Developments in online monitoring of haemodialysis patients: Towards global assessment of dialysis adequacy

Current Opinion in Nephrology and Hypertension

Volumn 12, Issue 6, 2003, Pages 633-638

  Lambie, Stewart H ^a   McIntyre, Christopher W ^a  

^a DERBY CITY GENERAL HOSPITAL   (United Kingdom)

Author keywords

Adequacy; Haemodialysis; Haemodynamic response; Online monitoring; Sodium flux

Indexed keywords

HEMOGLOBIN; SODIUM; UREA;

BLOOD PRESSURE; BLOOD PRESSURE MEASUREMENT; BLOOD VOLUME; CALIBRATION; CONCENTRATION (PARAMETERS); DIALYSATE; DIALYSIS; EQUIPMENT; FEEDBACK SYSTEM; HEMODIALYSIS; HEMODYNAMICS; HUMAN; HYPOTENSION; MATHEMATICAL MODEL; MEASUREMENT; MORTALITY; ONLINE MONITORING; PARAMETER; PATIENT; PATIENT MONITORING; PHOTOELECTRIC PLETHYSMOGRAPHY; PRESCRIPTION; PRIORITY JOURNAL; PULSE WAVE; REVIEW; SODIUM BALANCE; SODIUM TRANSPORT; TECHNIQUE; TECHNOLOGY; TEMPERATURE; THERMODILUTION; UREA BLOOD LEVEL;

FORECASTING; HEMODYNAMIC PROCESSES; HUMANS; ONLINE SYSTEMS; RENAL DIALYSIS; SODIUM; TELEMETRY; UREA;

EID: 0442307762     PISSN: 10624821     EISSN: None     Source Type: Journal    
DOI: 10.1097/00041552-200311000-00010     Document Type: Review

References (45)

1. Mercadal L, Petitclerc T, Jaudon MC, et al. Is ionic dialysance a valid parameter for quantification of dialysis efficiency? Artif Organs 1998; 22:1005-1009.
2. Locatelli F, Di Filippo S, Manzoni C, et al. Monitoring sodium removal and delivered dialysis by conductivity. Int J Artif Organs 1995; 18:716-721.
3. Ronco C, Bellomo R. Central circulation, peripheral circulation and recirculation. Blood Purif 1997; 15:334-335.
4. Bos WJ, Bruin S, van Olden RW, et al. Cardiac and hemodynamic effects of hemodialysis and ultrafiltration. Am J Kidney Dis 2000; 35:819-826.
5. McIntyre CW, Lambie SH, Taal MW, Fluck RJ. Assessment of haemodialysis adequacy by ionic dialysance: intra-patient variability of delivered dose. Nephrol Dial Transplant 2003; 18:559-562. This confirms the utility of online ionic dialysance monitoring in clinical situations, demonstrating considerable intra-patient variation in dialysis adequacy.
6. Kloppenburg WD, Stegeman CA, Hooyschuur M, et al. Assessing dialysis adequacy and dietary intake in the individual hemodialysis patient. Kidney Int 1999; 55:1961-1969.
7. Brimble KS, Onge JS, Treleaven DJ, Carlisle EJ. Comparison of volume of blood processed on haemodialysis adequacy measurement sessions vs regular non-adequacy sessions. Nephrol Dial Transplant 2002; 17:1470-1474.
8. I. NKF-K/DOQI Clinical Practice Guidelines for Hemodialysis Adequacy: update 2000. Am J Kidney Dis 2001; 37 (Suppl 1):S7-S64.
9. Di Filippo S, Andrulli S, Manzoni C, et al. On-line assessment of delivered dialysis dose. Kidney Int 1998; 54:263-267.
10. Goldau R, Kuhlmann U, Samadi N, et al. Ionic dialysance measurement is urea distribution volume dependent: a new approach to better results. Artif Organs 2002; 26:321-332. This article describes a refinement of ionic dialysance measurements taking into account the transfer of sodium during the increased dialysate conductivity required by the technique. It will lead to increased accuracy of results.
11. Teruel JL, Fernandez Lucas M, Marcen R, et al. Estimate of the dialysis dose using ionic dialysance [in Spanish]. Nefrologia 2001; 21:78-83.
12. Katopodis KP, Hoenich NA. Accuracy and clinical utility of dialysis dose measurement using online ionic dialysance. Clinical Nephrology 2002; 57:215-220. This was a small study (nine patients) with a variety of findings, including intra-patient variability of adequacy, giving an effective demonstration of the clinical application of online conductivity monitoring.
13. Ronco C, Brendolan A, Milan M, et al. Impact of biofeedback-induced cardiovascular stability on haemodialysis tolerance and efficiency. Kidney Int 2000; 58:800-808.
14. Jurkiewicz M, Sole S, Almirall J, et al. Validation of an automatic urea analyser used in the continuous monitoring of hemodialysis parameters. Analyst 1996; 121:959-963.
15. Canaud B, Bosc JY, Leblanc M, et al. On-line dialysis quantification in acutely ill patients: preliminary clinical experience with a multipurpose urea sensor monitoring device. Asaio J 1998; 44:184-190.
16. Calzavara P, Calconi G, Da Rin G, et al. A new biosensor for continuous monitoring of the spent dialysate urea level in standard hemodialysis. Int J Artif Organs 1998; 21:147-150.
17. Lee WC, Tsai CJ, Huang CC, et al. Assessment of dialysis adequacy using the dialysate urea monitor: preliminary experience of the dialysate urea monitor. Ren Fail 1997; 19:789-797.
18. Hernandez-Herrera G, Martin-Malo A, Rodriguez M, Aljama P. Assessment of the length of each hemodialysis session by on-line dialysate urea monitoring. Nephron 2001; 89:37-42.
19. Lim PS, Lee HP, Kho B, et al. Evaluation of pre- and postdilutional on-line hemodiafiltration adequacy by partial dialysate quantification and on-line urea monitor. Blood Purif 1999; 17:199-205.
20. t/V, providing the first report of truly continuous monitoring of dialysis efficiency.
21. Fridolin I, Magnusson M, Lindberg LG. On-line monitoring of solutes in dialysate using absorption of ultraviolet radiation: technique description. Int J Artif Organs 2002; 25:748-761. This is an intriguing report of the use of ultraviolet absorbance to provide a continuous reading of dialysate urea, as well as correlating with other low molecular weight molecules in the dialysate.
22. Gotch FA, Sargent JA. A mechanistic analysis of the National Cooperative Dialysis Study (NCDS). Kidney Int 1985; 28:526-534.
23. Eknoyan G, Beck GJ, Cheung AK, et al. Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 2002; 347:2010-2019.
24. Moret K, Hassell D, Kooman JP, et al. Ionic mass balance and blood volume preservation during a high, standard, and individualized dialysate sodium concentration. Nephrol Dial Transplant 2002; 17:1463-1469. This group have shown that detailed observation of sodium flux during haemodialysis, with novel insights, can be provided by online conductivity monitoring in this important field.
25. Dominic SC, Ramachandran S, Somiah S, et al. Quenching the thirst in dialysis patients. Nephron 1996; 73:597-600.
26. Daugirdas JT. Dialysis hypotension: a hemodynamic analysis. Kidney Int 1991; 39:233-246.
27. Paolini F, Mancini E, Bosetto A, Santoro A. Hemoscan: a dialysis machine-integrated blood volume monitor. Int J Artif Organs 1995; 18:487-494.
28. McMahon MP, Campbell SB, Shannon GF, et al. A non-invasive continuous method of measuring blood volume during haemodialysis using optical techniques. Med Eng Phys 1996; 18:105-109.
29. Leypoldt JK, Cheung AK, Steuer RR, et al. Determination of circulating blood volume by continuously monitoring hematocrit during hemodialysis. J Am Soc Nephrol 1995; 6:214-219.
30. Johner C, Chamney PW, Schneditz D, Kramer M. Evaluation of an ultrasonic blood volume monitor. Nephrol Dial Transplant 1998; 13:2098-2103.
31. Krepel H, Nette R, Akcahuseyin E, et al. Variability of relative blood volume during haemodialysis. Nephrol Dial Transplant 2000; 15:673-679.
32. Andrulli S, Colzani S, Mascia F, et al. The role of blood volume reduction in the genesis of intradialytic hypotension. Am J Kidney Dis 2002; 40:1244-1254. This confirms previous findings of variable RBV profiles, which do not predict hypotensive episodes. The authors hold some hope that combination of early RBV response combined with heart rate response and dialysate-plasma sodium gradient could predict hypotension.
33. Tonelli M, Astephen P, Andreou P, et al. Blood volume monitoring in intermittent hemodialysis for acute renal failure. Kidney Int 2002; 62:1075-1080. This is a simple analysis of RBV traces were not found to predict hypotension in an intensive therapy unit population (57 treatments in 20 patients).
34. Mitra S, Chamney P, Greenwood R, Farrington K. Linear decay of relative blood volume during ultrafiltration predicts hemodynamic instability. Am J Kidney Dis 2002; 40:556-565. These authors again demonstrate the unreliability of directly observed RBV parameters, but provide a mathematically derived measure of deviation from linearity of the RBV trace as a possible future measure to help to define dry weight, as well as to avoid hypotension.
35. Santoro A, Mancini E, Paolini F, et al. Blood volume regulation during hemodialysis. Am J Kidney Dis 1998; 32:739-748.
36. Basile C, Giordano R, Vernaglione L, et al. Efficacy and safety of haemodialysis treatment with the Hemocontrol biofeedback system: a prospective medium-term study. Nephrol Dial Transplant 2001; 16:328-334.
37. Wolkotte C, Hassell DR, Moret K, et al. Blood volume control by biofeedback and dialysis-induced symptomatology: a short-term clinical study. Nephron 2002; 92:605-609. This paper extends the use of RBV guided biofeedback haemodialysis to the stable (unselected) haemodialysis population, and again demonstrates benefit.
38. Santoro A, Mancini E, Basile C, et al. Blood volume controlled hemodialysis in hypotension-prone patients: a randomized, multicenter controlled trial. Kidney Int 2002; 62:1034-1045. This study extended the original seminal observations by Santoro et al. of the benefits of RBV guided biofeedback haemodialysis to larger patient numbers, confirming the advantages gained by the use of this system.
39. McIntyre CW, Lambie SH, Fluck RJ. Biofeedback controlled haemodialysis (BF-HD) reduces symptoms and increases both haemodynamic tolerability and dialysis adequacy in non-hypotension prone stable patients. Clin Nephrol 2003; 60:105-112.
40. Maggiore Q, Pizzarelli F, Santoro A, et al. The effects of control of thermal balance on vascular stability in hemodialysis patients: results of the European randomized clinical trial. Am J Kidney Dis 2002; 40:280-290.
41. Bonforte G, Dozio B, Scanziani R, et al. Continuous on-line determination of recirculation by thermodilution in hemodialysis patients. Int J Artif Organs 1995; 18:526-529.
42. Dorlas JC, Nijboer JA, Butijn WT, et al. Effects of peripheral vasoconstriction on the blood pressure in the finger, measured continuously by a new noninvasive method (the Finapres). Anesthesiology 1985; 62:342-345.
43. Wesseling KH, de Wit B, van der Hoeven GMA, et al. Physiocal, calibrating finger vascular physiology for Finapres. Homeostasis 1995; 2:67-82.
44. Schmidt R, Roeher O, Hickstein H, Korth S. Prevention of haemodialysis-induced hypotension by biofeedback control of ultrafiltration and infusion. Nephrol Dial Transplant 2001; 16:595-603.
45. Lambie SH, Bennett T, McIntyre CW. Characterisation of the haemodynamic response to haemodialysis in diabetic and non-diabetic patients. Oral presentation, Renal Association, Spring 2003.