Reduced Complications during Hemodialysis by Automatic Blood Volume Controlled Ultrafiltration
| Autor: | Adelheid Gauly, Annemieke Dhondt, Ralf Wojke, E Tatsis, M Zahn, Jutta Passlick-Deetjen, Norazana Ibrahim, E Schuemann, J Engelmann, M Claus, H Hickstein, G Keusch, H Martin, W Boer, S Kuehne, D Garzoni, L Cremaschi, T Kleinoeder |
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| Rok vydání: | 2007 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Feedback control 030232 urology & nephrology Biomedical Engineering Ultrafiltration Medicine (miscellaneous) Blood Pressure Bioengineering Blood volume Hemodiafiltration 030204 cardiovascular system & hematology Biomaterials 03 medical and health sciences 0302 clinical medicine Renal Dialysis Humans Medicine Aged Muscle Cramp Blood Volume Cross-Over Studies business.industry General Medicine Surgery Hemodialysis Hypotension business |
| Zdroj: | The International Journal of Artificial Organs. 30:16-24 |
| ISSN: | 1724-6040 0391-3988 |
| Popis: | Background Intradialytic morbid events (IMEs, mostly hypotension) are frequent complications during hemodialysis (HD). This study investigated whether automatic feedback control via adjustment of the ultrafiltration rate reduces IME frequency. Methods In this multi-center cross-over study, 56 hypotension-prone patients were treated both with standard HD (sHD, applying a constant ultrafiltration rate) and HD applying a blood volume controlled ultrafiltration rate (cHD). The relative blood volume (RBV) was continuously monitored. The individual relative blood volume limit (RBVcrit) was determined from the measured RBV during initial sHD. During cHD, the ultrafiltration rate was automatically adjusted to keep the actual RBV above RBVcrit. Results In 3,081 HD treatments, slightly fewer IMEs were observed during cHD than during sHD (0.785±0.613 versus 0.695±0.547 per treatment, P=0.144). Less symptomatic events were seen during cHD: -13% for symptomatic hypotension (0.594 versus 0.685 per treatment, P=0.120), and -32% for cramps (0.049 versus 0.072 per treatment, P=0.009). Thirty-one patients with the highest IME rate (IME in at least every second treatment) especially benefited from cHD: 1.185±0.554 versus 0.979±0.543 IME per treatment (P=0.004). The reduction in blood pressure (BP) and the increase in heart rate were lower during the treatments with cHD than with sHD: systolic BP: -18.8±26.7 versus -22.2±28.9 mmHg (P=0.007), diastolic BP: -7.8±14.8 versus -9.1±15.3 mmHg (P=0.064), heart rate: 1.8±10.4 versus 2.3±11.6 per minute (P=0.014). Neither treatment duration nor ultrafiltration volume was significantly different between cHD and sHD. Conclusion For cHD, less intradialytic morbid events were observed than for sHD, and pre- to post-dialytic changes in blood pressure and heart rate were less pronounced. |
| Databáze: | OpenAIRE |
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