Role of intradialytic BVM devices

What is the role of intradialytic BVM devices?

Patients undergoing ultrafiltration therapy have sodium and water removed from the intravascular compartment, leading to hemoconcentration as red cell mass is distributed in less volume. This is matched by mobilization of retained salt and water from the ECF compartment, termed capillary refill. The movement of water results in hemodilution, a fall in hematocrit. If the rate of ultrafiltration exceeds capillary refill, the patient develops effective arterial volume depletion. This can lead to intradialytic hypotension, decreased tissue perfusion, and myocardial and cerebral stunning.

The principle behind intradialytic BVM devices is to noninvasively estimate the hematocrit in real time during dialysis in order to avoid overaggressive ultrafiltration and prevent intradialytic hypotension.

Initial studies using intradialytic BVM devices showed improvement in intradialytic hypotension. However, a larger randomized controlled trial (the Crit-Line Intradialytic Monitoring Benefit or CLIMB Study) comparing these devices with standard of care demonstrated a significantly higher adverse event rate and mortality with intradialytic BVM. Further study is ongoing.

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