Concordance of absolute and relative plasma volume changes and stability of Fcells in routine hemodialysis. Issue 1 (5th August 2015)

• Record Type: Journal Article
• Authors: Schneditz, Daniel; Ribitsch, Werner; Schilcher, Gernot; Uhlmann, Matthias; Chait, Yossi; Stadlbauer, Vanessa
• Is Part Of: Hemodialysis international. Volume 20:Issue 1(2016)
• Page Start: 120
• Page End: 128
• Publication Date: 2015-08-05
• Subjects: Ultrafiltration -- hematocrit -- plasma volume -- monitoring; Hemodialysis -- Periodicals; Renal Dialysis -- Periodicals; Renal Dialysis -- Congresses; Hemodialysis, Home -- Congresses; 617.461059
• DOI: 10.1111/hdi.12338
• Languages: English
• ISSNs: 1492-7535

Abstract

Abstract: Central hematocrit ( H ) measurements are currently used to track the degree of ultrafiltration‐induced hemoconcentration with the aim to detect and prevent excessive intravascular fluid depletion during hemodialysis (HD). Failure to maintain hemodynamic stability is commonly attributed to the misinterpretation of H caused by an unaccountable increase in F cells, the ratio of whole‐body hematocrit to H . It was the aim to examine F cells under everyday conditions in a group of stable HD patients. Absolute plasma volume ( V p ) and H were concomitantly measured during routine HD in the extracorporeal system in hourly intervals by noninvasive and continuous technology (CritLine‐Instrument‐III) and indocyanine green dye dilution to derive relative plasma volumes from V p and H ( RPV p, RPV H ), respectively, and to calculate F cells . Thirteen patients were studied during two midweek treatments ( n = 26). Both absolute V p ( P < 0.05) and relative plasma volumes RPV H ( P < 0.001) decreased during HD. V p at any time point was positively correlated to RPV H ( r = 0.52). Moreover, relative plasma volumes RPV H and RPV p determined by independent techniques were identical and showed negligible bias (−0.2%) but considerable limits of agreement (−15.6% to +15.3%). F cells was stable and in the range of 0.9 ± 0.05 throughout HD and not different from the value assumed at the beginning of HD. Although F cells remains constant in patients on routine dialysis and relative plasma volumes ( RPV H and RPV p ) determined by independent techniques are therefore comparable, the variability of experimental conditions during dialysis and the limited accuracy of absolute volume measurements using available technology continues to complicate the ultrafiltration control problem.