Effectiveness of blood volume change-guided ultrafiltration control (BV-UFC) in hemodialysis: a crossover comparative study.

BACKGROUND AND HYPOTHESIS: Intradialytic hypotension (IDH), a common hemodialysis (HD) complication, increases cardiovascular risks and affects prognosis. Rapid ultrafiltration (UF) is a key factor. The blood volume change-guided ultrafiltration control (BV-UFC) system, which adjusts UF rates based on real-time blood volume (BV) monitoring, aims to enhance hemodynamic stability and reduce IDH.

METHODS

A 6-week crossover trial compared BV-UFC and standard HD in reducing IDH. Patients underwent 2 weeks of each treatment. The primary outcome was the frequency of IDH episodes. Secondary outcomes were plasma refilling rate (PRR) and target UF volume achievement.

RESULTS

This study included 38 patients, with 31 patients completing the trial. The frequency of IDH episodes was significantly reduced in patients using the BV-UFC system (P = .019). HD sessions with BV-UFC system showed a significantly higher PRR throughout the treatment session, particularly during the first 0-1 h and 1-2 h of treatment (P = .019, P < .001, P < .001), as compared with standard HD and the target UF volume was consistently higher in the BV-UFC sessions (P < .01).

CONCLUSION

The BV-UFC system effectively reduced the incidence of IDH by automatically adjusting the UF rate based on BV, without compromising treatment safety or UF volume. These findings suggest that BV-UFC can enhance hemodynamic stability and improve dialysis outcomes in patients undergoing HD (jRCT Study No. jRCT1062230034, registration date: 1 July 2023).