Researchers have identified ranges of relative blood volume (RBV) during hemodialysis (HD) that are associated with improved survival.

In a study of 842 HD patients, an RBV of 93% to 96% at 1 hour into dialysis was associated with a significant 42% decreased risk of all-cause mortality compared with an RBV outside this range, in a fully adjusted model, a team led by Peter Kotanko, MD, of the Renal Research Institute and Icahn School of Medicine at Mount Sinai in New York, reported online ahead of print in Nephrology Dialysis Transplantation. An RBV of 89% to 94% in the second hour of dialysis and 86% to 92% in the third hour were associated with a significant 46% and 54% decreased risk of all-cause mortality, respectively, compared with an RBV outside these ranges.

In most HD sessions, the authors explained, the ultrafiltration rate exceeds the refill rate of fluid from the interstitium into the vascular space, resulting in a decrease in blood volume that potentially precipitates intradialytic hypotension and diminished perfusion of vital organs.

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Dr Kotanko and his colleagues concluded that their study indicates that specific intradialytic RBV ranges are associated with all-cause mortality in HD patients. “These findings may serve as a valuable basis for future clinical trials into the relationship between RBV profiles, fluid status as determined by objective methods and patient outcomes.”

The study population had a median age of 61 years. During a median follow-up of 30.8 months, 249 patients (29.6%) died.


Preciado P, Zhang H, Thijssen S, et al. All-cause mortality in relation to changes in relative blood volume during hemodialysis. Nephrol Dial Transplant. 2018; published online ahead of print.