Steuer R, Germain M, Leypoldt J, Cheung A
Enhanced fluid removal guided by blood volume monitoring during
chronic hemodialysis
42nd Annual Conference of the ASAIO
ASAIO J
(May) 42:(2):83 1996
A potential new advance in dialysis patient monitoring is the on-line
hematocrit monitor developed
by In-Line Diagnostics, and which will be incorporated into the ALTHIN line
of dialysis machines.
The use of hematocrit monitoring to predict and prevent symptoms was
described by
Steuer et al in April AJKD
. In this paper, Steuer et al describe the use of Hct monitoring to
uncover patients with
covert fluid overload. The hypothesis is, that such patients will have
little or no increase in Hct
during dialysis.
Of 56 patients, 10 had an blood volume (BV) increase of < 5%, while in 46
the change was greater
than 5%. In these 10 patients, total UF volume was increased by a mean of
0.8 liters. This
resulted in a mean increase in BV from 4.2% to 15%, and a fall in
postdialysis weight of 0.7 kg.
Apparently there was no increase in symptoms associated with the increased
fluid removal.
There results are quite preliminary. Obviously one would like to see some
benefit of increased UF
in this "overloaded" group, such as improved blood pressure or some other
sign of fluid overload.
Nevertheless, my own experience is, that covert fluid overload is a
huge problem in dialysis
units, and I think this use of the Hct monitor may be ultimately more useful
than trying to
determine a crash crit. Nevertheless, definitive studies need to be done.
Ideally, one should
measure plasma ANP levels or some other marker of fluid overload, or study
interdialytic vena cava
diameters. Also, patients with substantial residual renal function should be
excluded, as obviously
such patients may be relatively euvolemic to begin with, and have low blood
volume changes during
dialysis. (John T. Daugirdas, M.D., University of Illinois at Chicago)
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42nd Annual Conference of the ASAIO
Basic hemodialysis :
Complications (acute)
Basic hemodialysis :
Dialysis machines