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Abstract: PO1152

Novel Ultrafiltration Rate Feedback Controller for Attainment of Relative Blood Volume Targets During Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Rivera Fuentes, Lemuel, Renal Research Institute, New York, New York, United States
  • Tapia, Mirell, Renal Research Institute, New York, New York, United States
  • Rogg, Sabrina, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany
  • Thijssen, Stephan, Renal Research Institute, New York, New York, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
Background

Preciado et al. have identified half-hourly relative blood volume (RBV) targets during a hemodialysis (HD) session that are associated with significantly improved patient survival. Attainment of these RBV targets would require incessant empiric adjustments to the ultrafiltration rate (UFR) by the dialysis nurse. We developed a novel proportional-integral controller that takes RBV data from the commercially available CLiC® device as an input and provides UFR suggestions to guide the RBV curve into the desired targets. The clinician specifies the desired UF goal with the maximum allowed upward/downward deviation from this goal, and the UFR Feedback Controller then optimizes the RBV trajectory within the limits of the prescription. The present study aimed to characterize the behavior of this feedback controller

Methods

We conducted a single-arm, prospective, interventional pilot study in subjects on chronic HD at 3 dialysis centers in NYC. RBV was measured with the CLiC® device. CLiC® and HD machine data were fed into a research laptop running the UFR Feedback Controller software. The UFR recommendations (generated every 10 min) were evaluated by dialysis nurses who then either implemented or disregarded them as they deemed clinically appropriate

Results

15 subjects (58.9 ± 15.3 years, 53% black, weight gain 2.6 ± 0.8 L, HD time 222 ± 28 min) were studied (63 study visits, 4.2 ± 1.9 visits/subject). Of 300 analyzed RBV target timepoints, 63% had RBVs within the desired target range, 33% of the RBVs were above and 4% were below target. Stratified by timepoint, the on-target percentage increased from 37% at 30 min to 73% at 3h into HD. The rate of intradialytic morbid events did not appear to be increased. In subjects with at least 4 complete study visits (N=8), on average 71.8% of subjects were within the desired RBV target at 3h into HD

Conclusion

The UFR Feedback Controller behaved as expected, steering the patients’ RBV curves toward the predefined target ranges while strictly observing the prescribed UF goal. Preciado et al. had reported a third of patients within the favorable RBV target range at 3h into conventional HD. In contrast, with the use of this novel UFR Feedback Controller, approx. 72% of subjects were within the desired RBV target range at 3h

Funding

  • Private Foundation Support