Absolute blood volume and long-term survival in chronic hemodialysis patients.

Current online hemodiafiltration devices can be used to determine the absolute blood volume in clinical practice using the dialysate bolus method. Most of publications on this method have focused on preventing intradialytic complications. The influence of absolute blood volume on long-term prognosis has not been reported yet.

Vascular refilling in hemodialysis using feedback-controlled ultrafiltration profile.

Background: The rate and the duration of ultrafiltration (UF) are considered the most important factors to affect vascular refilling. The aim of the study was to investigate whether a UF profile could improve the vascular refilling.

Methods: Dialysis was delivered by a machine providing feedback control of ultrafiltration rates.

Vascular refilling depends on the ratio of blood volume to extracellular volume in hemodialysis patients.

The ratio of blood volume to extracellular volume is approximately one to three under physiological conditions and also in stable chronic hemodialysis patients. Recently, it was found that this ratio remains unchanged during hemodialysis despite ultrafiltration. This would signify that the higher the ratio, the lower the refilling and vice versa.

Dynamics of vascular refilling in extended nocturnal hemodialysis.

Introduction: Long dialysis treatments are generally assumed to mitigate the ultrafiltration (UF) induced volume perturbation and to improve vascular refilling because of reduced UF rates and sufficient time for volume re-equilibration. The time course of vascular refilling was therefore examined during extended nocturnal dialysis.

Methods: For each hour of dialysis, vascular refilling volume was calculated from the absolute blood volume changes and UF volume removed.

An improved method to estimate absolute blood volume based on dialysate dilution.

Online hemodiafiltration machines equipped with a blood volume monitor and the possibility to rapidly infuse exact amounts of ultrapure dialysate into the extracorporeal circulation can be used to determine absolute blood volume in clinical practice. The aim of the present study was to evaluate the reproducibility of such measurements. Intra-individual reproducibility was evaluated in four measurements taken in hourly intervals within the same dialysis treatment.

Feedback control of absolute blood volume: A new technical approach in hemodialysis.

Introduction: The success of automatic feedback control systems to improve hemodynamic stability by preventing relative blood volume from dropping beyond a critical value during dialysis is limited. The aim of this study was to use one of these systems for control of absolute rather than relative blood volume to prevent volume-dependent morbid events.

Methods: Dialysis was delivered by a machine providing feedback control of ultrafiltration rates, relative blood volume monitoring, and accurate bolus infusion of 240 mL of dialysate to measure absolute blood volume at the beginning of dialysis.

Patient radiation dose in percutaneous biliary interventions: recommendations for DRLs on the basis of a multicentre study.

Objective: Percutaneous biliary interventions (PBIs) can be associated with a high patient radiation dose, which can be reduced when national diagnostic reference levels (DRLs) are kept in mind. The aim of this multicentre study was to investigate patient radiation exposure in different percutaneous biliary interventions, in order to recommend national DRLs.

Methods: A questionnaire asking for the dose area product (DAP) and the fluoroscopy time (FT) in different PBIs with ultrasound- or fluoroscopy-guided bile duct punctures was sent to 200 advanced care hospitals.

Adjustment of target weight based on absolute blood volume reduces the frequency of intradialytic morbid events.

Introduction: Adequate volume management removing excess volume and at the same time avoiding intradialytic morbid events (IME) remains a core problem in current hemodialysis (HD) therapy. Recently, we developed a feasible method to determine absolute blood volume (Vs, in mL/kg) in patients on HD. The aim of this study was to investigate the suitability of Vs measurements for volume management.

Vascular Refilling Is Not Reduced in Dialysis Sessions with Morbid Events.

Background: It is commonly believed that insufficient vascular refilling leads to hypovolemia during hemodialysis and contributes to intradialytic morbid events (IME). But data of refilling volumes at the time of IME are lacking.

Methods: We compared the vascular refilling in 10 patients with IME with 14 stable patients with normal blood volume at the dialysis end (66-80 mL/kg).

Comorbidities, Hospitalization, and Living Status of Dialysis Patients Over 80 Years.

Background: An increasing number of patients start dialysis when they are over 80 years or reaches their eighties on dialysis. The burden of dialysis can affect their quality of life.

Methods: Clinical and social data of all patients aged 80 years or older who underwent chronic dialysis treatment in a single center were analyzed.

Vascular refilling is independent of volume overload in hemodialysis with moderate ultrafiltration requirements.

Introduction Blood volume changes and vascular refilling during hemodialysis (HD) and ultrafiltration (UF) have been assumed to depend on volume overload (Vo ). It was the aim to study the magnitude of vascular refilling in stable HD patients with moderate volume expansion in everyday dialysis using novel technical approaches. Methods Patients were studied during routine dialysis and UF based on clinical dry weight assessment.

[Secondary retroperitoneal fibrosis in a 39-year-old man after rectal cancer].

A 39-year-old man had been treated for rectal cancer 6 years ago by lower anterior resection of the rectum and perioperative radiochemotherapy. Since then follow-up had been unremarkable but now the patient presented with unspecific lower abdominal pain. The cause of the pain was identified as paraneoplastic retroperitoneal fibrosis secondary to metachronous pulmonary metastases of the rectal cancer.

Effects of Osmotic Changes on Measuring Relative Blood Volume: Comparison of Three Hemodialysis Devices.

Recording the relative blood volume is a standard feature of modern dialysis devices. Three different measurement systems are incorporated in currently available dialysis machines. The Gambro-Hospal group and Nikkiso feature blood volume monitors based on different optical methods.

Determination of the critical absolute blood volume for intradialytic morbid events.

The reduction of blood volume below a critical threshold is assumed to trigger intradialytic morbid events (IME). Recently, we presented a simple method to determine the absolute blood volume during routine hemodialysis (HD) carried out without blood sampling and without injection of dyes or radiolabeled markers. Such information could be used to detect excessive volume reduction during HD and to prevent IME.

Relative Blood Volume Monitoring during Renal Replacement Therapy in Critically Ill Patients with Septic Shock: A Preliminary Report.

Background: Volume management during renal replacement therapy (RRT) in septic shock is always in the conflict between aggravating hypovolemia by undue ultrafiltration (UF) and insufficient reduction of fluid overload which is associated with adverse outcome. Relative blood volume (RBV) monitoring could be helpful for timely transition from fluid resuscitation to fluid removal.

Methods: Data of RBV were continuously monitored and used for guidance of UF and fluid resuscitation in 21 consecutive patients with severe septic multiple organ failure.

Hemodialysis in patients over 80 years.

Background: In Germany, every fifth patient starting dialysis is now 80 years of age or older. The question that is currently relevant is not whether we have to treat patients who are older than 80. Rather the question now is how to treat this elderly group of patients.

A simple and feasible method to determine absolute blood volume in hemodialysis patients in clinical practice.

Background: We developed a simple method to determine the absolute blood volume (V) during hemodialysis in everyday clinical practice and examined its relationship with volume overload, clinical relevance, and accuracy.

Methods: The increase in relative blood volume (RBVpost - RBVpre) measured before and after infusion of 240 ml of ultra-pure dialysate using the bolus function of a commercial online hemodiafiltration machine incorporating a relative blood volume monitor was applied to determine absolute blood volume. The specific blood volume (Vs, blood volume per kg body mass at dry weight, in ml/kg) was compared to volume status as assessed by bioimpedance analysis and clinical criteria.

Effects of sodium on measuring relative blood volume during hemodialysis differ by techniques.

Recording the relative blood volume is a standard feature of modern dialysis devices, enabling feedback guidance of ultrafiltration and dialysate conductivity. Technically, the process is based on optical or ultrasonic methods. On the grounds of clinical evidence suggesting a malfunction of the optical hemoglobin (Hb)-dependent absorbance method in the presence of sodium changes, we compared the system with the ultrasonic method.

Extended daily on-line high-volume haemodiafiltration in septic multiple organ failure: a well-tolerated and feasible procedure.

Background: The outcome of patients with septic multiple organ failure (MOF) remains poor. There are experimental and clinical data indicating a beneficial effect of high-volume haemofiltration. Delivering high-volume therapy is only cost effective using on-line devices because of high costs for additional solution bags in conventional continuous renal replacement therapy (CRRT).

Quality management in the prophylaxis of venous thrombembolism--results of a survey including 464 medical and surgical patients.

Background: We surveyed the quality of risk stratification politics and monitored the rate of entries to our company-wide protocol for venous thrombembolism (VTE) prophylaxis in order to identify safety concerns.

Patients And Methods: Audit in 464 medical and surgical patients to evaluate quality of VTE prophylaxis.

Results: Patients were classified as low 146 (31 %), medium 101 (22 %), and high risk cases 217 (47 %).

Analysis of the heat shock response of Neisseria meningitidis with cDNA- and oligonucleotide-based DNA microarrays.

Oligonucleotide- and cDNA-based microarrays comprising a subset of Neisseria meningitidis genes were assessed for study of the meningococcal heat shock response and found to be highly suitable for transcriptional profiling of N. meningitidis. Employing oligonucleotide arrays encompassing the entire genome of N.

Interaction of Neisseria meningitidis with human dendritic cells.

Infection with Neisseria meningitidis serogroup B is responsible for fatal septicemia and meningococcal meningitis. The severity of disease directly correlates with the production of the proinflammatory cytokines tumor necrosis factor alpha (TNF-alpha), interleukin-1 (IL-1), IL-6, and IL-8. However, the source of these cytokines has not been clearly defined yet.