Classification of the Pattern of Blood Volume (BV) Curve and Its Relationship with Blood Pressure (BP) and Fluid Control State in Maintenance Hemodialysis (HD) Patients.

초록

Monitoring of central blood volume during HD session may permit the assessment of both fluid balance and hemodynamic stability in maintenance HD patients. Bed-side monitoring of the BV change during HD session is possible by transmissive photometric measurement of hematocrit concentration. To evaluate whether the pattern of BV curve is related to the BP state, we analyzed the BP control states, adequate control: <150/90mmHg with 2 or less antihypertensives; hypertensive: >150/90mmHg or need of antihypertensives 3 or more; hypotensive: intradialytic hypotension more than 8 episodes/month, according to BV curve pattern using CRIT-LINE IIR in 87 stable maintenance HD patients. We classified BV curve patterns according to shape, amount of total BV reduction and presence plateau phase, type 1: irregular shape in which blood volume curve was increased above 0% or rebounded at any time of session; type 2: linear decrease with of total BV reduction less than 10%; type 3: sigmoid decrease with plateau within the first half of the session; type 4: linear decrease with total BV reduction more than 10%, or any shape with total BV reduction more than 15%. In type 1(n=18), 83.5% were hypertensive, 16.7% were normotensive and none was hypotensive. In type 2 (n=24), 62.5% were hypertensive, 37.5% were normotensive and none was hypotensive. All were normotensive in type 3 (n=21) and all were hypotensive in type 4 (n=24). In the subsequent BV curve measurements, 33.3% of type 1 and 2 sifted to 2 or 3 by reducing dry weight. Type 3 occasionally shifted to type 1 or 2 with the change of target ultrafiltration. Shifting to other types was rarely found in type 4. In conclusion, patients with type 1 and 2 BV curve were typically hypertensive and seemed to need more dry weight reduction. Patients with type 3 seemed to have ideal dry body weight. Patients with type 4 were most problematic because of their tendency to show intradialytic hypotensive morbidity. Monitoring of the BV curve patte