A New Approach to Blood Pressure and Blood Volume Modulation during Hemodialysis: An Adaptive Fuzzy Control Module

1995 ◽  
Vol 18 (9) ◽  
pp. 513-517 ◽  
Author(s):  
M. Nordic ◽  
S. Giove ◽  
S. Lorenzi ◽  
P. Marchini ◽  
E. Saporiti
Keyword(s):  
Blood Pressure ◽  
Fuzzy Control ◽  
Blood Volume ◽  
Adaptive Fuzzy Control ◽  
Control Variable ◽  
Dry Weight ◽  
Dialysis Session ◽  
Ultrafiltration Rate ◽  
New Approach ◽  
Value Net

The paper proposes a fuzzy logic based procedure able to control as far as possible the behaviour of the blood pressure of a patient during a dialysis session, allowing him to reach the foreseen dry weight. A PI discrete-time fuzzy control is used in order to compare the controlled variables concerning the (blood pressure and blood volume) to the reference values. Two different reference tables, concerning the pressure and volume errors and rates are introduced, then the proposed control actions are mixed in order to obtain the final value (net ultrafiltration rate). A smooth function of volemia acts on the second control variable, Na concentration in the dialysate. The adaptive control system was simulated on an IBM-PC, rules and terms were expressed by linguistic judgements like: IF “situation”, THEN “action”. A pre-processor converts the rules into the numerical values of the reference tables. The obtained simulation results are satisfactory, the introduction of the Na control allows reaching the target dry weight of the patient with a stable blood pressure.

Projection and Simulation Results of an Adaptive Fuzzy Control Module for Blood Pressure and Blood Volume During Hemodialysis

ASAIO Journal ◽  
1994 ◽  
Vol 40 (3) ◽  
pp. M686-M690 ◽  
Author(s):  
Maurizio Nordio ◽  
Silvio Giove ◽  
Santino Lorenzi ◽  
Pietro Marchini ◽  
Fabio Mirandoli ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Fuzzy Control ◽  
Blood Volume ◽  
Adaptive Fuzzy Control ◽  
Control Module ◽  
Adaptive Fuzzy ◽  
Simulation Results

scholarly journals SaO043FROM DRY WEIGHT TO TARGET BLOOD VOLUME: A NEW APPROACH TO AUTOMATED VOLUME MANAGEMENT IN HAEMODIALYSIS

2018 ◽  
Vol 33 (suppl_1) ◽  
pp. i333-i333
Author(s):  
Susanne Kron ◽  
Daniel Schneditz ◽  
Til Leimbach ◽  
Klemens Budde ◽  
Joachim Kron
Keyword(s):  
Blood Volume ◽  
Dry Weight ◽  
New Approach ◽  
Volume Management

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.

Evidence of Profiled Hemodialysis Efficacy in the Treatment of Intradialytic Hypotension

1998 ◽  
Vol 21 (7) ◽  
pp. 398-402 ◽  
Author(s):  
L. Colì ◽  
G. La Manna ◽  
V. Dalmastri ◽  
A. De Pascalis ◽  
G. Pace ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Volume ◽  
Sodium Concentration ◽  
Dialysis Session ◽  
Intradialytic Hypotension ◽  
Dialysis Patients ◽  
Non Invasive ◽  
Comparison Of The Results ◽  
Weight Decrease ◽  
Dialysate Sodium

In the last 10 years the percentage of dialysis patients suffering from clinical intradialytic intolerance has greatly increased. Profiled hemodialysis (PHD) is a new technical approach, alternative to standard hemodialysis (SHD) for the treatment of intradialytic symptomatic hypotension. It is based on intradialytic modulation of the dialysate sodium concentration, using a dialysate sodium concentration profile elaborated by a new mathematical kinetic model. The aim of PHD is to reduce the intradialytic blood volume decrease, thanks to a dialysate sodium profile, which allows a reduction in the plasma osmolarity decrease, thereby boosting intravascular fluid refilling. This work aims at clinically validating the PHD technique, by testing its ability, against SHD, to maintain a more stable intradialytic blood volume; this evaluation was supported by monitoring some hemodynamic parameters. Twelve dialysis patients on SHD treatment were selected because of their intradialytic symptomatic hypotension. Twelve SHD (one per patient) and 12 PHD sessions (one per patient) were performed to achieve the same sodium mass removal and body weight decrease on both PHD and SHD. During these sessions we monitored the blood volume variation % by the critline (a non invasive blood volume monitoring device), the mean blood pressure and heart rate directly and, finally, the stroke volume and cardiac output indirectly by bidimensional doppler-echocardiography. Comparison of the results obtained with the two techniques shows PHD to achieve a significantly more stable blood volume, blood pressure and cardiovascular function than SHD, in particular during the second and the third hour of the dialysis session.

scholarly journals Correlation Between Predialysis Systolic Blood Pressure and Predialysis Hydration Status in Hemodialysis Patients

2018 ◽  
Vol 3 (4) ◽  
pp. 1025-1030
Author(s):  
Magdalena Castro ◽  
Rodrigo Orozco ◽  
Pedro Figueroa ◽  
Cristina Hertz ◽  
Victoria Aspillaga
Keyword(s):  
Blood Pressure ◽  
Body Weight ◽  
Systolic Blood Pressure ◽  
Total Body Water ◽  
Pearson Correlation ◽  
Body Water ◽  
Hydration Status ◽  
Dialysis Session ◽  
Ultrafiltration Rate ◽  
Total Body

One of the goals of hemodialysis is to maintain normal hydration status in ESRD patients. Pre hemodialysis systolic blood pressure is usually used as a clinical parameter of hydration status and to set ultrafiltration rate before Hd. It is unclear how much pre-Hd SBP correlated with hydration status. The aim was to determine correlation between pre-Hd SBP and hydration status before Hd. An observational correlation study was performed in two dialysis centers in Santiago, Chile, from January-June, 2011. Adult patients in Hd for at least three months, who gave their informed consent were included. Patients with pacemaker, amputee, hospitalized and metallic prostheses were excluded. Total-body water and overhydrated were assessed with bioimpedance spectroscopy before the first and third dialysis session of the week. Pre-Hd SBP, pre-Hd body weight, pre-Hd TBW and pre-Hd OH, were analyzed using Pearson correlation and linear regression model. 96 measurements were assessed, 52 % were male with median age 59.5 years. The correlation between pre-Hd SBP and pre-Hd overhydration was r=0.33, and total body water r=0.15, with a predicted value, R2=0.10 and R2 =0.14 respectively. Pre-Hd SBP had low correlation with pre-Hd hydration status and by itself, is not a reliable parameter to set ultrafiltration rate before Hd. Nevertheless Pre-Hd body weight predicted in 70 % the pre-Hd TBW.

scholarly journals Relationship between Dose of Bolus Dialysate Infusion and Blood Pressure in Intermittent Infusion Hemodiafiltration

2019 ◽  
Vol 48 (1) ◽  
pp. 27-32
Author(s):  
Shigeru Otsubo ◽  
Kei Eguchi ◽  
Michio Mineshima ◽  
Ken Tsuchiya ◽  
Kosaku Nitta
Keyword(s):  
Blood Pressure ◽  
Intermittent Infusion ◽  
Dry Weight ◽  
Optimal Dose ◽  
Fluid Volume ◽  
Maintenance Hemodialysis ◽  
Dialysis Session ◽  
Intradialytic Hypotension ◽  
Bolus Infusion ◽  
The Difference

Background: Intermittent infusion hemodiafiltration is a recently developed convective method of renal replacement therapy using cyclic back-filtration infusion. Quick and regular infusion prevents intradialytic hypotension. However, the optimal dose of bolus dialysate infusion required to stabilize blood pressure has not been reported. Here, we investigated the relationship between the dose of bolus dialysate infusion and blood pressure. Summary: A total of 77 patients on maintenance hemodialysis were enrolled in this study. Dialysate was infused rapidly by backward filtration at a rate of 150 mL/min at 30-min intervals using an automated dialysis machine. The effects with two bolus infusion volumes (100 and 200 mL) were compared, each for an observation period of 2 weeks. Systolic blood pressure (SBP) was measured at the start and at the end of each dialysis session, and the highest SBP and lowest SBP measurements were also recorded. Patients were divided according to dry weight into a <52 kg group and a ≥52 kg group, and various parameters were compared between the 100 and 200 mL bolus infusion volumes in each group. Among patients in the <52 kg group, SBP did not vary at any of the time points. However, for patients in the ≥52 kg group, SBP at the end of treatment was significantly lower in the 100-mL group than in the 200-mL group (141 ± 20 vs. 144 ± 21 mm Hg, p = 0.041), and the minimum SBP was also lower in the 100-mL group than in the 200-mL group (127 ± 17 vs. 131 ± 18 mm Hg, p = 0.010). Key Messages: Among patients with a dry weight of ≥52 kg, blood pressure was more stable when a bolus fluid volume of 200 mL was used, compared with a volume of 100 mL. However, for patients with a dry weight of <52 kg, the significance of the difference in bolus fluid volumes disappeared. Thus, the replacement fluid volume might be better determined based on the patient’s dry weight. Trial Registration: UMIN 000028145, Registered July 10, 2017.

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