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

Susumu Ookawara,Kunihiko Yoshiya,Norio Hanafusa,Satoshi Kiryu,Yoshiyuki Morishita,Takayuki Uchida,Keito Tokuyama,Kaoru Tabei,Haruhisa Miyazawa,Takeshi Suganuma,Osamu Iimura,Kiyonori Ito,Kyoko Hojyo,Chiharu Ito,Yuichiro Ueda

doi:10.1186/s41100-020-00295-8

Abstract

BackgroundIt 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.MethodsForty-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.ResultsNo 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.ConclusionsHD 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 RegistrationUMIN, UMIN000024670. Registered on December 1, 2016.

Highlights

Excessive body- fluid removal has been known to result in intradialytic hypotension (IDH) through the impairment of plasma refilling from the interstitium to the capillary circulation [1]
This event is more likely to occur at the late phase of hemodialysis (HD) [2], mainly due to the development of hemodynamic instability associated with ultrafiltration (UF)- induced blood volume (BV) reduction
In this study, we aimed to perform the crossover study on HD with BV change-guided UF control (BV-UFC) compared to standard HD in terms of hemodynamic stability, including the prevalence of IDH, as a primary outcome, and changes in blood pressure (BP), differences in %ΔBV, and achievement of the target UF volume (UFV) at the end of HD as secondary outcomes

Summary

Introduction

Excessive body- fluid removal has been known to result in intradialytic hypotension (IDH) through the impairment of plasma refilling from the interstitium to the capillary circulation [1] This event is more likely to occur at the late phase of hemodialysis (HD) [2], mainly due to the development of hemodynamic instability associated with ultrafiltration (UF)- induced blood volume (BV) reduction. 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). This system has limited application in the clinical setting. 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

Objectives

Methods

Results

Conclusion