title: Automatic feedback control of relative blood volume changes during hemodialysis improves blood pressure stability during and after dialysis.
abstract: 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.
authors.affiliation: Dialysis Center Groningen, Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands. c.f.m.franssen@int.umcg.nl
authors.forename: Casper F M
authors.initials: CF
authors.lastname: Franssen
authors.forename: Judith J
authors.initials: JJ
authors.lastname: Dasselaar
authors.forename: Paulina
authors.initials: P
authors.lastname: Sytsma
authors.forename: Johannes G M
authors.initials: JG
authors.lastname: Burgerhof
authors.forename: Paul E
authors.initials: PE
authors.lastname: de Jong
authors.forename: Roel M
authors.initials: RM
authors.lastname: Huisman
mesh_terms: D000368:Aged; D001794:Blood Pressure; D001810:Blood Volume; D001811:Blood Volume Determination / Q000379:methods; D048909:Diabetes Complications / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects