Individually adjusted absolute blood volume feedback control: A promising solution for intradialytic hypotension

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2023-02-14 DOI:10.1111/hdi.13074

Marta Álvarez Nadal, Nuria Rodríguez Mendiola, Martha Elizabeth Díaz Domínguez, Milagros Fernández Lucas

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引用次数: 2

Abstract

Introduction

Intradialytic hypotension (IDH) remains one of the most frequent complications associated to hemodialysis (HD), frequently triggered by a reduction in absolute blood volume (ABV) not compensated by vascular refilling. A recently developed dilutional method allows routinary measurement of ABV and, by a simple algorithm, may turn blood volume monitor (BVM) guided UF (ultrafiltration) biofeedback into an ABV control, automatically adjusting UF rate to maintain ABV above a preset threshold. The aim of this study is to identify an individual critical ABV threshold and test the ability of an ABV feedback control to avoid IDH.

Methods

We studied 24 patients throughout three consecutive midweek HD treatments. ABV and blood pressure (BP) were measured every 30 min and anytime the patient referred any symptoms to identify each patient's critical ABV (ABV at the time of hypotension). A fixed bolus dilution approach at the start of HD was used to calculate ABV. Then, patients were followed through three additional HD treatments and IDH development was analyzed.

Findings

Seventy-one treatments performed in 24 patients. ABV monitoring showed a constant decrease as HD treatment progressed. Thirteen IDH events were observed in eight different patients, with a mean systolic BP drop in IDH treatments of 37.38 ± 4.31 mmHg and a mean adjusted ABV at hypotension of 71.07 ± 14.88 mL/kg. Critical ABV was individually set in patients prone to IDH. As expected, ABV feedback control successfully maintained ABV over preset critical ABV. IDH events were avoided in 21 out of 22 treatments performed. ABV drop was successfully reduced, as well as SBP drop (despite similar UF than prior to ABV feedback control implementation).

Discussion

ABV feedback control avoided IDH in 21 out of 22 treatments performed by maintaining blood volume above critical ABV, significantly reducing ABV variations without compromising prescribed UF.

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单独调节绝对血容量反馈控制:一个有希望的解决方案，为透析性低血压

分析性低血压(IDH)仍然是与血液透析(HD)相关的最常见的并发症之一，通常由绝对血容量(ABV)的减少引起，而不是由血管再充盈补偿。最近开发的一种稀释方法允许常规测量ABV，并且通过简单的算法，可以将血容量监视器(BVM)引导的UF(超滤)生物反馈转变为ABV控制，自动调节UF速率以保持ABV高于预设阈值。本研究的目的是确定个体临界ABV阈值，并测试ABV反馈控制避免IDH的能力。方法对24例患者进行连续三次周中HD治疗。每30分钟及患者提及任何症状时测量ABV和血压(BP)，以确定每位患者的临界ABV(低血压时的ABV)。HD开始时采用固定体积稀释法计算ABV。然后，对患者进行三次额外的HD治疗，并分析IDH的发展情况。结果24例患者共进行71次治疗。ABV监测显示，随着HD治疗的进展，ABV持续下降。在8例不同的患者中观察到13例IDH事件，IDH治疗时平均收缩压下降37.38±4.31 mmHg，低血压时平均调整ABV为71.07±14.88 mL/kg。对易发生IDH的患者单独设定临界ABV。正如预期的那样，ABV反馈控制成功地在预设的临界ABV上维持了ABV。22例治疗中有21例避免了IDH事件。ABV下降成功降低，SBP下降(尽管UF与ABV反馈控制实施前相似)。ABV反馈控制在22例治疗中有21例通过维持血容量高于临界ABV来避免IDH，显著减少ABV变化而不影响规定的UF。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.