Fluid Management

Historically, clinical emphasis has been placed on toxin removal in dialysis using numerous technological advances, complex methods of analyzing clearance and improved dialyzer membranes. However, fluid management in hemodialysis has remained largely unchanged. With Crit-Line technology, providers can now access information that can help improve fluid management in hemodialysis patients. Please note that Crit-Line technology does not provide a treatment algorithm and does not directly intervene in the dialysis treatment.

Managing fluid during hemodialysis has always been a challenge. Based on the data that the Crit-Line technology provides, the dialysis technician may intervene (i.e., increase or decrease the rate at which fluid is removed from the body) in order to potentially remove the maximum amount of fluid from the dialysis patient without the patient experiencing the common symptoms of dialysis which include nausea, cramping and vomiting. Therefore, it has been suggested that better fluid management can help improve dialysis patient care.1

Crit-Line technology provides objective data and visually displays the relative blood volume slope, which indicates the balance between the dialysis patient's vascular refill and ultrafiltration rates. Based on that information, the provider can intervene and adjust the rate of fluid removal in order to remove the maximum amount of fluid. The slopes or profiles that are displayed by Crit-Line technology are typically categorized as A, B or C and are defined as follows:

View Fluid Management Findings →

 

PROFILE A

PROFILE A

An "A" profile indicates that the patient's plasma refill rate is occurring at the same or a greater rate than ultrafiltration. This profile suggests that the ultrafiltration rate might be increased without immediate risk of intradialytic symptoms.
PROFILE B

PROFILE B

A "B" profile is a gradual slope that has been targeted to find the best compromise between a high ultrafiltration rate and the prevention of intradialytic symptoms. The ideal slope is not a fixed percentage of change in BV, and will vary from patient to patient.
PROFILE C

PROFILE C

A "C" profile is represented by a steep slope which indicates a rapid decrease in blood volume, and bears a higher risk for intradialytic symptoms such as lightheadedness, nausea, vomiting, cramping or hypotension.

 

 

1. Agarwal, R, Alborzi, P, Satayan, S. Light RP "Dry-weight Reduction in Hypertensive Hemodialysis Patients (DRIP): A Randomized , Controlled Trial." Hypertension 53 no. 3 (2009) 500-507.