Adjusting Fluid Removal Based on Blood Volume in Hemodialysis: A Randomized Study
Intradialytic Hypotension, End Stage Renal Failure on Dialysis
About this trial
This is an interventional treatment trial for Intradialytic Hypotension focused on measuring Intradialytic Hypotension, Renal Dialysis, Blood Volume Determination, Clinical Trials, Randomized, Crossover Studies
Eligibility Criteria
Run-in Phase Inclusion Criteria:
- >18 years old
- Maintenance hemodialysis patients for more than 3 months
- Undergo hemodialysis 3-4 times per week for a minimum of three hours per session
- Have >30% of their hemodialysis sessions in the preceding 8 weeks complicated by symptomatic IDH.
- Able to provide written informed consent.
Randomization Phase Inclusion Criteria:
- >18 years old
- Maintenance hemodialysis patients for more than 3 months
- Undergo hemodialysis 3-4 times per week for a minimum of three hours per session
- Have >30% of their hemodialysis sessions in the preceding 4 weeks complicated by symptomatic IDH.
Exclusion Criteria:
- Serum sodium ≤133mmol/L
- Hemoglobin <80g/L
- Active Malignancy
- History of blood transfusions or hospitalizations in the preceding 4 weeks
- Planned change in the renal replacement modality during the planned study period
Sites / Locations
- Alberta Health Services Southern Alberta Renal Program
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Best clinical practice HD
Best clinical practice plus BVM-guided UF biofeedback
All study patients will be dialyzed with the Fresenius 5008 HD machine (Fresenius Medical Care, Bad Homburg, Germany) using high flux dialyzers. For an 8-week period, patients in the best clinical practice (control) phase will use their same prescription as the run-in phase, dialysate sodium of 138mmol/L, dialysate calcium of 1.25mmol/L, dialysate temperature of 36oC, and constant UF rate. BVM will be disabled in this group.
Patients in the BVM-guided UF biofeedback (intervention) phase will have the same prescription as the control group but will also have the ultrafiltration rate automatically adjusted by the Fresenius 5008 HD machine based on the changes in the relative blood volume.