title: A simple and feasible method to determine absolute blood volume in hemodialysis patients in clinical practice.
abstract: BACKGROUND
  We developed a simple method to determine the absolute blood volume (V) during hemodialysis in everyday clinical practice and examined its relationship with volume overload, clinical relevance, and accuracy.
  
  
  METHODS
  The increase in relative blood volume (RBVpost - RBVpre) measured before and after infusion of 240 ml of ultra-pure dialysate using the bolus function of a commercial online hemodiafiltration machine incorporating a relative blood volume monitor was applied to determine absolute blood volume. The specific blood volume (Vs, blood volume per kg body mass at dry weight, in ml/kg) was compared to volume status as assessed by bioimpedance analysis and clinical criteria.
  
  
  RESULTS
  The blood volume measured in 30 stable hemodialysis patients was 6.51 ± 1.70 l at the beginning, corresponding to a specific blood volume of 80.1 ± 12.8 ml/kg, and dropped to 5.84 ± 1.61 l or 72.0 ± 12.1 ml/kg at the end of the dialysis session, respectively. Specific blood volume correlated with volume status assessed both clinically and by bioimpedance analysis. Intradialytic morbid events occurred only in treatments where specific blood volume fell below 65 ml/kg. The reproducibility of the technique was better than 4% and the in vitro accuracy corresponds to a resolution in Vs of better than 1 ml/kg.
  
  
  CONCLUSIONS
  Absolute blood volume can be easily measured at the beginning of the dialysis session using the current dialysis technology. Information about V and Vs could be a promising tool to avoid intradialytic morbid events. This technique could be completely automated without altering the hardware of currently available online dialysis devices. Therefore, it is recommended that this technique be integrated into all hemodiafiltration machines.
authors.affiliation: KfH Kidney Center Berlin-Köpenick, Berlin, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Kron
authors.forename: Daniel
authors.initials: D
authors.lastname: Schneditz
authors.forename: Til
authors.initials: T
authors.lastname: Leimbach
authors.forename: Sabine
authors.initials: S
authors.lastname: Aign
authors.forename: Susanne
authors.initials: S
authors.lastname: Kron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001331:Automation; D001810:Blood Volume / Q000187:drug effects; D001811:Blood Volume Determination / Q000379:methods*; D001835:Body Weight; D015314:Dialysis Solutions / Q000008:administration & dosage / Q000494:pharmacology; D017097:Electric Impedance; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D007688:Kidneys, Artificial; D008297:Male; D009120:Muscle Cramp / Q000209:etiology; D009325:Nausea / Q000209:etiology; D009862:Online Systems; D015203:Reproducibility of Results; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis / Q000209:etiology
chemical_list: D015314:Dialysis Solutions