Automatic feedback control of relative blood volume changes during hemodialysis improves blood pressure stability during and after dialysis
Article first published online: 10 OCT 2005
Volume 9, Issue 4, pages 383–392, October 2005
How to Cite
Franssen, C. F. M., Dasselaar, J. J., Sytsma, P., Burgerhof, J. G. M., de Jong, P. E. and Huisman, R. M. (2005), Automatic feedback control of relative blood volume changes during hemodialysis improves blood pressure stability during and after dialysis. Hemodialysis International, 9: 383–392. doi: 10.1111/j.1492-7535.2005.01157.x
- Issue published online: 10 OCT 2005
- Article first published online: 10 OCT 2005
- Manuscript received November 2004; revised March 2005.
- dialysis hypotension;
- relative blood volume;
- blood volume monitoring
Automatic feedback systems have been designed to control relative blood volume changes during hemodialysis (HD) as hypovolemia plays a major role in the development of dialysis hypotension. Of these systems, one is based on the concept of blood volume tracking (BVT). BVT has been shown to improve intra-HD hemodynamic stability. We first questioned whether BVT also improves post-HD blood pressure stability in hypotension-prone patients and second, whether BVT is effective in reducing the post-HD weight as many hypotension-prone patients are overhydrated because of an inability to reach dry weight. After a 3-week period on standard HD, 12 hypotension-prone patients were treated with two consecutive BVT treatment protocols. During the first BVT period of 3 weeks, the post-HD target weight was kept identical compared with the standard HD period (BVT-constant weight; BVT-cw). During the second BVT period of 6 weeks, we gradually tried to lower the post-HD target weight (BVT-reduced weight; BVT-rw). In the last week of each period, we studied intra-HD and 24 hr post-HD blood pressure behavior by ambulatory blood pressure measurement (ABPM). Pre- and post-HD weight did not differ between standard HD and either BVT-cw or BVT-rw. Heart size on a standing pre-dialysis chest X-ray did not change significantly throughout the study. There were less episodes of dialysis hypotension during BVT compared with standard HD (both BVT periods: p<0.01). ABPM data were complete in 10 patients. During the first 16 hr post-HD, systolic blood pressure was significantly higher with BVT in comparison with standard HD (both BVT periods: p<0.05). The use of BVT in hypotension-prone patients is associated with higher systolic blood pressures for as long as 16 hr post-HD. BVT was not effective in reducing the post-HD target weight in this patient group.