolute BV: immediately after beginning before ultrafiltration (UF) was started, and after one, two and three hours. ABV was determined by indicator dilution. A defined volume bolus of 240 mL dialysate was infused into the venous blood line by pressing the emergency button of the HDF machine 5008 (FMC). For this reason, total UF volume was increased by 1L. UF was automatically stopped during and after the infusion. The resulting increase in relative blood volume (RBVpost-RBVpre) was measured by the ultrasonic relative BVM incorporated in the dialysis machine. ABV was measured in hourly intervals and for assessment of reproducibility the volume at treatment start (t=0) where RBV is 100% was calculated for all measurements as: aBV in mL = bolus volume 240 mL x 100% / increase RBV in % ABV data were normalized for body mass at dry weight (in mL/kg). Additionally, in 5 patients the RBV graph was monitored immediately at the beginning of dialysis without UF in a separate dialysis session. Results ABV at t=0 were consistently larger when calculated from measurements done immediately after the beginning compared to measurements obtained after 1 h (6.52 ± 1.40 L or 80.6 ± 14.5 mL/kg vs. 5.16 ± 1.40 L or 63.9 ± 14.3 mL/kg). Specific BV derived from 2 and 3 h measurements did not significantly differ from the measured volumes after 1 hour (61.4 ± 13.8 mL/kg, and 60.9 ± 13.9 mL/kg). The standard deviations of the 3 examinations in the same study patient during a further course of dialysis were between 0.6 and 5.3 ml/kg (ø 2.6 ml/kg). In a separate session, RBV decreases without UF at the beginning of dialysis in the first 3 minutes by 0.5 % and in 5 minutes by 0.6 %. Conclusion If BV is diluted by additional priming volume and bolus volume, a part of this volume will leave the circulation. This represented the time frame where the bolus was initially infused and the measurements were carried out. This loss is caused by the reduction in plasma colloid osmotic pressure induced by the dilution thereby changing the microvascular filtration equilibrium. The increase in RBV display is not solely caused by the bolus volume in this time and, and therefore, calculated BV would be overestimated by about 17 mL/kg. If measurement is performed at a later time, UF will take place and, consequently, refilling. This inward drive matches the outward bolus escape as a counterforce. BV measurement during a further course of dialysis is well reproducible with a deviation of only ± 2.6 ml/kg. The method would therefore be sufficiently precise in clinical practice. Therefore, we propose the determination of aBV only after 1 hour dialysis when a sufficient refilling takes place. With a software modification, the BV measurement could be routinely automated during each dialysis treatment. Manufacturers are asked to implement this technology in their devices.

scholarly journals Oxidative Status before and after Renal Replacement Therapy: Differences between Conventional High Flux Hemodialysis and on-Line Hemodiafiltration

Nutrients ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 2809 ◽  
Author(s):  
José Alberto Navarro-García ◽  
Elena Rodríguez-Sánchez ◽  
Jennifer Aceves-Ripoll ◽  
Judith Abarca-Zabalía ◽  
Andrea Susmozas-Sánchez ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Antioxidant Defense ◽  
Oxidized Ldl ◽  
Oxidative Status ◽  
Dialysis Session ◽  
High Flux ◽  
Oxidative Markers ◽  
Before And After ◽  
Total Antioxidant ◽  
On Line

Hemodialysis patients experience high oxidative stress because of systemic inflammation and depletion of antioxidants. Little is known about the global oxidative status during dialysis or whether it is linked to the type of dialysis. We investigated the oxidative status before (pre-) and after (post-) one dialysis session in patients subjected to high-flux dialysis (HFD) or on-line hemodiafiltration (OL-HDF). We analyzed carbonyls, oxidized LDL (oxLDL), 8-hydroxy-2′-deoxyguanosine, and xanthine oxidase (XOD) activity as oxidative markers, and total antioxidant capacity (TAC), catalase, and superoxide dismutase activities as measures of antioxidant defense. Indices of oxidative damage (OxyScore) and antioxidant defense (AntioxyScore) were computed and combined into a global DialysisOxyScore. Both dialysis modalities cleared all markers (p < 0.01) except carbonyls, which were unchanged, and oxLDL, which increased post-dialysis (p < 0.01). OxyScore increased post-dialysis (p < 0.001), whereas AntioxyScore decreased (p < 0.001). XOD and catalase activities decreased post-dialysis after OL-HDF (p < 0.01), and catalase activity was higher after OL-HDF than after HFD (p < 0.05). TAC decreased in both dialysis modalities (p < 0.01), but remained higher in OL-HDF than in HFD post-dialysis (p < 0.05), resulting in a lower overall DialysisOxyScore (p < 0.05). Thus, patients on OL-HDF maintain higher levels of antioxidant defense, which might balance the elevated oxidative stress during dialysis, although further longitudinal studies are needed.

scholarly journals P1073NF-U OF A NEW POLYMETHYLMETHACRYLATE MEMBRANE IMPROVES THE NUTRITIONAL STATUS AND PATIENT-REPORTED SYMPTOMS OF ELDER DIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Tetsuro Chida ◽  
Hiroyuki Igarashi ◽  
Ikuto Masakane
Keyword(s):  
Nutritional Status ◽  
Serum Albumin ◽  
Dialysis Session ◽  
Subjective Symptoms ◽  
Dialysis Patients ◽  
Dialysis Vintage ◽  
Patient Reported ◽  
Before And After ◽  
On Line ◽  
Set Up

Abstract Background and Aims Malnutrition is the most powerful prognostic factor in dialysis patients, and elder dialysis patients have a higher risk of malnutrition because of multiple comorbidities and daily inactivity. Hence, it is very important to set up a dialysis prescription for preventing progression of malnutrition. We reported nutritional advantage of polymethylmethacrylate (PMMA) membrane for preventing dialysis patients from the progression of malnutrition in the previous report. NF-U has been developed with better hemocompatibility and lesser albumin leakage during the dialysis session than conventional PMMA membranes. We studied additional advantages of NF-U on the nutritional status, patient-reported symptoms and other clinical parameters in elder dialysis patients. Method This study was a retrospective one. 10 elder chronic dialysis patients of greater than 75 years old were enrolled into the study; 5 males and 5 females, the mean age was 82.8 years old, and the average dialysis vintage was 11.2 years. NF-U were installed because of low albuminemia, dry weight (DW) loss and other signs of malnutrition. The previous membrane materials were polyether polymer alloy (6), vitamin E coated polysulfone (1), on-line HDF with polyethersulfone (2) and polysulfone (1). On-line HDF were performed in predilution with the substitution volume of 12L/hr. During the observation period the dialysis prescription except dialysis membrane was not changed. Serum albumin, β2MG, CRP, nPCR, GNRI, ％CGR, DW, CTR were compared one month and four month after the replacement with NF-U. In consideration of the seasonal variation of nutritional status, DW and CTR were compared with that of one year before the study. The changes in body composition were analyzed by Inbody770® (Inbody Japan, Tokyo, Japan)at three months before and after the replacement with NF-U. We also evaluated patient-reported subjective symptoms by our original tool as “Patient-oriented Dialysis (POD)” system three months before and after NF-U installation. Results Serum albumin increased from 3.0g/dl to 3.3g/dl. GNRI increased from 87.7 to 91.4. %CGR increased from 91.9% to 102.8%. No significant changes were observed in β2MG, CRP and nPCR. Although DW had continuously decreased from 52.7kg to 51.7kg before NF-U installation, DW increased from 52.0kg to 52.7kg by NF-U. CTR did not change. Muscle volume and body fat mass also increased. Regarding subjective symptoms, total POD score was significantly improved and especially dialysis related fatigue was remarkably reduced by NF-U. Conclusion The current study clearly showed that NF-U of a new PMMA membrane improved the nutritional status of elder dialysis patients with higher risk of malnutrition although the study was a limited retrospective one. Furthermore, NF-U also improved patient-reported subjective symptoms such as fatigue which was reported as a mortality risk factor and the most important patient’s outcome. We have not yet established a golden standard or parameter to set up dialysis prescriptions properly to elder dialysis patients. However, improvement of nutritional status and fatigue are one of the most important parameters to expect better outcome of them. We conclude that NF-U should be one of the best choices to treat elder dialysis patients.

Regional Relative Blood Volume MR Maps of Meningiomas Before and After Partial Embolization

1998 ◽  
Vol 22 (1) ◽  
pp. 104-110 ◽  
Author(s):  
Roland Bruening ◽  
Ren H. Wu ◽  
Tarek A. Yousry ◽  
Christian Berchtenbreiter ◽  
Juergen Weber ◽  
...  
Keyword(s):  
Blood Volume ◽  
Before And After ◽  
Relative Blood Volume

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.

Optimizing Ultrafiltration Rate Profiles for the Estimation of Blood Volume During Hemodialysis

2015 ◽  
Author(s):  
C. V. Hollot ◽  
J. Horowitz ◽  
R. P. Shrestha ◽  
M. G. Germain ◽  
Y. Chait
Keyword(s):  
Clinical Practice ◽  
Blood Volume ◽  
Morbidity And Mortality ◽  
Ultrafiltration Rate ◽  
Non Invasive ◽  
Patient Morbidity ◽  
Volume Measurements ◽  
Relative Blood Volume ◽  
Volume Estimates ◽  
Initial Blood

Knowledge of a patient’s blood volume during hemodialysis is important as removing too much or too little fluid or removing it too fast has been associated with increased patient morbidity and mortality. Non-invasive absolute blood volume measurements are currently not available. We show how to estimate initial absolute blood volume from readily available relative blood volume measurements, but, in addition that blood volume estimates under present clinical practice will have high variance. We derive D-optimal ultrafiltration profiles for estimation of an individual’s initial blood volume, and demonstrate their performance by simulation.

Klein with Lacan: A Study on the Reception of Lacanian Ideas in Uruguay and Its Effects on Clinical Practices (1955–82)

2020 ◽  
Vol 22 (3) ◽  
pp. 341-361
Author(s):  
Gonzalo Grau-Pérez ◽  
J. Guillermo Milán
Keyword(s):  
Clinical Practice ◽  
Clinical Material ◽  
Clinical Practices ◽  
Before And After ◽  
The Difference ◽  
The 1960S ◽  
The Relationship ◽  
Discursive Approach ◽  
The Way ◽  
Clinical Cases

In Uruguay, Lacanian ideas arrived in the 1960s, into a context of Kleinian hegemony. Adopting a discursive approach, this study researched the initial reception of these ideas and its effects on clinical practices. We gathered a corpus of discursive data from clinical cases and theoretical-doctrinal articles (from the 1960s, 1970s and 1980s). In order to examine the effects of Lacanian ideas, we analysed the difference in the way of interpreting the clinical material before and after Lacan's reception. The results of this research illuminate some epistemological problems of psychoanalysis, especially the relationship between theory and clinical practice.

ADRENAL 17-HYDROXYCORTICOSTEROID SECRETION IN THE DOG IN RESPONSE TO ETHANOL

1972 ◽  
Vol 70 (4) ◽  
pp. 736-740 ◽  
Author(s):  
T. Suzuki ◽  
R. Higashi ◽  
T. Hirose ◽  
H. Ikeda ◽  
K. Tamura
Keyword(s):  
Venous Blood ◽  
Secretion Rate ◽  
Conscious Dogs ◽  
Blood Samples ◽  
Before And After

ABSTRACT Conscious dogs were infused intravenously with ethanol in doses of 0.7 and 1.0 g/kg. The adrenal venous blood samples were collected before and after the infusion of ethanol and analysed for 17-hydroxycorticosteroids (17-OHCS). After the infusion of 0.7 g/kg (subanaesthetic dose) of ethanol the adrenal 17-OHCS secretion rate showed either a slight increase or no change. After the infusion of 1.0 g/kg (anaesthetic dose) of ethanol the adrenal 17-OHCS secretion rate increased markedly and reached 1.21±0.15 (mean±sem) μg/kg/min, while it was 0.09±0.023 μg/kg/min before the infusion.

EFEKTIVITAS BOOKLET TERHADAP PENGETAHUAN DAN SIKAP PEMELIHARAAN KESEHATAN GIGI MULUT PADA IBU HAMIL

2019 ◽  
Vol 4 (1) ◽  
pp. 66
Author(s):  
Rahmaini Fitri
Keyword(s):  
Oral Health ◽  
Pregnant Women ◽  
The Body ◽  
Wilcoxon Test ◽  
Percentage Increase ◽  
Oral Diseases ◽  
Health Maintenance ◽  
Knowledge And Attitudes ◽  
Before And After ◽  
Knowledge And Attitude

Pregnancy causes physiological changes in the body and as well as in the oral cavity. Dental and oral diseases associated with pregnancy that is, gingivitis, periodontitis and pregnancy granuloma. Mouth dental disease during pregnancy is not only influenced by the pregnancy itself but rather the lack of knowledge about dental and oral health maintenance. Efforts to improve the knowledge of pregnant women about oral health is done by providing information, information necessary for health education media. In this case the media is created and used to improve the knowledge of pregnant women is the booklet. This study aimed to analyze the differences in knowledge and attitudes before and after maintenance booklet oral health in pregnant women. This study is a quasi experiment with one group pre  and post test design. The sample is the first trimester pregnant women who come to the health center in Sentosa Baru Medan as many as 34 people. Analysis of the data  forcompare the average difference in scores of knowledge and attitudes before and after the intervention used the Wilcoxon test. The results showed there is an increased knowledge and attitude maintenance of oral health in pregnant women after being given a booklet with a value of p < 0.001, a percentage increase of 30% knowledge and attitudes percentage of 37%. The conclusions of this study is increased knowledge and attitude maintenance of oral health in pregnant women after being given a booklet.

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