Blood Volume in Hemodialysis & Kidney Diseases

Need for Better Tools to Assess Volume Status

Complications during hemodialysis are frequent and are associated with significant negative health effects and even mortality among patients with kidney diseases. In example, intradialytic hypotension may occur as a result of a reduction in blood volume during ultrafiltration and the importance of providing quantitative measurement of volume status can be of importance to guide decision making by the managing MD.

In 2018, there were approximately 450.000 cases of prevalent hemodialysis patients with end stage renal disease in the US alone. That amounts to an estimated 70 million hemodialysis treatments per year with an estimated 12 million events of intradialytic hypotension. In general, cardiovascular complications caused an average 2.5 days of hospitalization  among hemodialysis patients with 6% mortality rate within 30 days of discharge.

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

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

“A Brief Review of Intradialytic Hypotension with a Focus on Survival”, Jason A. Chou, Kamyar Kalantar-Zadeh, and Anna T. Mathew, 2017 (link)

“In the absence of meaningful renal function, volume status assessment and management are very challenging, given the limitations of the physical exam, lack of objective criteria by which to quantify intra- and extravascular volume”

“Absolute Blood Volume in Hemodialysis Patients”

“For a given patient, with a certain physiologic/pathophysiologic situation and a certain treatment regimen (primarily with respect to dialysis duration and frequency), absolute blood volume will dictate how low the post-dialysis weight can be reduced without causing intravascular volume depletion and compromising tissue perfusion.”

“Absolute blood volume in hemodialysis patients: why is it relevant, and how to measure it?”, Stephan Thijssen Franz Kappel, Peter Kotanko, 2013 (link)

Better Treatment of Anaemia in CKD Patients

According to a recent study, the role of volume retention on the anemia of patients with chronic kidney disease (CKD) has largely been underestimated. Measuring blood volume, plasma volume and red blood cell volumes (RBCV) – using the Detalo –  the study demonstrated that in 77% of the anemic patients their anemia was not related to a reduced RBCV as it was assumed. Rather, their anemia was related to an excessively expanded plasma volume.

The authors speculate that for patients with plasma overload induced anemia, that blood volume guided therapy may change therapy strategy from the contemporary administration of erythropoietic to diuretic agents. 

“Red blood cell volume is not decreased in ESA‐naive anemic chronic kidney disease patients”, Carsten Lundby, Belen Ponte, Anne‐Kristine Lundby, Paul Robach, and Sophie de Seigneux, 2083 (link)

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.