Abstract

Contributing Factors to Effecient Fluid Removal and Utility of Monitoring for Blood Volume Change in Hemodialysis Change of blood volume (ΔBV) and vascular refilling rate (VRR) during hemodialysis (HD) were investigated to improve efficiency and safety of fluid removal. 27% of 163 out-patients on maintenance HD required over 1.0L/h of UFR on the first dialysis day of the week. Only two in a group of 33 out-patients on maintenance HD showed peripheral edema before HD, whereas their abdominal girth significantly decreased after HD, which might mean removal of fluids from abdominal cavity. A maximum of -32% of ΔBV during HD, measured by CRIT-LINE™ instrument, was seen under O.7L/h of UFR, however in an overhydrated patient ΔBV was confined in only -3% even under 0.8L/h of UFR. Mean VRR at 0.5hours and 2 hours after beginning of HD, calculated from ΔBV when ultrafiltration were stopped, were 638ml/h and 905ml/h respectively. Fluid removal rates on single HD, expressed as % change of body weight, were significantly correlated with both VRR and abdominal girth reduction rates. In conclusion, the factor that makes high UFR in HD possible without any trouble is sufficient VRR being able to keep BV and, monitoring of ΔBV using CRIT-LINE™ instrument might be worth assessing the balance between UFR and VRR during HD.