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Use of blood volume monitor to achieve dry weight and hemodynamic stability in hemodialysis patients (Master thesis)

Τσιολπίδης, Δημήτριος/ Tsiolpidis, Dimitrios

Determining an accurate target weight for fluid removal is often difficult and subjective.Clinicians should avoid excessive volume depletion in dialysis patients, which can lead to hypotension and cramping, while aiming for ultrafiltration rates that relieve symptoms of fluid overload. The Crit-Line™ monitor (Fresenius Medical Care NA, Waltham, Mass., USA) is an FDA-cleared device that noninvasively measures hematocrit, calculated hemoglobin, oxygen saturation, and changes in intravascular blood volume continuously during hemodialysis. Using the Crit-Line™ screen has been shown to help estimate target weight. In this paper, the practical approach to the application of the Crit-Line™ screen for the assessment of dry weight and hemodynamic stability of patients on hemodialysis is described. The study concerns a total sample of 153 patients. Specifically, a Crit-Line™ monitor was placed on 51 hemodialysis patients of the Artificial Kidney Unit during a dialysis session and for a period of 3 months. Demographic characteristics (sex, age), coexisting diseases (diabetes mellitus - DM, cardiovascular disease), clinical findings (hypotensive episodes, headache, cramps, vomiting), SBP and DBP at the beginning and end of their session, patients entry and exit weight, pre- and post-session dry weight and Crit-Line™ placement and Crit-Line™ curve were recorded. It is observed that Dxirou plays an important role in BP changes as well. It appears that the co-morbidity of DM is related to BP changes and that DM patients experienced more hypotensive episodes. It is also observed that changes in the crit line curve also entail changes in BP and that patients with a Crit-Line™ 3 curve presented more hypotensive episodes. In conclusion, in the present study it appeared that the placement of the Crit-Line™ monitor showed that the dry weight index contributes to the prediction of BP changes and hypotensive episodes. However, the clinical picture of the patients is particularly important for the monitoring of the blood volume, such as the existence of a history of diabetes mellitus which also affects BP and, by extension, the presence of hypotensive episodes.