Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland.
Department of Physical Therapy and Rehabilitation, Medical University of Lublin, Lublin, Poland.
PLoS One. 2019 Aug 12;14(8):e0220764. doi: 10.1371/journal.pone.0220764. eCollection 2019.
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.
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).
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).
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.
血液透析（HD）过程中的相对血容量（RBV）变化通常基于红细胞压积、血红蛋白或总血蛋白的在线测量来估计。本研究的目的是评估 HD 过程中上述参数的变化，以比较个体方法估计的 RBV 变化的潜在差异。
对 25 名无尿维持性 HD 患者进行为期一周的常规 HD 治疗监测。在每个 HD 治疗开始和结束时，从动脉透析血线采集血样。使用血液学分析仪 Advia 2120 和临床化学分析仪 Advia 1800（西门子医疗）对血样进行分析。
在分析的 30 次超滤范围为 0.7-4.0 L（2.5±0.8 L）的 HD 治疗中，红细胞压积（HCT）增加了 9.1±7.0%（平均值±标准差），血红蛋白（HGB）增加了 10.6±6.3%，总血浆蛋白（TPP）增加了 15.6±9.5%，总血蛋白（TBP）增加了 10.4±5.8%，红细胞计数（RBC）增加了 10.8±7.1%，而平均红细胞体积（MCV）降低了 1.5±1.1%（所有变化均具有统计学意义，p<0.001）。HGB 平均比 HCT 增加了 1.5%（p<0.001）。HGB 与 TBP 增加之间的差异无统计学意义（p=0.16）。
在 HD 期间估计 RBV 变化时，可以将跟踪 HGB 或 TBP 视为等效。由于 MCV 的减少，基于 HCT 的 RBV 变化估计可能会低估实际的血容量变化。
