Abstract: TH-PO0857
Dynamics of Plasma Refill Rate Relative to Ultrafiltration Rate During Hemodialysis
Session Information
- Dialysis: Prescription, Physiology, and Treatment Optimization
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Yueh, Sheng-Han, Renal Research Institute, New York, New York, United States
- Meigel, Felix J., Renal Research Institute, New York, New York, United States
- Fuertinger, Doris H., Renal Research Institute, New York, New York, United States
- Usvyat, Len A., Renal Research Institute, New York, New York, United States
- Kotanko, Peter, Renal Research Institute, New York, New York, United States
- Zhang, Hanjie, Renal Research Institute, New York, New York, United States
Background
Hemodialysis (HD) requires in most patients' substantial fluid removal, which can deplete intravascular volume and may result in hemodynamic instability and intradialytic hypotension (IDH), a complication associated with increased mortality. Plasma refill rate (PRR) from the interstitial space counteracts intravascular volume depletion during ultrafiltration. Using high-frequency Crit-Line monitoring (Fresenius Medical Care North America, Waltham, MA), we derived PRR trajectories and studied their relationship with ultrafiltration rate (UFR). Our aim was to gain further insights into fluid balance dynamics during hemodialysis.
Methods
Data from April 26, 2022, across 342 dialysis clinics, 5,738 patients with sessions ≥3 hours were analyzed. UFR and body weight were extracted from electronic health records. PRR normalized to post-dialysis body weight was calculated as previously described (Wang CH et al., Kidney360, 2023; 505–514). The PRR-to-UFR ratio (PRR index, PRRi) was calculated. PRRi were visualized between 5 and 180 minutes into the treatment using median values at each time point across patients by LOESS smoothing (LOESS).
Results
PRRi increased from 0.5 (95% CI: 0.47–0.52) at 5 minutes into HD to a peak of 0.87 (95% CI: 0.86–0.88) at around 60 minutes into HD, and then plateaued at a stable value of around 0.85.
Conclusion
In the first hour of hemodialysis, PRRi increases, indicating an early depletion of intravascular space. Later, PRRi stabilizes at about 85% of UFR. If this dynamic of PRRi is associated with the timing of intradialytic morbid events, such as muscle cramps or IDH (Keane DF et al., Kidney Int. 2021), warrants further analysis. This relationship may help to establish PRRi as an early physiological marker for guiding ultrafiltration strategies and improving patient outcomes.
Acknowledgment
Artificial intelligence tools were used to assist in the writing of this abstract. The authors reviewed and edited the content and take full responsibility for the final version.
Funding
- Commercial Support – Fresenius Medical Care