Primary Research For The Blood Volume And Plasma Refilling Change During Hemodialysis

Objective:Hypotension is one of the most common complication duringhemodialysis. A large quantity of researches manifested that the unbalance ofultrafiltration and plasma refilling is the major cause of hypotension. Pastresearches did not describe the plasma refilling in detail with a viewpoint thatplasma refilling vary from person to person in some early small sampleexperiments. In this study we detected the blood volume chang in maintenancehemodialysis patients during hemodialysis, using some formulas to accountplasma refilling related coefficient, especially the continuous change ofplasma refilling-ultrafiltration rate (PUR). Searching the character of plasmarefilling under steady ultrafiltration.Methods:Continuous monitoring the blood volume change of patients inThe number three affiliated hospital of HeBei medical university during thetotal four hour dialysis course. All the patients was separated to two groupsdepend on the rate of ultrafiltration to weight that before dialysis, which werecalled low-ultrafiltrate group and high-ultrafiltrate group. Choosing normalhemodialysis mood, steady ultrafiltrate without any special ultrafiltrate curve.Using Fresenius BVM4008to monitoring the blood volume change duringhemodialysis course, record the data every15minutes. Changing the bloodvolume data into plasma refilling-ultrafiltration rate (PUR) by related formulas.Analysis the continuous change of PUR.Results:1common information:53patients are selected into the study group for55times,44patients have completed continuous4hour monitoring for46times, in which each group contains a half. The average age of low-ultrafiltrategroup is59.30±2.93(30-78)years, with an average of33,09±4.75(6-120)months since dialysis. The average hemoglobin (HGB) is105.140±2.45g/L in the low-ultrafiltrate group while the average albumin is41.48±0.62g/L.Thelow-ultrafiltrate group has an average ultrafiltration rate of602.17±32.50(301-875) ml/h, with a body weight of67.93±2.34(48.1-86.8) kg beforedialysis, which the UFR is8.94±0.45(5.35-11.75). The average age ofhigh-ultrafiltrate group is51.35±3.55(22-73) years, with an average of45.35±6.41(11-120) months since dialysis.The average hemoglobin (HGB)is105.00±3.41g/Lin the high-ultrafiltrate group while the average albumin is41.70±0.63g/L.The high-ultrafiltrate group has an average ultrafiltration rateof906.91±37.62(575-1250)ml/h,with a body weight of60.84±2.01(60.4-92.6)kg before dialysis, which the UFR is14.92±0.42(11.78-19.38). No difference could be found in the point of age, dialysis age,HGB,and ALB.(P>0.05)2The result of blood volume monitoring: The blood volume of patientsin both two groups decreases as the dialysis precesses. At the end of thedialysis pression, the patients in the low-ultrafiltrate group achieve an averageblood volume of85.56±1.11%while the high-ultrafiltrate group patients equala blood volume of80.40±0.94%. The two groups have different tendence inblood volume changing under different ultrafiltration(P<0.05).3The result of plasma refilling-ultrafiltration rate (PUR): There is nodifference between the two groups in the PUR changing during the dialysisprecess(P>0.05). Combine the two groups into one group and then take intoanalysis. It could find that PUR in the frist30minutes after dialysis beginningis much lower than that at the later time. After the first30minutes, PUR standsteady as a constant until the end, with no difference in any point (P>0.05).The constant express as0.748in this study.Conclusion: Blood volume gradually decreases as the hemodialysisproceed. Ultrafiltration may affect the blood volume changing tendence. Somelaw could be found in plasma refilling. As the PUR shows, PUR remains in alow level and gradually raises at the first30minutes after dialysis beginning.After that the PUR remain steady as a constant with a degree of0.748. PURunder different ultrafiltration rate show no difference until the overload volume is dismissed.