Influence of ultrafiltration volume on blood volume changes during hemodialysis as observed in day-of-the-week analysis of hemodialysis sessions

Abstract

Monitoring of relative blood volume changes (DeltaRBV) has been propagated for the prevention of hemodialysis hypotension. Although the influence of ultrafiltration volume on DeltaRBV is well-known, there is no mention in the literature that DeltaRBV results should be interpreted differently for the first, second, or third hemodialysis session of the week. To elucidate whether DeltaRBV and its derivative, DeltaRBV normalized for ultrafiltration volume (DeltaRBV/ultrafiltration ratio), vary systematically over the week, we separately analyzed these parameters for the first, second, and third hemodialysis session of the week in 13 chronic hemodialysis patients over a 17-week period. As expected, mean (+/-SD) ultrafiltration volume was significantly (p < 0.001) higher during the first session than during the second and third hemodialysis sessions (3163 +/- 615, 2622 +/- 674 and 2607 +/- 638 ml, respectively). DeltaRBV was significantly (p < 0.01) more negative at the first session than at the second and third hemodialysis sessions (-10.1 +/- 2.7, -9.3 +/- 3.0 and -9.3 +/- 3.1%, respectively). The DeltaRBV/ultrafiltration ratio was significantly (p < 0.01) less negative at the first session than at the second and third hemodialysis sessions (-3.2 +/- 0.6, -3.5 +/- 0.8 and -3.6 +/- 0.6%/l, respectively). In conclusion, DeltaRBV and the DeltaRBV/ultrafiltration ratio differ systematically between the first and other hemodialysis sessions in patients on a thrice-weekly hemodialysis schedule, most likely as a result of different ultrafiltration volumes.