Review Current Fluid Management Findings and Publications

Published 04.29.2019

Historically, clinical emphasis has been placed on toxin removal in dialysis using numerous technological advances, complex methods of analyzing clearance and improved dialyzer membranes. However, fluid management in hemodialysis has remained largely unchanged. With Crit-Line® technology, providers can now access information that can help improve fluid management in hemodialysis patients. Please note that Crit-Line technology does not provide a treatment algorithm and does not directly intervene in the dialysis treatment.

Managing fluid during hemodialysis has always been a challenge. Based on the data that the Crit-Line technology provides, the dialysis technician may intervene (i.e., increase or decrease the rate at which fluid is removed from the body) in order to potentially remove the maximum amount of fluid from the dialysis patient without the patient experiencing the common symptoms of dialysis which include nausea, cramping and vomiting. Therefore, it has been suggested that better fluid management can help improve dialysis patient care.1

Crit-Line technology provides objective data and visually displays the relative blood volume slope, which indicates the balance between the dialysis patient's vascular refill and ultrafiltration rates. Based on that information, the provider can intervene and adjust the rate of fluid removal in order to remove the maximum amount of fluid. The slopes or profiles that are displayed by Crit-Line technology are typically categorized as A, B or C and are defined as follows:

 

Profile A

An "A" profile indicates that the patient's plasma refill rate is occurring at the same or a greater rate than ultrafiltration. This profile suggests that the ultrafiltration rate might be increased without immediate risk of intradialytic symptoms.

Profile B

A "B" profile is a gradual slope that has been targeted to find the best compromise between a high ultrafiltration rate and the prevention of intradialytic symptoms. The ideal slope is not a fixed percentage of change in BV, and will vary from patient to patient.

Profile C

A "C" profile is represented by a steep slope which indicates a rapid decrease in blood volume, and bears a higher risk for intradialytic symptoms such as lightheadedness, nausea, vomiting, cramping or hypotension.

Fluid Management Findings

Key Findings from Publications:

  • Therapy guided by Relative Plasma Volume (RPV) slope may serve as a valid tool to better achieve target weight using augmented reduction therapy among hemodialysis patients.2

  • RPV monitoring yields information that is prognostically important and independent of several risk factors including UF volume, aggressiveness of UF and interdialytic ambulatory blood pressure.3

  • RPV monitoring can assist in better achieving target weight.4

  • RPV has been used to find the best compromise between a high ultrafiltration rate and the prevention of intradialytic symptoms.2,5,6,7,8,9

 

  1. Agarwal, R, Alborzi, P, Satayan, S. Light RP “Dry-weight Reduction in Hypertensive Hemodialysis Patients (DRIP): A Randomized , Controlled Trial.” Hypertension 53 no. 3 (2009) 500-507.
  2. Sinha AD, Light RP, Agarwal R: “Relative Plasma Volume Monitoring During Hemodialysis Aids the Assessment of Dry Weight.” Hypertension 55 (2010): 305-3110. 
  3. Agarwal, R. “Hypervolemia is Associated With Increased Mortality Among Hemodialysis Patients.” Hypertension 56 (2010): 512-517. 
  4. Agarwal, R, Alborzi, P, Satayan, S. Light RP “Dry-weight Reduction in Hypertensive Hemodialysis Patients (DRIP): A Randomized , Controlled Trial.” Hypertension 53 (2009): 500-507. 
  5. Rodriguez HJ, Domenici R, Diroll A, Goykhman I. “Assessment of Dry Weight by Monitoring Changes in Blood Volume During Hemodialysis using Crit-Line.” Kidney Int 68 (2005): 854-861. 
  6. Goldstein S, Smith C, Currier H. “Non-invasive Interventions to Decrease Hospitalization and Associated Costs for Pediatric Patients Receiving Hemodialysis.” JASN 14 (2003), 2127-2131. 
  7. Michael M, Brewer ED, Goldstein SL. “Blood Volume Monitoring to Achieve Target Weight in Pediatric Hemodialysis Patients” Pediatri Nephrol 19 no. 4 (2004) 432-437. 
  8. Reddan, DN, Szczech LA et al. “Intradialytic Blood Volume Monitoring in Ambulatory Hemodialysis Patients: A Randomized Trial” J Am Soc Nephrol 16 (2005): 2162-2169. 
  9. Jain SR, Smith L, Brewer ED, Goldstein SL. “Non-invasive Intravascular Monitoring in the Pediatric Hemodialysis Population” Pediatri Nephrol < 18 no. 1 (2001) 15-8.

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Caution: Federal (US) law restricts these devices to sale by or on the order of a physician.

Note: Read the Instructions for Use for safe and proper use of these devices. For a complete description of hazards, contraindications, side effects and precautions, see full package labeling.

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