Estimation of absolute blood volume in hemodialysis patients: A numerical algorithm for assessing blood volume increase after dialysate bolus infusion

Leszek Pstras; Simon Krenn; Jacek Waniewski; Michael Schmiedecker; Sebastian Mussnig; Janosch Niknam; Peter Wabel; Christopher Clemens Mayer; Daniel Schneditz; Manfred Hecking

doi:10.1016/j.bspc.2023.105440

Estimation of absolute blood volume in hemodialysis patients: A numerical algorithm for assessing blood volume increase after dialysate bolus infusion

Leszek Pstras
, Simon Krenn
, Jacek Waniewski
, Michael Schmiedecker
, Sebastian Mussnig
, Janosch Niknam
, Peter Wabel
, Christopher Clemens Mayer
, Daniel Schneditz
, Manfred Hecking

Medical Signal Analysis

Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences
Department of Medicine III, Division for Nephrology and Dialysis, Medical University of Vienna
Independent Researcher
Otto Loewi Research Center, Division of Physiology, Medical University of Graz

Research output: Contribution to journal › Article › peer-review

Abstract

Objective
A feasible method has recently been proposed for estimating absolute blood volume (ABV) in hemodialysis (HD) patients based on intradialytic infusion of a dialysate bolus and visual assessment of the subsequent increase in relative blood volume (RBV) tracked by the dialysis machine. The aim of this study was to develop a method for more objective determination of such RBV increase to improve the accuracy of ABV estimation.

Methods
We proposed a numerical algorithm consisting of interpolation and polynomial fitting of RBV signals, which we evaluated on data from 64 HD sessions in 48 patients with 240 mL of dialysate infused approximately 1 h into HD. The estimated ABV values were compared with those from a simple two-point method described previously as well as with the values calculated using the Nadler formula and the Lemmens-Bernstein-Brodsky formula.

Results
Compared to the simple method, the improved method provided higher (more plausible) estimates of ABV (median 4.79 vs 4.53 L, p < 0.001) and specific ABV (median 68.5 vs 66.4 mL/kg, p < 0.001). The improved method also provided much lower intra-patient variability of ABV estimated in different sessions of the same week (median spread 180 vs 462 mL, p < 0.001) and showed narrower limits of agreement with both Nadler and Lemmens-Bernstein-Brodsky formulae.

Conclusion
The proposed numerical method constitutes a substantial improvement over the simple method by averaging the noise and short-term variability in RBV signals.

Significance
More accurate estimates of ABV in HD patients could aid in managing their fluid status.

Original language	English
Article number	105440
Pages (from-to)	1-9
Number of pages	9
Journal	Biomedical Signal Processing and Control
Volume	88
Issue number	Part A
Early online date	10 Oct 2023
DOIs	https://doi.org/10.1016/j.bspc.2023.105440
Publication status	Published - Feb 2024

Research Field

Medical Signal Analysis

Keywords

Absolute blood volume
Fluid status
Hemodilution
Relative blood volume
Ultrafiltration

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10.1016/j.bspc.2023.105440Licence: CC BY

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Pstras, L., Krenn, S., Waniewski, J., Schmiedecker, M., Mussnig, S., Niknam, J., Wabel, P., Mayer, C. C., Schneditz, D., & Hecking, M. (2024). Estimation of absolute blood volume in hemodialysis patients: A numerical algorithm for assessing blood volume increase after dialysate bolus infusion. Biomedical Signal Processing and Control, 88(Part A), 1-9. Article 105440. https://doi.org/10.1016/j.bspc.2023.105440

@article{7c102fe234444769b0d56d0371d5fd03,

title = "Estimation of absolute blood volume in hemodialysis patients: A numerical algorithm for assessing blood volume increase after dialysate bolus infusion",

abstract = "Objective A feasible method has recently been proposed for estimating absolute blood volume (ABV) in hemodialysis (HD) patients based on intradialytic infusion of a dialysate bolus and visual assessment of the subsequent increase in relative blood volume (RBV) tracked by the dialysis machine. The aim of this study was to develop a method for more objective determination of such RBV increase to improve the accuracy of ABV estimation. Methods We proposed a numerical algorithm consisting of interpolation and polynomial fitting of RBV signals, which we evaluated on data from 64 HD sessions in 48 patients with 240 mL of dialysate infused approximately 1 h into HD. The estimated ABV values were compared with those from a simple two-point method described previously as well as with the values calculated using the Nadler formula and the Lemmens-Bernstein-Brodsky formula. Results Compared to the simple method, the improved method provided higher (more plausible) estimates of ABV (median 4.79 vs 4.53 L, p < 0.001) and specific ABV (median 68.5 vs 66.4 mL/kg, p < 0.001). The improved method also provided much lower intra-patient variability of ABV estimated in different sessions of the same week (median spread 180 vs 462 mL, p < 0.001) and showed narrower limits of agreement with both Nadler and Lemmens-Bernstein-Brodsky formulae. Conclusion The proposed numerical method constitutes a substantial improvement over the simple method by averaging the noise and short-term variability in RBV signals. Significance More accurate estimates of ABV in HD patients could aid in managing their fluid status.",

keywords = "Absolute blood volume, Fluid status, Hemodilution, Relative blood volume, Ultrafiltration",

author = "Leszek Pstras and Simon Krenn and Jacek Waniewski and Michael Schmiedecker and Sebastian Mussnig and Janosch Niknam and Peter Wabel and Mayer, \{Christopher Clemens\} and Daniel Schneditz and Manfred Hecking",

note = "1746-8094/{\textcopyright} 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).",

year = "2024",

month = feb,

doi = "10.1016/j.bspc.2023.105440",

language = "English",

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pages = "1--9",

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Pstras, L, Krenn, S, Waniewski, J, Schmiedecker, M, Mussnig, S, Niknam, J, Wabel, P, Mayer, CC, Schneditz, D & Hecking, M 2024, 'Estimation of absolute blood volume in hemodialysis patients: A numerical algorithm for assessing blood volume increase after dialysate bolus infusion', Biomedical Signal Processing and Control, vol. 88, no. Part A, 105440, pp. 1-9. https://doi.org/10.1016/j.bspc.2023.105440

TY - JOUR

T1 - Estimation of absolute blood volume in hemodialysis patients

T2 - A numerical algorithm for assessing blood volume increase after dialysate bolus infusion

AU - Pstras, Leszek

AU - Krenn, Simon

AU - Waniewski, Jacek

AU - Schmiedecker, Michael

AU - Mussnig, Sebastian

AU - Niknam, Janosch

AU - Wabel, Peter

AU - Mayer, Christopher Clemens

AU - Schneditz, Daniel

AU - Hecking, Manfred

PY - 2024/2

Y1 - 2024/2

N2 - Objective A feasible method has recently been proposed for estimating absolute blood volume (ABV) in hemodialysis (HD) patients based on intradialytic infusion of a dialysate bolus and visual assessment of the subsequent increase in relative blood volume (RBV) tracked by the dialysis machine. The aim of this study was to develop a method for more objective determination of such RBV increase to improve the accuracy of ABV estimation. Methods We proposed a numerical algorithm consisting of interpolation and polynomial fitting of RBV signals, which we evaluated on data from 64 HD sessions in 48 patients with 240 mL of dialysate infused approximately 1 h into HD. The estimated ABV values were compared with those from a simple two-point method described previously as well as with the values calculated using the Nadler formula and the Lemmens-Bernstein-Brodsky formula. Results Compared to the simple method, the improved method provided higher (more plausible) estimates of ABV (median 4.79 vs 4.53 L, p < 0.001) and specific ABV (median 68.5 vs 66.4 mL/kg, p < 0.001). The improved method also provided much lower intra-patient variability of ABV estimated in different sessions of the same week (median spread 180 vs 462 mL, p < 0.001) and showed narrower limits of agreement with both Nadler and Lemmens-Bernstein-Brodsky formulae. Conclusion The proposed numerical method constitutes a substantial improvement over the simple method by averaging the noise and short-term variability in RBV signals. Significance More accurate estimates of ABV in HD patients could aid in managing their fluid status.

AB - Objective A feasible method has recently been proposed for estimating absolute blood volume (ABV) in hemodialysis (HD) patients based on intradialytic infusion of a dialysate bolus and visual assessment of the subsequent increase in relative blood volume (RBV) tracked by the dialysis machine. The aim of this study was to develop a method for more objective determination of such RBV increase to improve the accuracy of ABV estimation. Methods We proposed a numerical algorithm consisting of interpolation and polynomial fitting of RBV signals, which we evaluated on data from 64 HD sessions in 48 patients with 240 mL of dialysate infused approximately 1 h into HD. The estimated ABV values were compared with those from a simple two-point method described previously as well as with the values calculated using the Nadler formula and the Lemmens-Bernstein-Brodsky formula. Results Compared to the simple method, the improved method provided higher (more plausible) estimates of ABV (median 4.79 vs 4.53 L, p < 0.001) and specific ABV (median 68.5 vs 66.4 mL/kg, p < 0.001). The improved method also provided much lower intra-patient variability of ABV estimated in different sessions of the same week (median spread 180 vs 462 mL, p < 0.001) and showed narrower limits of agreement with both Nadler and Lemmens-Bernstein-Brodsky formulae. Conclusion The proposed numerical method constitutes a substantial improvement over the simple method by averaging the noise and short-term variability in RBV signals. Significance More accurate estimates of ABV in HD patients could aid in managing their fluid status.

KW - Absolute blood volume

KW - Fluid status

KW - Hemodilution

KW - Relative blood volume

KW - Ultrafiltration

U2 - 10.1016/j.bspc.2023.105440

DO - 10.1016/j.bspc.2023.105440

M3 - Article

SN - 1746-8094

VL - 88

SP - 1

EP - 9

JO - Biomedical Signal Processing and Control

JF - Biomedical Signal Processing and Control

IS - Part A

M1 - 105440

ER -

Estimation of absolute blood volume in hemodialysis patients: A numerical algorithm for assessing blood volume increase after dialysate bolus infusion

Abstract

Research Field

Keywords

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