Effect Of Body Fluid Distribution Monitor By Using On-line Blood Volume Monitor And Bioelectric Impedance On The Control Of Blood Pressure During Hemodialysis

Objective: To clarify the effect of non-invasive body fluid distribution monitor by using blood volume monitor and bioelectric impedance on evaluation the changes of blood volume and the distribution of body fluid during hemodialysis, and then adjust the dry weight of dialysis patients to prevent complications such as symptomatic hypotension and refractory hypertension.Methods: 100 patients on maintenance hemodialysis were enrolled, among them 54 male and 46 female, with age of 57.45±13.98(23-82) years, dialysis periods of 58.67±31.54(4-112)months. The patients were divided into 3 groups according to the clinical manifestations, normal blood pressure group (n=34), symptomatic hypotension group (n=22), and refractory hypertension group (n=44). The changes of RBV,ΔRBV,ΔRBV/Δt,Hb,Hct,BWC,ECV%,ICV%,ECV/ICV with the BVM and BEI were observed, and the changes of heart rate,respiration,blood pressure,ultrafiltration volume and ultrafiltration rate of these patients were recorded. Results: The accumulative ultrafiltration volume of every group increased with the decrease of ultrafiltration rate during hemodialysis. In symptomatic hypotension group, the highest ultrafiltration volume and ultrafiltration rate were observed, with the most significant decrease of RBV andΔRBV . The decrease of SBP,DBP,MAP in symptomatic hypotension group were significantly lower than that in normal blood pressure group(P<0.05). A significant positive correlation was observed betweenΔRBV与ΔMAP (r=0.846, P=0.001). The total ultrafiltration volume, ultrafiltration rate and the decrease in both RBV andΔRBV were all lowest in the refractory hypertension group. The blood pressure in refractory hypertension group was significant higher than others(P<0.001),and a negative correlation betweenΔRBV与ΔMAP was observed in this group(r=-0.911,P=0.004). The ECV% and ECV/ICV pre-hemodialysis in three groups were all higher than normal control group,but was significant higher in refractory hypertension group than in others(P<0.05). ICV% in three groups were all lower than in normal control group,but was the lowest data in the symptomatic hypotension group. The ECV% and ECV/ICV post-hemodialysis in three groups decreased, and was always significant higher in refractory hypertension group than in normal control group (P<0.05). ICV% in three groups increasedgradually during hemodialysis, but was still lower than that in normal control group.After up-regulation or down-regulation of the dry body weight, 5 patients withrefractory hypotension and 7 patients with refractory hypertension experiencedeffective blood pressure control respectively.Conclusion: Non-invasive body fluid distribution monitor by using blood volumemonitor and bioelectric impedance provides a good method to confirm the patients'ultrafiltratrion volume and regulation of dry weight ,which leads to an optimal andindividualized volume and blood pressure control.