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Titolo ASN 2005 - [PUB410] Combined On-Line Analysis of Blood Volume-Curves and Calf-Bioimpedance-Curves Reveals Changes in Plasma Refilling Rate during Hemodialysis.
Autore Eric Seibert, Martin K. Kuhlmann, Fansan Zhu, Claudio Ronco, S. Johnson, A. Kaufman, Nathan W. Levin Clinical Research, Renal Research Institute, New York, NY; Nephrology, St. Bartolo Hospital, Vicenza, Italy; Beth Israel Medical Ctr., New York, NY
Referenza ASN 2005 - 8.11.2005 - 13.11.2005 Philadelphia, Pennsylvania, USA
Contenuto Intradialytic hypotension may result from an imbalance between ultrafiltration rate (UFR) and plasma refilling rate (PRR). BVM alone can not decide whether decreasing intravascular volume is due to reaching dry weight or UFR exceeding PRR. Assessment of excess extracellular fluid (ECV) is required for this decision. Continuous intradialytic calf bioimpedance spectroscopy (cBIS) monitors electrical resistance changes in the calf due to changes in calf ECV. We hypothesized that combined analysis of BVM and cBIS may allow better assessment of PRR and detection of a time point where UFR exceeds PRR as a result of reaching dry weight. Post-HD weight was reduced from baseline (BL) in 16 patients until dry weight according to cBIS criteria was reached [BIS-DW: Zhu, IJAO 2004]. cBIS (Hydra 4200, Xitron) and BVM curves were recorded continuously during HD and their slopes during the first 30 and last 20 minutes of 31 BL and 31 BIS-DW treatments were analyzed. In BL treatments, where dry weight was not reached, cBIS slopes were steeper during the first 30 compared to the last 20 minutes of HD (-1.84 1.39 vs. -1.0 1.27, p<0.01), while BVM slopes (Fresenius) did not differ. In BIS-DW treatments, cBIS slopes were significantly steeper than BVM slopes during the first 30 minutes of HD (-1.92 1.29 vs. -1.31 1.22, p<0.05). The mean ratio of BVM/cBIS slopes was 0.78 1.37. This relationship was reversed towards the end of BIS-DW treatments, when BVM slopes turned significantly steeper than cBIS slopes (-0.35 0.12 vs. -0.64 0.51, p= 0.05). The mean ratio of BVM/cBIS slopes became 2.17 5.68. The described change in the ratio gained statistical significance with p<0.01. Conclusions: Combined analysis of BVM and cBIS curves may be used to distinguish the cause of reduced PRR during HD. The reversal of the BVM/cBIS slope ratio after dry weight is reached, reflects a decrease in blood volume due to an imbalance between PRR and UFR. Continuation of UF beyond this time during HD will increase the risk for intradialytic hypotension
Data 20.12.2005
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