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Aurelio A de los Reyes V, Doris H Fuertinger, Franz Kappel, Anna Meyring-Wösten, Stephan Thijssen, Peter Kotanko
An assessment of fluid status can be obtained by monitoring relative blood volume (RBV) during hemodialysis (HD) treatment. The dynamics of RBV is determined by fluid removal from the intravascular compartment by ultrafiltration (UF) and vascular refill from the interstitium. To characterize this dynamics, a two-compartment model describing the short-term dynamics of vascular refilling and UF is developed. Fluid movement between the compartments is governed by lymphatic and microvascular fluid shifts. Further, protein flux is described by convection, diffusion and the lymphatic protein flux...
February 7, 2016: Journal of Theoretical Biology
Paul Balter, Linda H Ficociello, Patrice B Taylor, Len Usvyat, Dixie-Ann Sawin, Claudy Mullon, Jose Diaz-Buxo, Paul Zabetakis
BACKGROUND: Inadequate removal of extracellular volume markedly increases blood pressure and contributes to high morbidity and mortality in hemodialysis patients. Advances in fluid management are needed to improve clinical outcomes. The aim of this quality improvement project was to examine the advantages of using a hematocrit-based, blood volume monitor (Crit-Line * ) for 12 months, as part of a clinic-wide, fluid management program in one dialysis facility. METHODS: Forty-five individuals were receiving hemodialysis at one facility at project initiation and are included in this analysis...
2015: Current Medical Research and Opinion
Rouba Garro, Scott Sutherland, Liz Bayes, Steven Alexander, Cynthia Wong
BACKGROUND: The national average for achieving the KDOQI-recommended hemoglobin (Hgb) target level of 11-12 g/dL is low with the current anemia management protocol of measuring Hgb levels every 2-4 weeks to guide intervention. The objective of this study was to correlate initial Hgb readings from the CRIT-LINE monitor with actual serum Hgb levels in pediatric patients on hemodialysis (HD). METHODS: Data were collected from pediatric HD patients who had Hgb tests ordered for routine and/or clinical reasons...
June 2015: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Paul Balter, Mikhail Artemyev, Paul Zabetakis
The Crit-Line™ monitor measures relative changes in intravascular blood volume during hemodialysis. The device is also used to monitor hematocrit and oxygen saturation. Using this device to decrease fluid volume has yielded inconsistent results on outcome measures such as hospitalization rates, erythropoietin utilization, and blood pressure reduction. Through a year-long deployment of the Crit-Line™ monitor, the Renal Research Institute (RRI) has shown that outcomes can be improved even in a busy dialysis clinic with attention to the details of how the device is utilized...
2015: Blood Purification
Scott P Sibbel, Linda H Ficociello, Michael Black, Mayuri Thakuria, Claudy Mullon, Jose Diaz-Buxo, Thomas J Alfieri
BACKGROUND: The Crit-Line® monitor (CLM) is a device for monitoring hematocrit, oxygen saturation and change in intravascular blood volume during hemodialysis. Prior studies have evaluated CLM use in dialysis patients, but not specifically in those new to dialysis. METHODS: In this retrospective analysis, 199 patients initiating dialysis at 8 facilities routinely using CLM were compared with 796 propensity score-matched non-CLM patients initiating dialysis at facilities not using CLM...
2014: Blood Purification
Hiroshi Yamada, Minako Saeki, Junko Ito, Kazuhiro Kawada, Aya Higurashi, Hiromi Funakoshi, Kohji Takeda
The pulse CO-Oximeter (Radical-7; Masimo Corp., Irvine, CA) is a multi-wavelength spectrophotometric method for noninvasive continuous monitoring of hemoglobin (SpHb). Because evaluating the relative change in blood volume (ΔBV) is crucial to avoid hypovolemia and hypotension during hemodialysis, it would be of great clinical benefit if ΔBV could be estimated by measurement of SpHb during hemodialysis. The capability of the pulse CO-Oximeter to monitor ΔBV depends on the relative trending accuracy of SpHb...
February 2015: Journal of Clinical Monitoring and Computing
Gia Oh, Cynthia Wong, Brandy Begin, Kari Salsbery, Scott Sutherland, Abanti Chaudhuri
BACKGROUND: We hypothesized that the percent change in resistance (%RΔ) from bioimpedance analysis (BIA) measurements during hemodialysis (HD) can provide information on pediatric HD patients' hydration status. METHODS: Whole-body single-frequency BIA measurements were obtained before HD, each hour on HD, and after HD during two HD sessions. Pre-and post-HD weights, blood pressures, Crit-Line® measurements, and intradialytic symptoms were collected on the day of the BIA measurements...
August 2014: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Naoki Sugano, Keitaro Yokoyama, Naohiko Kato, Yoichiro Hara, Satoshi Endo, Jun Mitome, Taisei Kin, Goro Tokudome, Satoru Kuriyama, Tatsuo Hosoya, Takashi Yokoo
BACKGROUND: Bioelectrical impedance analysis (BIA) is a non-invasive method to estimate total body water (TBW) and extracellular water (ECW) volume. Crit-Line(®) (CL), on the other hand, assesses intravascular water (IVW) volume. We evaluate continuous changes in body water composition during hemodialysis (HD) with concurrent use of BIA and CL. METHODS: BIA at the start and the end of the HD session was measured using a BIA device. To investigate the shifting pattern of body water composition, patients were subjected to simultaneous monitoring of BIA with CL...
December 2014: Clinical and Experimental Nephrology
Sonika Puri, Jun-Ki Park, Frank Modersitzki, David S Goldfarb
Accurate assessment of blood volume (BV) may be helpful for prescribing hemodialysis (HD) and for reducing complications related to hypovolemia and volume overload. Monitoring changes in relative BV (RBV) using hematocrit, e.g., Crit-Line Monitor (CLM-III), an indirect method, cannot be used to determine absolute BV. We report the first study of BV measurement for assessing volume status in HD patients using the indicator dilutional method. Ten adult HD patients were enrolled in this prospective observational study...
April 2014: Hemodialysis International
Amanda Stavinoha, Vinai Modem, Raymond Quigley
Maintaining a dialysis patient's hemoglobin (Hgb) within a very narrow range can be challenging. Relying on Hgb measurements only once or twice a month can cause large fluctuations in their measurements. Utilizing the Hgb measurement from noninvasive modalities has been studied in adult populations. Our study focused on a pediatric hemodialysis population where blood volumes are much smaller to see if these measurements would adequately work for adjusting erythropoietin dosages. We reviewed our patients' data over a 6-month time period and collected simultaneous measurements of Hgb performed in the laboratory, as well as the initial Crit-Line measurement...
October 2013: Hemodialysis International
Ramon Roca-Tey, Rosa Samon, Omar Ibrik, Amparo Roda, Juan C González-Oliva, Jordi Viladoms
INTRODUCTION: Periodic blood flow (QA) measurement is the preferred way for arteriovenous fistula (AVF) surveillance in chronic hemodialysis (HD) patients. Objectives. 1) Assess the efficacy of the temperature gradient method (TGM) on the QA determinations using the Twister™ device and to compare the functional results with the Delta-H method. 2) Evaluate the effect of blood pressure on the AVF function. Patients and method. We measured the QA non invasively in 30 AVF (24 radial and 6 brachial; mean duration 53...
2012: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Ramón Roca-Tey, Rosa Samon, Omar Ibrik, Empar Roda, Juan Carlos González-Oliva, Román Martínez-Cercós, Jordi Viladoms
PURPOSE: To report experience over five years of vascular access (VA) stenosis surveillance. METHODS: We prospectively monitored the blood flow rate (QA) of 145 VA in 131 ESRD (age 62.6 ±13.5 y) patients (pts). QA measurement: within the first hour of the hemodialysis (HD) session by the Delta-H method using the Crit Line III Monitor. All VA with baseline QA < 700 mL/min or decreased > 20% from baseline over time met the positive evaluation (PE) criteria and were referred for angiography (AG) plus elective intervention if stenosis = 50%...
July 2012: Journal of Vascular Access
Arjun D Sinha
Despite advancements in dialysis therapy, the subjective clinical examination still remains the standard of care in managing volume removal in chronic dialysis. While there is no definitive trial establishing that dry weight management guided by an assistive technology is superior to the clinical method, there is ample evidence that there is a need for these technologies to be developed. Mortality, cardiovascular morbidity, and sequelae of volume overload remain far too common under the current paradigm. Recent studies indicate that the mortality associated with volume overload is independent of hypertension, suggesting that if mortality is to be improved, then a measure of volume independent of blood pressure must be developed...
2011: Blood Purification
Izumi Yoshida, Katsunobu Ando, Yasuhiro Ando, Susumu Ookawara, Masayuki Suzuki, Hiroaki Furuya, Osamu Iimura, Daisuke Takada, Masaharu Kajiya, Takanori Komada, Honami Mori, Kaoru Tabei
We developed a new optical device (Nikkiso) to assess changes through blood volume monitoring (BVM) during hemodialysis and were able to determine the ideal levels in which changes in blood volume percentage (BV%) occur among hemodialysis patients in one hemodialysis center. We evaluated both the reliability of BVM and these ideal levels in a multicenter group. The purpose of this manuscript is to develop a navigating system to set dry weight in a variety of situations as the final goal. First, based on the obtained BVM (BV%(BVM) ) measurements, the relationships between BV% and hematocrit (BV%(HT) ) and between BV% and CRIT-LINE (BV%(CLM) ; Hema Metrics, Kaysville, UT, USA) were then evaluated...
December 2010: Therapeutic Apheresis and Dialysis
Adam E Gaweda, Brian H Nathanson, Alfred A Jacobs, George R Aronoff, Michael J Germain, Michael E Brier
BACKGROUND AND OBJECTIVES: Anemia management protocols in ESRD call for hemoglobin (Hb) monitoring every 2 to 4 weeks. Short-term Hb variability affects the reliability of Hb measurement and may lead to incorrect dosing of erythropoiesis stimulating agents. We prospectively analyzed short-term Hb variability and quantified the relationship between frequency of Hb monitoring and error in Hb estimation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using the Crit-Line III TQA device, we prospectively observed Hb during each dialysis treatment in 49 ESRD patients and quantified long- and short-term Hb variability...
November 2010: Clinical Journal of the American Society of Nephrology: CJASN
Warren R Ho, Michael J Germain, Jane Garb, Sue Picard, Molly-Kate Mackie, Cherry Bartlett, Eric J Will
BACKGROUND: Haemoglobin variability may be associated with increased death. Frequent haemoglobin monitoring may allow earlier detection of trends in haemoglobin slopes, alerting staff to intercurrent events. The more frequent haemoglobin values may provide early evidence of response to erythropoietin (EPO) doses, and allow more appropriate anaemia management. Our objective is to assess whether frequent haemoglobin monitoring data (12x/month) using a computer algorithm (AMIE, Leeds, UK) will reduce haemoglobin variability compared with 1x/month monitoring...
August 2010: Nephrology, Dialysis, Transplantation
Arjun D Sinha, Robert P Light, Rajiv Agarwal
Among hemodialysis patients, the assessment of dry weight remains a matter of clinical judgment because tests to assess dry weight have not been validated. The objective of this study was to evaluate and validate relative plasma volume (RPV) monitoring as a marker of dry weight. We performed RPV monitoring using the Crit-Line monitor at baseline and at 8 weeks in 150 patients participating in the Dry-Weight Reduction in Hypertensive Hemodialysis Patients Trial. The intervention group of 100 patients had dry weight probed, whereas 50 patients served as time controls...
February 2010: Hypertension
Jula K Inrig, Uptal D Patel, Robert D Toto, Donal N Reddan, Jonathan Himmelfarb, Robert M Lindsay, John Stivelman, James F Winchester, Lynda A Szczech
Pulse pressure is a well established marker of vascular stiffness and is associated with increased mortality in hemodialysis patients. Here we sought to determine if a decrease in pulse pressure during hemodialysis was associated with improved outcomes using data from 438 hemodialysis patients enrolled in the 6-month Crit-Line Intradialytic Monitoring Benefit Study. The relationship between changes in pulse pressure during dialysis (2-week average) and the primary end point of non-access-related hospitalization and death were adjusted for demographics, comorbidities, medications, and laboratory variables...
November 2009: Kidney International
R Roca-Tey, R Páez, A Rivas, R Samon, O Ibrik, I Giménez, J Viladoms
INTRODUCTION: Vascular calcification is a common finding in patients (pts) with end-stage renal disease (ESRD). OBJECTIVE: The aim of this cross-sectional study was to investigate the prevalence and functional effect of native arteriovenous fistula AVF (feeding artery and/or arterialized vein) calcifications evaluated by spiral computed tomography (CT) in ESRD pts undergoing chronic hemodialysis (HD). PATIENTS AND METHOD: Forty-five upper limb AVF (radial 44...
2009: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Robert M Lindsay, Tanya Shulman, Suma Prakash, Gihad Nesrallah, Mercedeh Kiaii
BACKGROUND: Volume overload is a factor in the hypertension of hemodialysis (HD) patients. Fluid removal is therefore integral to the hemodialysis treatment. Fluid removal by hemodialysis ultrafiltration (UF) may cause intradialytic hypotension and leg cramps. Understanding blood pressure (BP) and volume changes during UF may eliminate intradialytic hypotension and cramps. Studies (S1, S2, and S3) were carried out to determine the amount and direction of changes in body fluid compartments following UF and to determine the relationships between BP, changes in blood volume (DeltaBV), central blood volume (CBV), cardiac output (CO), peripheral vascular resistance (PVR) plus total body water (TBW), and intra- and extracellular fluid volumes (ICF, ECF) in both the whole body and body segments (arms, legs, trunk)...
June 1, 2003: Hemodialysis International
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