title: Measurement of Cardiac Output and Blood Volume During Hemodialysis with Fluorescent Dye Dilution Technique.
abstract: Intradialytic hypotensive events (IDH) accompanied by deleterious decreases of the cardiac output complicate up to 25% of hemodialysis treatments. Monitoring options available to track hemodynamic changes during hemodialysis have been found ineffective to anticipate the occurrence of IDH. We have assembled opto-electronic instrumentation that uses the fluorescence of a small bolus of indocyanine green dye injected in the hemodialysis circuit to estimate cardiac output and blood volume based on indicator dilution principles in patients receiving hemodialysis. The instrument and technique were tested in 24 adult end-stage renal failure subjects during 64 hemodialysis sessions. A single calibration factor could be used across subjects and across time. Intra-subject variability of the measurements over time was <10%. Stroke volume index (SVI) (mean ± SEM = 34 ± 1 vs. 39 ± 2 mL m-2) and central blood volume (CBV) index (783 ± 36 vs. 881 ± 33 mL m-2) were lower at the beginning of the sessions in which IDH eventually occurred. Cardiac index, SVI, and CBV index decreased with hemodialysis in all treatment sessions but the decrease was more intense in the IDH sessions. We conclude that hemodynamic monitoring can be implemented in patients receiving hemodialysis with minimal disruption of the treatment and could help understand intradialytic hypotension.
authors.affiliation: Department of Biomedical Engineering, University of Southern California, DRB 140, University Park, Los Angeles, CA, 90089-1111, USA. maarek@usc.edu.
authors.forename: Jean Michel I
authors.identifier: 0000-0003-1240-7521
authors.initials: JM
authors.lastname: Maarek
authors.affiliation: Department of Anesthesiology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Eduardo H
authors.initials: EH
authors.lastname: Rubinstein
authors.affiliation: Department of Psychiatry & the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA.
authors.forename: Yumei
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Southern California Clinical & Translational Science Institute, University of Southern California, Los Angeles, CA, USA.
authors.forename: Christianne J
authors.initials: CJ
authors.lastname: Lane
authors.affiliation: Division of Nephrology and Hypertension Center, Department of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Vito M
authors.initials: VM
authors.lastname: Campese
authors.affiliation: Department of Biomedical Engineering, University of Southern California, DRB 140, University Park, Los Angeles, CA, 90089-1111, USA.|Department of Psychiatry & the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Holschneider
mesh_terms: D000328:Adult; D000368:Aged; D001811:Blood Volume Determination / Q000379:methods; D002302:Cardiac Output; D005260:Female; D005456:Fluorescent Dyes / Q000008:administration & dosage / Q000493:pharmacokinetics; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*
chemical_list: D005456:Fluorescent Dyes
keywords: Blood volume; Cardiac output; Fluorescence; Hemodialysis; Hemodynamic monitoring; Indocyanine green; Intradialytic hypotension; Near-infrared fluorescence spectroscopy