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Abstract：
Background: Management of body fluid volumes and adequate prescription of ultrafiltration (UF) remain key issues in the treatment of chronic kidney disease patients.Objective: This study aims to estimate the magnitude as well as the precision of absolute blood volume (Vb) modeled during regular hemodialysis (HD) using standard data available with modern dialysis machines.Methods: The estimation utilizes a two-compartment fluid model and a mathematical optimization technique to predict UF-induced changes in hematocrit measured by available on-line techniques. The method does not rely on a specific hematocrit sensor or a specific UF or volume infusion protocol and uses modeling and prediction tools to quantify the error in Vb estimation.Results: The method was applied to 21 treatments (pre-UF body mass: 65.57±13.44 kg, UF-volume: 3.99±1.14 L) obtained in ten patients (4 female). Pre-HD Vb was 5.4±0.53 L with an average coefficient of variation of 9.8% (range 1 to 22%). A significant moderate correlation was obtained when Vb was compared to a different method applied to the same data set (r = 0.5). Specific blood volumes remained above the critical level of 65 mL/kg in 17 treatments (80.9%).Conclusion: The method offers the opportunity to detect critical blood volumes during HD and to judge the quality and reliability of that information based on the precision of the Vb estimate.
摘要：
背景：体液量的管理和超滤（UF）的适当处方仍然是治疗慢性肾脏病患者的关键问题。目的：本研究旨在使用现代透析机提供的标准数据来估计常规血液透析（HD）期间建模的绝对血量（Vb）的大小和精度。方法：估算利用两室流体模型和数学优化技术来预测通过可用的在线技术测得的UF引起的血细胞比容变化。该方法不依赖于特定的血细胞比容传感器或特定的UF或体积输注方案,并且使用建模和预测工具来量化Vb估计中的误差。结果：该方法适用于21种治疗（UF前体重：65.57±13.44kg，UF体积：3.99±1.14L）在10名患者（4名女性）中获得。HD前Vb为5.4±0.53L，平均变异系数为9.8％（范围1至22％）。当将Vb与应用于相同数据集的不同方法进行比较时（r=0.5），获得了显着的中等相关性。在17种治疗中，特定的血液体积保持在65mL/kg的临界水平以上（80.9％）。结论：该方法提供了在HD期间检测临界血容量的机会，并根据Vb估计的精度判断该信息的质量和可靠性。
