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Kidney Week

Abstract: PO0876

Transcapillary Refilling Rate Profile in Hemodiafiltration

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Rivas de Noriega, Juan Pablo, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Mexico City, Mexico
  • Medina, Gerardo, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Mexico City, Mexico
  • Gil, Salvador Lopez, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Mexico City, Mexico
Background

Reaching dry weight in end-stage kidney disease (ESKD) patients is subject to high ultrafiltration rates (UFR) during their hemodiafiltration (HDF) sessions. We seek to profile the transcapillary refilling rate (TRR) during HDF, which we infer to be an important protective factor against intradialytic hypotension (IHD).

Methods

We studied 30 patients in HDF scheduled 3 times a week. Absolute blood volume was measured with the dilutional method and plasma volume was calculated based on the patient’s hematocrit. Each session was divided in 18 intervals of 10 minutes each, we used a fixed UFR during each one in order to calculate the expected plasma volume. Real plasma volume at the end of each interval was calculated on the basis of the relative blood volume. The difference between the real and the expected plasma volume was the plasma refill volume, which divided by the time of each interval gave us the TRR. The HDF session prescription was determined by the nephrologist in charge of the HDF clinic.

Results

84 HDF sessions were recorded. Mean age was 44 years (+/- 18.8), 66% were female. TRR:UFR ratio difference between patients with and without IDH was statistically significant (p <0.001, CI 95%), as well as the UFR-TRR delta (p <0.001, CI 95%). This ratio achieved stability after 30 minutes. Eight patients (27%) presented an IDH episode during HDF, during a total of 9 sessions (10.7%); 8 (89%) occurred in the final hour and 1 (11%) occurred in the first 10 minutes and corresponded to a patient who presented fever and bacteremia.

Conclusion

Both the TRR:UFR ratio and UFR-TRR delta were statistically significant for predicting IDH. Understanding each patient’s TRR will help us plan interventions in order to try and optimize it and reduce the risk of IDH.

Figure 1. UFR (solid lines) and TRR (dashed lines) profiles.