Abstract: SA-PO419
In Patients on Hemodialysis, Relative Blood Volume Ranges Related to Improved Survival Are Associated with Increased Volume Reductions in Vascular and Interstitial Spaces
Session Information
- Hemodialysis and Frequent Dialysis - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Meigel, Felix J., Fresenius Medical Care AG, Bad Homburg, Hessen, Germany
- Ho, Kevin, Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
- Kotanko, Peter, Renal Research Institute, New York, New York, United States
- Fuertinger, Doris H., Fresenius Medical Care AG, Bad Homburg, Hessen, Germany
Background
Observational research has identified in-target relative blood volume ranges (iRBV) that are associated with improved hemodialysis (HD) patient survival [1]. Employing an in-silico approach, we investigated differences in fluid removal between virtual patients (avatars) achieving RBV either within or above these iRBV ranges.
Methods
We generated 10,694 avatars based on real-world data from HD patients in an anonymized dialysis database (Apollo Dial DB). Data comprised weight, sex, treatment duration, and ultrafiltration volume. Pre-HD blood volume (Nadler formula) and fluctuating plasma refill rate (PRR) profiles were created to be statistically in line with published data [1,2]. Assuming constant ultrafiltration rates (UFR), we computed RBV profiles for each avatar. We compared the ‘in-target’ avatar group (RBV values within iRBV) with the ‘above-target’ group (RBV values above iRBV ranges).
Results
In-target and above-target groups differed by post-HD weight (79.3 ± 22.3 vs 86.0 ± 23.6 kg) and sex (58% vs 67% male). The in-target group had higher UFRs compared to the above-target group [median (IQR): 10.1 (8.2, 11.6) vs 7.1 (5.4, 9.0) ml/kg/h]. In the in-target group, volume reduction rates were increased in both vascular [2.5 (2.2, 2.9) vs. 1.2 (0.8, 1.5) ml/kg/h] and interstitial (PRR) spaces [7.5 (5.7, 9.0) vs. 5.9 (4.3, 7.8) ml/kg/h].
Conclusion
Volume reduction was greater in vascular and interstitial spaces in the in-target group compared to the above-target group. The increased blood volume reduction does not appear to translate to higher intradialytic hypotension rates in the in-target group [1].
References:
[1] P. Preciado et al., ‘All-cause mortality in relation to changes in relative blood volume during hemodialysis’, Nephrol Dial Transplant (2019)
[2] C. Wang et al., ‘Plasma Refill Rate: A potential hemodynamic marker of intradialytic hypotension during hemodialysis’, ASN Kidney Week Abstract: PO1058 (2020)
Funding
- Commercial Support – Fresenius Medical Care