Document Detail

A new method to evaluate patient characteristic response to ultrafiltration during hemodialysis.
MedLine Citation:
PMID:  17551900     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Several factors are involved in the pathogenesis of dialysis discomfort interfering with optimal fluid removal and reducing the efficacy of the treatment; the most important one is a decrease in blood volume caused by an imbalance between ultrafiltration (UF) and plasmarefilling (PR) rates. OBJECTIVES: This study is aimed at devising a method to tailor the dialysis therapy to each individual patient, by analyzing the relationship between PR and UF during the sessions in stable patients and widening the knowledge of fluid exchanges during the treatment. METHODS: Thirty stable patients undergoing maintenance hemodialysis were enrolled. Three dialysis sessions were monitored for each patient; systemic pressure, blood composition, blood volume % variation, weight loss and conductivity were recorded repeatedly. A Plasma Refilling Index (PRI), defined and calculated by means of parameters measured throughout the dialysis, was introduced as a novel instrument to study plasma refilling phenomena. Results. The PRI provides understanding of patient response (in terms of plasma refilling) to the set UF. In the monitored sessions, the PRI trend is found to be characteristic of each patient; a PRI course that is at variance with the characteristic trend is a signal of inadequate or unusual dialysis scheduling. Moreover, statistical analysis highlights two different PRI trends during the first hour and during the rest of the treatment, suggesting the presence of different treatment phases. CONCLUSION: The main advantage of the PRI index is that it is non-invasive peculiar to each patient and easy to compute in a dialysis routine based on online data recorded by the monitor. A deviation from the characteristic trend may be a warning for the clinician. The analysis of the PRI trend also suggests how to modulate UF as a function of interstitial to intravascular fluid removal balance during dialysis.
G Casagrande; U Teatini; G Romei Longhena; F Miglietta; R Fumero; M L Costantino
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The International journal of artificial organs     Volume:  30     ISSN:  0391-3988     ISO Abbreviation:  Int J Artif Organs     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-06-06     Completed Date:  2007-10-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802649     Medline TA:  Int J Artif Organs     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  377-84     Citation Subset:  IM    
Laboratory of Biological Structure Mechanics (LaBS), Department of Structural Engineering, Politecnico di Milano, Milan, Italy.
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MeSH Terms
Blood Pressure
Blood Volume
Body Water
Monitoring, Physiologic*
Plasma Volume*
Renal Dialysis*
Weight Loss

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