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New blood volume monitoring method for hemodialysis: A-V pressure gradient measurement by synchronized one-point
Masami Oda1, Sanehiro Hokama, Kimio Sugaya
1Department of Urology, School of Medicine, University of the Ryukyus, Okinawa, Japan. oda@med.u-ryuku.ac.jp
During hemodialysis, rapid ultrafiltration often causes symptomatic hypotension. To predict the occurrence of volume-dependent hypotension as early as possible, continuous hematocrit monitoring with the Crit-Line noninvasive monitor has been widely used to measure blood volume changes during hemodialysis. As another potential method of monitoring blood volume variations, we studied blood viscosity, which is theoretically associated with the pressure gradient across the dialyzer. Blood viscosity (calculated by the Hugen-Poiseuille formula) is a major determinant of the blood flow rate and is associated with the pressure difference between the postpump arterial (A) and venous (V) pressures. The A-V pressure gradient fluctuates due to pump pulsation, so we minimized this noise by always reading the pressure gradient at the same point out of 1400 partitions on the rotary pump. To test this synchronized one-point reading method, the A-V pressure gradient was measured using 3 different xanthan gum solutions and was found to be linearly proportional to the model blood flow rate. In an experimental dialysis system using a xanthan gum solution (300 mg/L), the A-V pressure gradient showed a gradual linear increase along with the ultrafiltration rate up to 1 L/h as the viscosity slowly increased in the dialyzer. The changes of blood volume shown by this method were significantly correlated with data obtained using the Crit-Line in 8 patients undergoing hemodialysis. This simple and inexpensive method may allow monitoring of blood volume changes and thus provide data that are beneficial for fluid management in hemodialysis patients suffering from clinical dialysis intolerance.
During hemodialysis, rapid ultrafiltration often causes symptomatic hypotension. To predict the occurrence of volume-dependent hypotension as early as possible, continuous hematocrit monitoring with the Crit-Line noninvasive monitor has been widely used to measure blood volume changes during hemodialysis. As another potential method of monitoring blood volume variations, we studied blood viscosity, which is theoretically associated with the pressure gradient across the dialyzer. Blood viscosity (calculated by the Hugen-Poiseuille formula) is a major determinant of the blood flow rate and is associated with the pressure difference between the postpump arterial (A) and venous (V) pressures. The A-V pressure gradient fluctuates due to pump pulsation, so we minimized this noise by always reading the pressure gradient at the same point out of 1400 partitions on the rotary pump. To test this synchronized one-point reading method, the A-V pressure gradient was measured using 3 different xanthan gum solutions and was found to be linearly proportional to the model blood flow rate. In an experimental dialysis system using a xanthan gum solution (300 mg/L), the A-V pressure gradient showed a gradual linear increase along with the ultrafiltration rate up to 1 L/h as the viscosity slowly increased in the dialyzer. The changes of blood volume shown by this method were significantly correlated with data obtained using the Crit-Line in 8 patients undergoing hemodialysis. This simple and inexpensive method may allow monitoring of blood volume changes and thus provide data that are beneficial for fluid management in hemodialysis patients suffering from clinical dialysis intolerance.
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