Key result
Continuous measurement of absolute plasma refill rate during hemodialysis showed a significant decrease in the first hour from 21 to 9 ml/min, which was unaffected by AES or HAES.
Why the study?
Does a feedback-regulated ultrafiltration algorithm allow continuous measurement of absolute plasma refill rate in hypotension-prone hemodialysis patients?
Does a feedback-regulated ultrafiltration algorithm allow continuous measurement of absolute plasma refill rate in hypotension-prone hemodialysis patients?
Continuous, online measurement of refill patterns using feedback-regulated ultrafiltration reveals a rapid fall in refill during early dialysis, which may help accurately estimate dry weight.
Answers are grounded in this paper and cite their sources.
Early plasma refill decline observed via feedback ultrafiltration in one case; hypothesis-generating for refining dry weight targets in hypotension-prone hemodialysis.
Methods to continuously measure absolute refill during dialysis are not available. It would be useful to have such a method because it would allow investigating the mechanism of refill the effect of interventions. We designed a feedback algorithm that adjusts ultrafiltration rate (QUF) according to hemoglobin (Hb) concentration changes in such a way that relative blood volume (BV) remains constant within a narrow target range. In this situation, the generated QUF quantitatively reflects refill. Refill patterns were studied in five hypotension prone patients. In addition, on separate occasions, we studied the effect of antiembolism stockings (AES) and infusion of hydroxy-ethylated starch (HAES) on refill in these patients. Refill during the first hour fell significantly from 21 +/- 3 ml/min to 9 +/- 2 ml/min (p < 0.05). In the second hour, refill decreased further and became zero in four out of five patients. Neither AES nor HAES measurably affected refill. The marked and rapid fall in refill in the early stages of dialysis suggests untimely depletion of the interstitial compartment and underestimation of dry weight. We propose that continuous, online measurement of refill patterns may be of value for accurate estimation of dry weight in dialysis patients.
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Brummelhuis et al. (2008) studied Hemodialysis with hypotension proneness (n=5). Feedback regulated ultrafiltration, antiembolism stockings (AES), and hydroxy-ethylated starch (HAES) was evaluated on Absolute plasma refill rate (p=< 0.05). Continuous measurement of absolute plasma refill rate during hemodialysis showed a significant decrease in the first hour from 21 to 9 ml/min, which was unaffected by AES or HAES.
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