Linear decay of relative blood volume during ultrafiltration predicts hemodynamic instability

Sandip Mitra, Paul Chamney, Roger Greenwood, Ken Farrington

Research output: Contribution to journalArticlepeer-review

41 Citations (Scopus)


BACKGROUND: Relative blood volume (RBV) changes during hemodialysis (HD) are poorly understood. We wish to define characteristics of RBV profiles at different hydration states predictive of hemodynamic instability.

METHODS: Thirty patients underwent online RBV monitoring during an HD session with intermittent ultrafiltration (UF) pulses administered until the onset of hypotension. The RBV decay constant (tau) was derived from curve fitting. Linear divergence, the net deviation of the RBV curve during UF from predicted linear decay, was computed from initial 1-minute slopes.

RESULTS: The best correlation with proximity to dry weight (PDW) was provided by linear divergence (r = 0.817; P < 0.001), its major determinant in multiple regression analysis. Other predictors were RBV at initiation of UF pulse, UF pulse volume, and UF decay constant (tau(UF)). These parameters were significantly different in UF pulses within 1 kg and 1 kg or greater of dry weight. There were no correlations with refill parameters. The occurrence of hypotension was not different at RBVs less than 90% (7.4%) or 90% or greater (5.3%). tau(UF), linear divergence, RBV at initiation of UF pulse (all P < 0.001), and UF decay amplitude (P < 0.01) were different between hypotensive and normotensive UF pulses. Hypotension was the only independent predictor of tau(UF) (R2 = 0.40; P < 0.001). The only independent predictor of linear divergence was PDW (R2 = 0.667; P < 0.001).

CONCLUSION: Approaching dry weight, the RBV decline during UF switched from exponential to linear decay, probably indicating failing vascular refill. Monitoring deviation from linearity may allow improved hemodynamic stability and attainment of optimal post-HD weight.

Original languageEnglish
Pages (from-to)556-65
Number of pages10
JournalAmerican Journal of Kidney Diseases
Issue number3
Publication statusPublished - Sept 2002


  • Adult
  • Aged
  • Antihypertensive Agents
  • Blood Circulation
  • Blood Pressure
  • Blood Pressure Monitoring, Ambulatory
  • Blood Volume
  • Body Water
  • Catheters, Indwelling
  • Hemodynamics
  • Humans
  • Hypotension
  • Linear Models
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Renal Dialysis
  • Ultrafiltration
  • Journal Article


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