Intravascular volumes and the influence on anemia assessed by a carbon monoxide rebreathing method in patients undergoing maintenance hemodialysis

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY Hemodialysis International Pub Date : 2023-10-12 DOI:10.1111/hdi.13118

Vårin Vinje, Tobias Bomholt, Carsten Lundby, Peter Oturai, Marianne Rix, Kristine Lindhard, Mads Hornum

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Abstract

Introduction

Fluid overload is a major challenge in hemodialysis patients and might cause hypervolemia. We speculated that hemodialysis patients reaching dry weight could have undetected hypervolemia and low hemoglobin (Hb) concentration (g/dL) due to hemodilution.

Methods

The study included hemodialysis patients (n = 22) and matched healthy controls (n = 22). Blood volume, plasma volume, red blood cell volume, and total Hb mass were determined using a carbon monoxide (CO)-rebreathing method in hemodialysis patients reaching dry weight and controls. Blood volume measurements were also obtained by a dual-isotope labeling technique in a subgroup for validation purposes.

Findings

In the hemodialysis group, the median specific blood volume was 89.3 mL/kg (interquartile range [IQR]: 76.7–95.4 mL/kg) and was higher than in the control group (79.9 mL/kg [IQR: 70.4–88.0 mL/kg]; p < 0.037). The median specific plasma volume was 54.7 mL/kg (IQR: 47.1–61.0 mL/kg) and 44.0 mL/kg (IQR: 38.7–49.5 mL/kg) in the hemodialysis and control groups, respectively (p < 0.001). Hb concentration was lower in hemodialysis patients (p < 0.001), whereas no difference in total Hb mass was observed between groups (p = 0.11). A correlation was found between blood volume measured by the CO-rebreathing test and the dual-isotope labeling technique in the control group (r = 0.83, p = 0.015), but not the hemodialysis group (r = 0.25, p = 0.60).

Discussion

The hemodialysis group had increased specific blood volume at dry weight due to high plasma volume, suggesting a hypervolemic state. However, correlation was not established against the dual-isotope labeling technique underlining that the precision of the CO-rebreathing test should be further validated. The total Hb mass was similar between hemodialysis patients and controls, unlike Hb concentration, which emphasizes that Hb concentration is an inaccurate marker of anemia among hemodialysis patients.

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一氧化碳再呼吸法评估维持性血液透析患者的血管内容量和对贫血的影响。

引言：血液透析患者的主要挑战是液体过载，可能导致高容量血症。我们推测，达到干重的血液透析患者可能由于血液稀释而出现未被检测到的高容量血症和低血红蛋白（Hb）浓度（g/dL）。方法：纳入血液透析患者（n = 22）和匹配的健康对照组（n = 22）。在达到干重的血液透析患者和对照组中，使用一氧化碳（CO）再呼吸法测定血容量、血浆容量、红细胞容量和总Hb质量。为了验证目的，还通过亚组中的双同位素标记技术获得了血容量测量值。结果：血液透析组的中位比血容量为89.3 mL/kg（四分位间距[IQR]：76.7-95.4 mL/kg），并且高于对照组（79.9 mL/kg【IQR:70.4-88.0 mL/kg]；p 讨论：血液透析组由于血浆容量高，在干重时比血容量增加，表明处于高容量状态。然而，没有建立与双同位素标记技术的相关性，这强调了CO再呼吸测试的准确性应该进一步验证。血液透析患者和对照组的总Hb质量相似，不同于Hb浓度，后者强调Hb浓度是血液透析患者贫血的不准确标志。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hemodialysis International UROLOGY & NEPHROLOGY-

CiteScore

2.50

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.