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      Hemodialysis-induced changes in hematocrit, hemoglobin and total protein: Implications for relative blood volume monitoring

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          Abstract

          Background

          Relative blood volume (RBV) changes during hemodialysis (HD) are typically estimated based on online measurements of hematocrit, hemoglobin or total blood protein. The aim of this study was to assess changes in the above parameters during HD in order to compare the potential differences in the RBV changes estimated by individual methods.

          Methods

          25 anuric maintenance HD patients were monitored during a 1-week conventional HD treatment. Blood samples were collected from the arterial dialysis blood line at the beginning and at the end of each HD session. The analysis of blood samples was performed using the hematology analyzer Advia 2120 and clinical chemistry analyzer Advia 1800 (Siemens Healthcare).

          Results

          During the analyzed 30 HD sessions with ultrafiltration in the range 0.7–4.0 L (2.5 ± 0.8 L) hematocrit (HCT) increased by 9.1 ± 7.0% (mean ± SD), hemoglobin (HGB) increased by 10.6 ± 6.3%, total plasma protein (TPP) increased by 15.6 ± 9.5%, total blood protein (TBP) increased by 10.4 ± 5.8%, red blood cell count (RBC) increased by 10.8 ± 7.1%, while mean corpuscular red cell volume (MCV) decreased by 1.5 ± 1.1% (all changes statistically significant, p < 0.001). HGB increased on average by 1.5% more than HCT (p < 0.001). The difference between HGB and TBP increase was insignificant (p = 0.16).

          Conclusions

          Tracking HGB or TBP can be treated as equivalent for the purpose of estimating RBV changes during HD. Due to the reduction of MCV, the HCT-based estimate of RBV changes may underestimate the actual blood volume changes.

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          Most cited references37

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          The body/venous hematocrit ratio: its constancy over a wide hematocrit range.

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            Measurement of relative blood volume changes during haemodialysis: merits and limitations.

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              Nature and rate of vascular refilling during hemodialysis and ultrafiltration.

              The change of blood volume, of blood and plasma density (rho b, rho p) following a short ultrafiltration pulse (duration: 20 min; mean rate -35 ml/min) within the first hour of hemodialysis was analyzed in 13 hemodynamically stable patients (30 single measurements). Protein concentration of refilling volume (7 g/liter) was calculated from its density (1009.25 +/- 3.7 kg/m3, at 20 degrees C) and from the linear relationship between plasma density and protein concentration (cp) of uremic plasma samples (rho p = 1007.46 + 0.2422 x cp). The filtration coefficient (Lp,calc) determined from a relation derived from Starling's hypothesis was 5.6 +/- 1.4 ml/(min.mm Hg.50 kg lean body mass); N = 13, mean +/- SD, minimum 3.2, maximum 8.0. A model describing the dynamics of blood and plasma volume was developed. It was fit to on-line measurements of relative blood volume changes by variation of the filtration coefficient and of initial blood volume (Lp,fit, Vb,fit). The linear regression between Vb,fit and blood volume determined from anthropometry (Vb,calc) was highly significant (r = 0.79, N = 30, P < 0.001). Compared to Vb,calc, Vb,fit was typically increased by 21 +/- 11%, reflecting a fluid overload at the beginning of the treatment. Lp,fit was not different from Lp,calc. Lp,fit significantly increased with blood volume excess. Due to the small but definite protein content of refilling volume, the model accounts for increased blood volume recovery and occasional overshoot of blood and plasma volumes following ultrafiltration.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Resources
                Role: InvestigationRole: Resources
                Role: ConceptualizationRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                12 August 2019
                2019
                : 14
                : 8
                : e0220764
                Affiliations
                [1 ] Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
                [2 ] Department of Physical Therapy and Rehabilitation, Medical University of Lublin, Lublin, Poland
                [3 ] Department of Nephrology, Medical University of Lublin, Lublin, Poland
                University of Nottingham School of Medicine, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-5705-6142
                http://orcid.org/0000-0001-8741-7930
                http://orcid.org/0000-0001-6043-3236
                Article
                PONE-D-19-08747
                10.1371/journal.pone.0220764
                6690539
                31404089
                72838de3-f0ef-4569-92bf-8407b1ea833f
                © 2019 Pstras et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 27 March 2019
                : 23 July 2019
                Page count
                Figures: 6, Tables: 3, Pages: 14
                Funding
                Funded by: National Science Centre (Poland)
                Award ID: N N518 289840
                Award Recipient :
                The clinical data presented in this article were originally collected within the study "Evaluation of disturbances of calcium-phosphate management in patients on dialysis" funded by the National Science Centre (Poland), grant no N N518 289840 to MD. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Nephrology
                Medical Dialysis
                Biology and Life Sciences
                Cell Biology
                Cellular Types
                Animal Cells
                Blood Cells
                Red Blood Cells
                Biology and Life Sciences
                Anatomy
                Body Fluids
                Blood
                Medicine and Health Sciences
                Anatomy
                Body Fluids
                Blood
                Biology and Life Sciences
                Physiology
                Body Fluids
                Blood
                Medicine and Health Sciences
                Physiology
                Body Fluids
                Blood
                Biology and Life Sciences
                Biochemistry
                Proteins
                Hemoglobin
                Medicine and Health Sciences
                Hematology
                Hematocrit
                Biology and Life Sciences
                Anatomy
                Body Fluids
                Blood
                Blood Counts
                Hematocrit
                Medicine and Health Sciences
                Anatomy
                Body Fluids
                Blood
                Blood Counts
                Hematocrit
                Biology and Life Sciences
                Physiology
                Body Fluids
                Blood
                Blood Counts
                Hematocrit
                Medicine and Health Sciences
                Physiology
                Body Fluids
                Blood
                Blood Counts
                Hematocrit
                Biology and Life Sciences
                Biochemistry
                Proteins
                Plasma Proteins
                Biology and Life Sciences
                Anatomy
                Body Fluids
                Blood
                Blood Volume
                Medicine and Health Sciences
                Anatomy
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                Blood Volume
                Biology and Life Sciences
                Physiology
                Body Fluids
                Blood
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                Medicine and Health Sciences
                Physiology
                Body Fluids
                Blood
                Blood Volume
                Biology and Life Sciences
                Anatomy
                Body Fluids
                Blood
                Plasma Volume
                Medicine and Health Sciences
                Anatomy
                Body Fluids
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                Plasma Volume
                Biology and Life Sciences
                Physiology
                Body Fluids
                Blood
                Plasma Volume
                Medicine and Health Sciences
                Physiology
                Body Fluids
                Blood
                Plasma Volume
                Custom metadata
                The data used are available at the following URL: http://dx.doi.org/10.18150/repod.9505831.

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