ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO818

Adjustment of Target Weight Based on Absolute Blood Volume Reduces the Frequency of Intradialytic Morbid Events

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • SCHNEDITZ, Daniel, Medical University Graz, Graz, Austria
  • Kron, Susanne, Charite Universitatsmedizin Berlin, Berlin, Germany
  • Leimbach, Til, KfH Kidney Center Berlin-Köpenick, Berlin, Germany
  • Budde, Klemens, Charite Universitatsmedizin Berlin, Berlin, Germany
  • Kron, Joachim, KfH Kidney Center Berlin-Köpenick, Berlin, Germany
Background

Adequate ultrafiltration (UF) avoiding intradialytic morbid events (IME) remains a core problem in current hemodialysis (HD) therapy. The aim of this study was to investigate the suitability of absolute blood volume (Vs, in mL/kg) to prescribe UF volume and to reduce the frequency of IME.

Methods

Following a 4 week baseline phase to quantify the frequency of IME, volume status was determined in a specified HD study during which relative blood volume (RBV, %) was measured by the blood volume monitor (BVM), Vs was measured using on-line dialysate dilution, and volume overload (Vo, L) was measured using bioimpedance spectroscopy. Symptomatic IME was defined as a drop in systolic blood pressure (PSYS) by more than 20 mmHg, or a PSYS below 90 mmHg, or the occurence of symptoms such as dizziness, light-headedness, sweating, or cramps. Suitability of different variables to discriminate for IME was examined by analysis of receiver-operator-characteristics (ROC-analysis) and calculation of the area under the ROC-curve (AUROC). Target weight was then increased or decreased based on measured Vs, Vo, and occurence of IME, and the frequency of IME was recorded during 4 weeks of follow-up.

Results

45 patients participated in this study. 22 (49%) patients experienced 66 IME in 12% of HD treatments during baseline. In 15 (33%) patients who experienced IME during the volume assessment study Vs (60.7±4.0 vs. 73.7±11.3 mL/kg, p<0.001) and Vo (1.1±0.9 vs. 2.5±1.8 L, p<0.01) was lower than in stable patients, while RBV (87.9±4.4 vs. 90.2±4.2%, p=n.s.) was comparable. AUROC was 0.92, 0.80, and 0.61 for Vs, Vo, and RBV, respectively. The sensitivity, specificity, and accuracy of the Vs≤65 mL/kg threshold to predict IME was 87%, 100%, and 91%, respectively. Target weight was increased (+1.5 kg) or decreased (-5kg) in 32 patients. The frequency of IME fell to 0.9% of all HD sessions in the following 4 weeks (p<0.001).

Conclusion

Absolute blood volume (Vs, mL/kg) is more accurate in assessing the risk for IME-prone patients than relative blood volume (RBV, %). Adjustment of target weight based on information of Vs, Vo, and IME appears as a feasible approach to reduce the frequency of IME.