Active Circulating Blood Volume During Hemodialysis: A Bench Model.

Intradialytic hypotension due to excessive fluid removal is a common complication of hemodialysis. A bench model was constructed to evaluate quantification of active circulating blood volume (ACBV). The model included a central pump representing the heart and compartments to represent the central and peripheral circulation. A blood oxygenator was used to simulate lung volume and two containers represented fast and slow circulation compartments. A separate dialysis circuit with a blood pump and two ultrasound flow-dilution probes was incorporated. Vascular access was simulated with both a shunt (fistula or graft) and a central venous catheter. Hypertonic saline (5%) was circulated in the system. A bolus of isotonic saline was introduced in the dialysis circuit, which dispersed through the physiologic model. ACBV was measured by comparing the baseline dilution curve to the curve as it returned to the probes. To evaluate the sensitivity of this technique, we investigated changing cardiac output, central venous volume, shunt flow, vascular access type, and HD pump flow. Overall percentage error (mean ± SD) across all tests (n = 15 conditions, each in triplicate) was 2.6% ± 7.4%. This study demonstrates the ability to accurately measure ACBV on the bench.