Abstract
BackgroundAbsolute blood volume (ABV) is a critical component of fluid status, which may inform target weight prescriptions and hemodynamic vulnerability of dialysis patients. Here, we utilized the changes in relative blood volume (RBV), monitored by ultrasound (BVM) upon intradialytic 240 mL dialysate fluid bolus-infusion 1 h after hemodialysis start, to calculate the session-specific ABV. With the main goal of assessing clinical feasibility, our sub-aims were to (i) standardize the BVM-data read-out; (ii) determine optimal time-points for ABV-calculation, “before-” and “after-bolus”; (iii) assess ABV-variation.MethodsWe used high-level programming language and basic descriptive statistics in a retrospective study of routinely measured BVM-data from 274 hemodialysis sessions in 98 patients.ResultsRegarding (i) and (ii), we automatized the processing of RBV-data, and determined an algorithm to select the adequate RBV-data points for ABV-calculations. Regarding (iii), we found in 144 BVM-curves from 75 patients, that the average ABV ± standard deviation was 5.2 ± 1.5 L and that among those 51 patients who still had ≥2 valid estimates, the average intra-patient standard deviation in ABV was 0.8 L. Twenty-seven of these patients had an average intra-patient standard deviation in ABV <0.5 L.ConclusionsWe demonstrate feasibility of ABV-calculation by an automated algorithm after dialysate bolus-administration, based on the BVM-curve. Based on our results from this simple “abridged” calculation approach with routine clinical measurements, we encourage the use of multi-compartment modeling and comparison with reference methods of ABV-determination. Hopes are high that clinicians will be able to use ABV to inform target weight prescription, improving hemodynamic stability.
Highlights
Fluid homeostasis is among the most complex physiological entities known to the medical sciences [1]. It can become deranged in a variety of conditions such as intensive medical care [2, 3], cardiac failure [4, 5], and chronic kidney disease (CKD) [6, 7]
Once CKD patients are on dialysis, optimal fluid management is essential for avoiding deleterious consequences at both ends of fluid dysbalance [8]
At the Chronic Hemodialysis (CHD) Unit of the Vienna General Hospital, dialysate bolus administration for Absolute blood volume (ABV) determination was introduced into routine clinical practice as of September 2019
Summary
Fluid homeostasis is among the most complex physiological entities known to the medical sciences [1]. It can become deranged in a variety of conditions such as intensive medical care [2, 3], cardiac failure [4, 5], and chronic kidney disease (CKD) [6, 7]. Clinical “dry weight,” originally defined as the target weight in a (hemo) dialysis (HD) patient at which the patient could not tolerate further fluid removal during the “probing dry weight” strategy, is not necessarily the same as the patient’s euvolemic weight, determined by objective measures [9]. With the main goal of assessing clinical feasibility, our sub-aims were to (i) standardize the BVM-data read-out; (ii) determine optimal time-points for ABV-calculation, “before-” and “after-bolus”; (iii) assess ABV-variation
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