Blood Volume in Hemodialysis & Kidney Diseases

What is Kidney Disease?

Kidney disease, or renal disease is damage to or disease of a kidney. Kidney disease usually causes a loss of kidney function to some degree and can result in kidney failure, the complete loss of kidney function. Kidney failure is known as the end-stage of kidney disease, where dialysis or a kidney transplant is the only treatment option.

Kidney failure can be divided into two categories: acute kidney failure or chronic kidney failure. While acute kidney failure is often reversible chronic kidney failure is not. Chronic failure affects about 1 in 1000 people. Causes of chronic kidney failure include diabetes, high blood pressure, nephrotic syndrome, and polycystic kidney disease. Complications are many and include uremia, high blood potassium, and volume overload. Complications of chronic failure also include heart disease, high blood pressure, and anemia.

Current Treatment of Kidney Disease

Treatment of chronic failure may include hemodialysis where a hemodialysis machine is used to filter away plasma from the circulation to reduce the volume overload. Patients may have to be treated daily with this procedure. One not trivial question often is “how much blood plasma should be removed”? Medical doctors may rely on what is termed a person’s dry weight which is essentially based on the ideal weight for a given body height and with the idea being to remove fluid corresponding to the difference in body weight. This approach may still be improved as when too much fluid is removed patients may experience hypotension. Studies have shown that the risk for developing hypotension (intradialytic hypotension) following hemodialysis is high (15-30%). This is unfortunate as intradialytic hypotension is be associated to several severe pathologies.

cases of US prevalent hemodialysis patients
events of intradialytic hypotension
hospitalised dies within 30 days

2018 Annual Data Report” from US Renal Data Systems (link)

Research on Blood Volume Guided Hemodialysis

Current research looks to determine the actual blood volume of a patient and then, by hemodialysis, remove what is in excess corresponding to normal values (i.e. not based on dry/ ideal weight). Such measurements could be performed on a monthly basis to help guide the treating medical doctor. Researchers speculate that blood volume guided hemodialysis could optimise the volume that may be removed per dialysis so that procedures performed per week could be reduced. The Detalo Health Performance blood volume analyzer has already been used in dialysis patients.

Healthy kidney produce the hormone erythropoietin that stimulates the bone marrow to produced red blood cells. As the kidneys fail, they may produce less erythropoietin, resulting in decreased production of red blood cells. Under normal condition a red blood cell survives 120 days before it is  broken down and this aso implies that if production is decreased this will eventually lead to anemia. Hence, many chronic kidney failure patients are being treated with recombinant human erythropoietin. As many chronic kidney failure patients may also be volume overloaded, i.e. experience an expanded plasma volume it may be difficult to diagnose if an anemic CKD patient should receive erythropoietin treatment or not. Since treatment with erythropoietin is reported to increase mortality for these patients, a correct diagnosis seems mandatory.

Researchers using the Detalo Performance device recently documented that out of 26 anemic CKD patients that 14 where in fact anemic do to hypervolemia (i.e. did not lack red blood cells). It is therefore speculated that blood volume measurements may facilitate a more personalized medicine.

Detalo Blood Volume Analyzers

Detalo automatically determines total blood volume, red blood cell volume and plasma volume in humans in a rapid, safe and precise manner.

The Detalo Performance is to be used for athletes and science and is available for purchase today. The Detalo Clinical is currently going through the medical certification procedures and should be available for clinical use in 2020.