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Kidney Week

Abstract: PO1153

A Novel Algorithm to Identify Presumably Fluid Overloaded Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Preciado, Priscila, Renal Research Institute, New York, New York, United States
  • Zhang, Hanjie, Renal Research Institute, New York, New York, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States

Adequate volume control is a major challenge in hemodialysis (HD) patients.Relative blood volume (RBV) monitoring evidence suggests that flat RBV slopes indicate fluid overload.We aim to develop an algorithm to identify presumably fluid overloaded HD patients based on a small number of consecutive RBV recordings


We based our analysis on the 842 prevalent HD patients in our previously published study, RBV was assessed over a 6-month baseline period and all-cause mortality recorded;an RBV between 86 and 92% three hours into treatment was associated with significantly better survival.Our goal was to develop an algorithm that would require a much shorter observation period with clinically meaningful sensitivity and specificity to identify (presumably FO) patients with flat RBV profiles (RBV >92% at 3 hours).We categorized patients as either positive (mean RBV >92%) or negative.We computed sensitivities and specificities relative to the positive and negative cases for 1-15 HD sessions and various rates of treatments with flat RBV curves


Sensitivities, specificities, and Youden’s indices (=sensitivity+specificity–1) for 1-15 treatments and across the different rates of positive RBV curves are shown. We found a sensitivity of 92%, specificity of 80%, and Youden’s index of 73% when >=50% of 10 preceding treatments were positive


Our algorithm requires only a small number of RBV readings to identify presumably fluid overloaded patients with a clinically acceptable sensitivity and specificity. It would be of interest to compare the performance of this algorithm with volume status as determined by bioimpedance;however, bioimpedance has not yet been approved for use in HD patients in the U.S.

Sensitivity, specificity & Youden’s index as a function of HD treatments and rate of treatments with flat RBV curves.