Blood volume monitoring.

BACKGROUND: In CKD stage 5 diabetic patients (DM), only approximately half of the interdialytic weight gain was accounted for by sodium intake. The other half was due to pure water gain, probably caused by hyperglycemia. Dialysis treatment faces two major troubles: the removal of the extra amount of water and the therapy of the compromised compensatory mechanisms. The described situation is the reason why new technologies in hemodialysis were developed. Blood volume monitoring (BVM) with regulation of ultrafiltration and sodium (Hemocontrol, Hospal, Belgium; Hameomaster, Nikkiso Co. Ltd, Japan) was evaluated to describe the advantages for efficacy and compatibility in hemodialysis therapy.

METHODS: 18 cardiovascular instable patients (DM) were included into the study (age 56.4 +/- 12.5, 7 female, 11 male). Begin of dialysis 39 +/- 9.3 months before the study, dialysis time/session 258.3 +/- 15.4 min, 3 sessions/week, blood flow 250 ml/min, dialysate flow 500 ml/min, prephase: standard bicarbonate dialysis (HD; HCO3 - 35 mmol/l) 2 weeks, BVM: 48 weeks. Clinical parameters evaluated before BVM and 48 weeks after BVM: number of muscle cramps (MC) and hypotensive episodes (HypoEp) during dialysis, optimal weight (OptW), single pool Kt/V (sp Kt/V), equilibrated Kt/V (db Kt/V), systolic blood pressure (BP), antihypertensive drugs (AntiDr), cardiac ejection fraction (EF) and left ventricular mass index (LVMI).

RESULTS: In comparison with HD after 48 weeks with BVM, we can demonstrate a reduction of MC by 83.7%, HypoEp by 88.9%, OptW by 1.7%. The improved refilling and reduction of OptW led to an increase of sp Kt/V by 34.8% and db Kt/V by 33.3%. AntiDr were reduced to 56.6% compared to HD, BP lowered by 4.4%. Due to BVM, EF increases to 123.8% and LVMI decreases by 25.2%.

CONCLUSION: BVM can improve clinical parameters for adequacy of hemodialysis. It offers a unique possibility to treat diabetic patients according to their special needs.