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Measurement of Cardiac Output and Blood Volume During Hemodialysis with Fluorescent Dye Dilution Technique

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Abstract

Intradialytic hypotensive events (IDH) accompanied by deleterious decreases of the cardiac output complicate up to 25% of hemodialysis treatments. Monitoring options available to track hemodynamic changes during hemodialysis have been found ineffective to anticipate the occurrence of IDH. We have assembled opto-electronic instrumentation that uses the fluorescence of a small bolus of indocyanine green dye injected in the hemodialysis circuit to estimate cardiac output and blood volume based on indicator dilution principles in patients receiving hemodialysis. The instrument and technique were tested in 24 adult end-stage renal failure subjects during 64 hemodialysis sessions. A single calibration factor could be used across subjects and across time. Intra-subject variability of the measurements over time was <10%. Stroke volume index (SVI) (mean ± SEM = 34 ± 1 vs. 39 ± 2 mL m−2) and central blood volume (CBV) index (783 ± 36 vs. 881 ± 33 mL m−2) were lower at the beginning of the sessions in which IDH eventually occurred. Cardiac index, SVI, and CBV index decreased with hemodialysis in all treatment sessions but the decrease was more intense in the IDH sessions. We conclude that hemodynamic monitoring can be implemented in patients receiving hemodialysis with minimal disruption of the treatment and could help understand intradialytic hypotension.

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Acknowledgments

This study was supported by in part by the Alfred E. Mann Institute for Biomedical Engineering at the University of Southern California, the NIH/NHLBI (Grant R01 HL103765), and the NIH/NCRR SC-CTSI (Grant UL1 RR031986). The authors thank Ms. Radhika Ananthakrishna and Ms. Yeasmin Nazmay for their technical assistance during the clinical studies.

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Authors and Affiliations

  1. Department of Biomedical Engineering, University of Southern California, DRB 140, University Park, Los Angeles, CA, 90089-1111, USA

    Jean Michel I. Maarek & Daniel P. Holschneider

  2. Department of Anesthesiology, University of California, Los Angeles, Los Angeles, CA, USA

    Eduardo H. Rubinstein

  3. Department of Psychiatry & the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA

    Yumei Guo & Daniel P. Holschneider

  4. Southern California Clinical & Translational Science Institute, University of Southern California, Los Angeles, CA, USA

    Christianne J. Lane

  5. Division of Nephrology and Hypertension Center, Department of Medicine, University of Southern California, Los Angeles, CA, USA

    Vito M. Campese

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  1. Jean Michel I. Maarek
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Correspondence to Jean Michel I. Maarek.

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Associate Editor John H. Linehan oversaw the review of this article.

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Maarek, J.M.I., Rubinstein, E.H., Guo, Y. et al. Measurement of Cardiac Output and Blood Volume During Hemodialysis with Fluorescent Dye Dilution Technique. Ann Biomed Eng 45, 580–591 (2017). https://doi.org/10.1007/s10439-016-1711-6

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  • DOI: https://doi.org/10.1007/s10439-016-1711-6

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