In this moment blood meaning8/17/2023 ![]() ![]() by a manual or automatic reduction of dialyzer ultrafiltration). One of the means of preventing IDH is to monitor the blood volume changes and to provide an adequate reaction once the blood volume falls too low or too quickly (e.g. In order to maintain cardiovascular stability and sustain adequate organ perfusion, the reduction of the total blood volume cannot be excessively large or abrupt, otherwise the cardiovascular regulatory mechanisms may not be able to maintain sufficient blood pressure leading to intradialytic hypotension (IDH)-the most common complication of HD 5, 6, 7, 8, 9. In a typical HD session, a few litres of fluid (2–4 L) are removed from the circulation over the course of a few hours (3–5 h), and hence, even with a properly working vascular refilling mechanism, the total blood volume is usually reduced. The resulting blood volume reduction is compensated by the so called vascular refilling 1, 2, 3, 4, which consists in the absorption of fluid from the tissues in the capillary beds (driven mainly by the oncotic pressure difference across the capillary walls) combined with the ongoing lymphatic absorption at the whole-body level. In haemodialysis (HD) the excess fluid (water and small solutes) is removed from the blood flowing through the dialyzer in the process called ultrafiltration. One of the main goals of dialysis therapy is to remove from the patient the excess fluid that accumulates in the body due to kidney failure. A possible overestimation of the actual RBV changes is the highest when the measurements are started within a couple of minutes after the infusion of priming saline is completed. The model-based simulations indicate that when the priming saline is not discarded but infused to the patient, a few-minute difference in the moment of starting RBV tracking through measurements of HCT, HGB or TBP may substantially affect the RBV changes observed throughout the dialysis session, especially with large priming volumes. The aim of this study was to use a mathematical model to assess this issue quantitatively. filling the extracorporeal circuit with the patient’s blood (with the priming saline being infused to the patient or discarded) may be associated with relatively dynamic changes in the circulation, and hence the observed RBV changes may depend on the exact moment of starting the measurements. The beginning of a haemodialysis procedure, i.e. RBV changes are typically estimated based on online measurements of certain haemoconcentration markers, such as haematocrit (HCT), haemoglobin (HGB) or total blood protein concentration (TBP). Relative blood volume (RBV) monitoring is frequently used in haemodialysis patients to help guide fluid management and improve cardiovascular stability. ![]()
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