A Novel Ultrafiltration Rate Feedback Controller for Use in Hemodialysis: First Clinical Experience

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Key Points The ultrafiltration rate feedback controller functioned as intended, improving relative blood volume target attainment over standard care. Predialytic, postdialytic, and mean intradialytic BPs were not statistically different between treatments with versus without controller usage. Intradialytic nadir BP was on average slightly lower with use of the controller (106 versus 111 mm Hg systolic). Background Relative blood volume (RBV) monitors are increasingly being used during hemodialysis. Manual ultrafiltration rate (UFR) adjustments to establish a favorable RBV trajectory are not feasible in routine practice. The goal of this study was to characterize the behavior of a new UFR feedback controller in vivo . Methods In this pilot trial, chronic hemodialysis patients were prospectively studied during up to six successful study dialysis treatments each. During each study visit, the feedback controller generated UFR recommendations designed to guide the subject's RBV curve toward a predefined target trajectory. Each recommendation was evaluated by licensed health care staff and then either implemented or disregarded. The results were compared with standard-of-care treatments in the same subjects. Results Fifteen subjects (age 59±15 years, eight men) were studied during a total of 63 treatments. The controller functioned as intended and issued a total of 1037 recommendations. Compared with standard-of-care treatments, its use was associated with a higher probability of RBV target range attainment (69% versus 47%) and lower nadir systolic (106 versus 111 mm Hg) and diastolic (55 versus 59 mm Hg) BP. Conclusions The UFR feedback controller operated as intended, and its use led to a substantial increase in the rate of RBV target range attainment. This technology holds promise for improving fluid management in chronic hemodialysis patients.

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