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Koh HJ, Kim SJ, Lee S. Progressive increase in vascular access blood flow after percutaneous transluminal angioplasty in patients on hemodialysis. Medicine (Baltimore) 2024; 103:e38408. [PMID: 39259056 PMCID: PMC11142771 DOI: 10.1097/md.0000000000038408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/27/2024] [Accepted: 05/09/2024] [Indexed: 09/12/2024] Open
Abstract
Percutaneous transluminal angioplasty (PTA) is the gold standard for treating stenoses with dysfunctional vascular access. Recently, we found that vascular access blood flow (VABF) measured immediately after PTA increased over time without the need for additional procedures in the patients who underwent PTA. Therefore, this study was conducted to confirm an increase in VABF after PTA and identify the factors associated with it. Patients on chronic hemodialysis at a single institution were retrospectively reviewed and those with accesses that had a measurement of VABF immediately after PTA and within 1 month from PTA were included in the study. The relationship between clinical parameters and changes in VABF were analyzed using paired t-test and linear regression. A total of 47 PTA accesses (fistulas, 26; grafts,21) were included. The mean VABF on the day of PTA and the following measurement were 796.9 ± 329.1 mL/min and 1105.1 ± 410.3 mL/min, respectively. In the univariate analysis, the diameter of the balloon catheter used in the PTA and serum uric acid (SUA) level were significantly associated with an increase in VABF. Atrial fibrillation was a significant factor for the percentage change in vascular access. In the multivariate analysis, SUA level, balloon catheter diameter, and atrial fibrillation remained independent factors for changes in VABF and percentage change in VABF, respectively. The study identified progressive increases in the VABF after PTA without additional procedures. SUA level, balloon catheter diameter used in PTA, and atrial fibrillation were independently associated with changes in VABF.
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Affiliation(s)
- Hyun Jin Koh
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Seung-Jung Kim
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Shina Lee
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
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Vinje V, Bomholt T, Lundby C, Oturai P, Rix M, Lindhard K, Hornum M. Intravascular volumes and the influence on anemia assessed by a carbon monoxide rebreathing method in patients undergoing maintenance hemodialysis. Hemodial Int 2024; 28:40-50. [PMID: 37827985 DOI: 10.1111/hdi.13118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Fluid overload is a major challenge in hemodialysis patients and might cause hypervolemia. We speculated that hemodialysis patients reaching dry weight could have undetected hypervolemia and low hemoglobin (Hb) concentration (g/dL) due to hemodilution. METHODS The study included hemodialysis patients (n = 22) and matched healthy controls (n = 22). Blood volume, plasma volume, red blood cell volume, and total Hb mass were determined using a carbon monoxide (CO)-rebreathing method in hemodialysis patients reaching dry weight and controls. Blood volume measurements were also obtained by a dual-isotope labeling technique in a subgroup for validation purposes. FINDINGS In the hemodialysis group, the median specific blood volume was 89.3 mL/kg (interquartile range [IQR]: 76.7-95.4 mL/kg) and was higher than in the control group (79.9 mL/kg [IQR: 70.4-88.0 mL/kg]; p < 0.037). The median specific plasma volume was 54.7 mL/kg (IQR: 47.1-61.0 mL/kg) and 44.0 mL/kg (IQR: 38.7-49.5 mL/kg) in the hemodialysis and control groups, respectively (p < 0.001). Hb concentration was lower in hemodialysis patients (p < 0.001), whereas no difference in total Hb mass was observed between groups (p = 0.11). A correlation was found between blood volume measured by the CO-rebreathing test and the dual-isotope labeling technique in the control group (r = 0.83, p = 0.015), but not the hemodialysis group (r = 0.25, p = 0.60). DISCUSSION The hemodialysis group had increased specific blood volume at dry weight due to high plasma volume, suggesting a hypervolemic state. However, correlation was not established against the dual-isotope labeling technique underlining that the precision of the CO-rebreathing test should be further validated. The total Hb mass was similar between hemodialysis patients and controls, unlike Hb concentration, which emphasizes that Hb concentration is an inaccurate marker of anemia among hemodialysis patients.
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Affiliation(s)
- Vårin Vinje
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tobias Bomholt
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Lundby
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Section for Health and Exercise Physiology, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Peter Oturai
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Rix
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Lindhard
- Department of Nephrology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mads Hornum
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Peng YH, Maarek JMI. Development and validation of quantitative optical index of skin blood content. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-210250RRR. [PMID: 35773754 PMCID: PMC9243648 DOI: 10.1117/1.jbo.27.6.065003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
SIGNIFICANCE We present an approach to estimate with simple instrumentation the amount of red blood cells in the skin microvasculature, designated as parameter LRBC. Variations of parameter LRBC are shown to reflect local changes in the quantity of skin red blood cells during a venous occlusion challenge. AIM To validate a simple algebraic model of light transport in skin using the Monte Carlo method and to develop a measure of the red blood cell content in skin microvessels using the Monte Carlo predictions; to guide the development of an instrument to measure experimentally variations of the amount of red blood cells in the skin. APPROACH Monte Carlo simulations were carried out in a multilayer model of the skin to compute remitted light intensities as a function of distance from the illumination locus for different values of the skin blood content. The simulation results were used to compute parameter LRBC and its variations with local skin blood content. An experimental setup was developed to measure parameter LRBC in human volunteers in whom skin blood content of the forearm increased during temporary interruption of the venous outflow. RESULTS In the simulations, parameter LRBC was ∼16 μm in baseline conditions, and it increased in near proportion with the blood content of the skin layers. Measuring the diffusely reflected light intensity 0.5 to 1.2 mm away from the illumination locus was optimal to detect appreciable changes of the reflected light intensity as skin blood content was altered. Parameter LRBC measured experimentally on the human forearm was 17 ± 2 μm in baseline conditions it increased at a rate of 4 ± 2 μm / min when venous outflow was temporarily interrupted. CONCLUSION Parameter LRBC derived experimentally with a two-wavelength diffuse reflectometer can be used to measure local variations of the amount of red blood cells in skin microvessels.
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Affiliation(s)
- Yu-Hao Peng
- University of Southern California, Department of Biomedical Engineering, Los Angeles, California, United States
| | - Jean-Michel I. Maarek
- University of Southern California, Department of Biomedical Engineering, Los Angeles, California, United States
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Kaptein MJ, Kaptein JS, Nguyen CD, Oo Z, Thwe PP, Thu MB, Kaptein EM. Changes in cardiac output with hemodialysis relate to net volume balance and to inferior vena cava ultrasound collapsibility in critically ill patients. Ren Fail 2020; 42:179-192. [PMID: 32050836 PMCID: PMC7034082 DOI: 10.1080/0886022x.2020.1726384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Cardiac output may increase after volume administration with relative intravascular volume depletion, or after ultrafiltration (UF) with relative intravascular volume overload. Assessing relative intravascular volume using respiratory/ventilatory changes in inferior vena cava (IVC) diameters may guide volume management to optimize cardiac output in critically ill patients requiring hemodialysis (HD) and/or UF.We retrospectively studied 22 critically ill patients having relative intravascular volume assessed by IVC Collapsibility Index (IVC CI) = (IVCmax-IVCmin)/IVCmax*100%, within 24 h of cardiac output measurement, during 37 intermittent and 21 continuous HD encounters. Cardiac output increase >10% was considered significant. Net volume changes between cardiac outputs were estimated from "isonatremic volume equivalent" (0.9% saline) gains and losses.Cardiac output increased >10% in 15 of 42 encounters with IVC CI <20% after net volume removal, and in 1 of 16 encounters with IVC CI ≥20% after net volume administration (p = 0.0136). All intermittent and continuous HD encounters resulted in intradialytic hypotension. Net volume changes between cardiac output measurements were significantly less (median +1.0 mL/kg) with intractable hypotension or vasopressor initiation, and net volume removal was larger (median -22.9 mL/kg) with less severe intradialytic hypotension (p < 0.001). Cardiac output increased >10% more frequently with least severe intradialytic hypotension and decreased with most severe intradialytic hypotension (p = 0.047).In summary, cardiac output may increase with net volume removal by ultrafiltration in some critically ill patients with relative intravascular volume overload assessed by IVC collapsibility. Severe intradialytic hypotension may limit volume removal with ultrafiltration, rather than larger volume removal causing severe intradialytic hypotension.
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Affiliation(s)
- Matthew J Kaptein
- Department of Medicine, Division of Nephrology, Loma Linda University Medical Center, Loma Linda, CA, USA.,Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA
| | - John S Kaptein
- Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA
| | - Christopher D Nguyen
- Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA
| | - Zayar Oo
- Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA
| | - Phyu Phyu Thwe
- Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA
| | - Myint Bo Thu
- Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA
| | - Elaine M Kaptein
- Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA
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Wilken M, Oh J, Pinnschmidt HO, Singer D, Blohm ME. Effect of hemodialysis on impedance cardiography (electrical velocimetry) parameters in children. Pediatr Nephrol 2020; 35:669-676. [PMID: 31838611 DOI: 10.1007/s00467-019-04409-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/08/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pediatric hemodialysis (HD) patients have a high incidence of cardiovascular morbidity and mortality. The study aim was to investigate whether impedance cardiography (electrical velocimetry, EV) is suitable as a hemodynamic trend monitoring tool in pediatric patients during HD. METHODS Measurements by EV were obtained before, during, and after HD in a prospective single-center pediatric observational study. In total, 54 dialysis cycles in four different pediatric patients with end-stage kidney disease on chronic HD were included. EV parameters analyzed were heart rate (HR), stroke volume (SV), stroke volume index (SI), cardiac output (CO), cardiac index (CI), thoracic fluid content (TFC), index of contractility (ICON), stroke volume variation (SVV), variation of ICON (VIC), R-R interval (TRR), pre-ejection period (PEP), left ventricular ejection time (LVET), and systolic time ration (STR). Systemic vascular resistance index (SVRI) was calculated. RESULTS EV did measure significant changes in cardiovascular parameters associated with HD. The following parameters increased after HD: HR (9%), SVV (19%), VIC (33%), PEP (8%), and STR (18%). A decrease after HD was measured in SV (18%), SI (18%), CO (10%), CI (10%), TFC (10%), ICON (7%), TRR (7%), LVET (8%), and LVET (8%). SVRI was not affected by HD. The changes were correlated to ultrafiltration. HD cycles without fluid withdrawal also altered cardiovascular parameters. CONCLUSIONS Pediatric HD with and without fluid withdrawal changes hemodynamic EV monitoring parameters. Possibly EV may be useful to optimize HD management in pediatric patients.
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Affiliation(s)
- Meike Wilken
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Neonatology and Pediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Gynecology, University Hospital, Halle / Saale, Germany
| | - Jun Oh
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans O Pinnschmidt
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominique Singer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Neonatology and Pediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin E Blohm
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Division of Neonatology and Pediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Neonatology and Pediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Bomholt T, Larsson S, Rix M, Rytter S, Feldt‐Rasmussen B, Hornum M, Lundby C. Intravascular volumes evaluated by a carbon monoxide rebreathing method in patients undergoing chronic hemodialysis. Hemodial Int 2020; 24:252-260. [DOI: 10.1111/hdi.12820] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/08/2020] [Accepted: 01/20/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Tobias Bomholt
- Department of Nephrology, RigshospitaletUniversity of Copenhagen Copenhagen Denmark
| | - Sara Larsson
- Department of Nephrology, RigshospitaletUniversity of Copenhagen Copenhagen Denmark
| | - Marianne Rix
- Department of Nephrology, RigshospitaletUniversity of Copenhagen Copenhagen Denmark
| | - Sarah Rytter
- Department of Nephrology, RigshospitaletUniversity of Copenhagen Copenhagen Denmark
| | - Bo Feldt‐Rasmussen
- Department of Nephrology, RigshospitaletUniversity of Copenhagen Copenhagen Denmark
- Faculty of Health and Medical Sciences, Department of Clinical MedicineUniversity of Copenhagen Copenhagen Denmark
| | - Mads Hornum
- Department of Nephrology, RigshospitaletUniversity of Copenhagen Copenhagen Denmark
- Faculty of Health and Medical Sciences, Department of Clinical MedicineUniversity of Copenhagen Copenhagen Denmark
| | - Carsten Lundby
- Centre for Physical Activity Research, Rigshospitalet Copenhagen Denmark
- Inland Norway University of Applied Sciences Lillehammer Norway
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Han YH, Kankala RK, Wang SB, Chen AZ. Leveraging Engineering of Indocyanine Green-Encapsulated Polymeric Nanocomposites for Biomedical Applications. NANOMATERIALS (BASEL, SWITZERLAND) 2018; 8:E360. [PMID: 29882932 PMCID: PMC6027497 DOI: 10.3390/nano8060360] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 01/09/2023]
Abstract
In recent times, photo-induced therapeutics have attracted enormous interest from researchers due to such attractive properties as preferential localization, excellent tissue penetration, high therapeutic efficacy, and minimal invasiveness, among others. Numerous photosensitizers have been considered in combination with light to realize significant progress in therapeutics. Along this line, indocyanine green (ICG), a Food and Drug Administration (FDA)-approved near-infrared (NIR, >750 nm) fluorescent dye, has been utilized in various biomedical applications such as drug delivery, imaging, and diagnosis, due to its attractive physicochemical properties, high sensitivity, and better imaging view field. However, ICG still suffers from certain limitations for its utilization as a molecular imaging probe in vivo, such as concentration-dependent aggregation, poor in vitro aqueous stability and photodegradation due to various physicochemical attributes. To overcome these limitations, much research has been dedicated to engineering numerous multifunctional polymeric composites for potential biomedical applications. In this review, we aim to discuss ICG-encapsulated polymeric nanoconstructs, which are of particular interest in various biomedical applications. First, we emphasize some attractive properties of ICG (including physicochemical characteristics, optical properties, metabolic features, and other aspects) and some of its current limitations. Next, we aim to provide a comprehensive overview highlighting recent reports on various polymeric nanoparticles that carry ICG for light-induced therapeutics with a set of examples. Finally, we summarize with perspectives highlighting the significant outcome, and current challenges of these nanocomposites.
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Affiliation(s)
- Ya-Hui Han
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen 361021, China.
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China.
| | - Ranjith Kumar Kankala
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen 361021, China.
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China.
- Fujian Provincial Key Laboratory of Biochemical Technology, Xiamen 361021, China.
| | - Shi-Bin Wang
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen 361021, China.
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China.
- Fujian Provincial Key Laboratory of Biochemical Technology, Xiamen 361021, China.
| | - Ai-Zheng Chen
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen 361021, China.
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China.
- Fujian Provincial Key Laboratory of Biochemical Technology, Xiamen 361021, China.
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Daugirdas JT, Schneditz D. Hemodialysis Ultrafiltration Rate Targets Should Be Scaled to Body Surface Area Rather than to Body Weight. Semin Dial 2018; 30:15-19. [PMID: 28043081 DOI: 10.1111/sdi.12563] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The association between higher ultrafiltration rates and poor outcomes in hemodialysis patients has received increased attention, to the point that various regulatory entities are considering adding ultrafiltration rate as a quality measure to be monitored and controlled. Most of the discussion to date has focused on ultrafiltration rate scaled to body weight, or more correctly, body mass (ml/hour per kg). One outcome study suggests that ultrafiltration rate might best be not scaled at all to body size, as modestly higher ultrafiltration rate in very small-size patients may be associated with some survival benefit, probably via increased dietary intake. Outcomes studies also suggest that the risk of exceeding a weight-scaled ultrafiltration target may be magnified in very large patients, and that body weight-scaled ultrafiltration targets in such patients should be set a lower level. Here, we present an analysis, based on physiological hemodynamic arguments, that it would be better to scale ultrafiltration rate to body surface area rather than to body mass. Whatever ultrafiltration rate is scaled to, attempts to restrict ultrafiltration rate by limiting interdialytic weight gain in small, possibly malnourished patients, should be done cautiously, to prevent an inadvertent lowering of intake of calories and dietary protein.
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Affiliation(s)
- John T Daugirdas
- Department of Medicine, Division of Nephrology, University of Illinois at Chicago, Chicago, Illinois
| | - Daniel Schneditz
- Institute of Physiology, Medical University of Graz, Graz, Austria
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