Estimation the Residual Pressure Component (RPC) Based on Transmembrane Pressure During Hemodialysis: A Retrospective Analysis of Clinical Dialysis Sessions
DOI:
https://doi.org/10.54361/LJMR.20.2.70Keywords:
TMP, Transmembrane Pressure, Nipro Surdial X, Hemodialysis, Dialysate Pressure, Residual Pressure Component, Bland-Altman Analysis, Operational MonitoringAbstract
Background: Transmembrane pressure (TMP) is a key indicator used to monitor ultrafiltration efficiency during hemodialysis sessions. However, traditional manual calculations of TMP rely solely on blood-side pressures, disregarding the dialysate pressure component—which is not directly measured by the machine—potentially leading to discrepancies between manual calculations. [2][1] Objective: This study aimed to evaluate the Residual Pressure Component (RPC) as a proxy for unmeasured dialysate pressure and to examine its contribution to explaining the differences between the transmembrane pressure value recorded by the machine (TMPmachine) and the manually reconstructed value (TMPmanual). calculated values and those recorded automatically. Methodology: A retrospective observational study was conducted involving 1,005 hemodialysis sessions using the Nipro Surdial X machine. Data on operating pressures, ultrafiltration rate, and blood flow rate were collected; the TMPmanual value was calculated using the formula (TMPmanual = (AP + VP) / 2),[10][9][5], and the residual pressure component (RPC) was derived using the relationship (RPC = TMPmanual − TMPmachine). Statistical analyses included descriptive statistics, Pearson correlation analysis, and Bland–Altman agreement analysis, alongside an exploratory operational classification of RPC values based on the data distribution [7][8].Results: The mean TMPmachine was approximately 44.9 ± 29.3 mmHg, while the mean TMPmanual was approximately 6.2 ± 4.9 mmHg, and the mean RPC was approximately -38.6 ± 30.5 mmHg. RPC showed a very strong inverse correlation with TMPmachine (r = -0.98). Bland–Altman analysis revealed a systematic bias and wide limits of agreement between the two methods. The RPC distribution also demonstrated three operational patterns: 62.2% of sessions fell within the operational range, 23.0% within the high negative pressure zone, and 14.8% within the positive pressure zone. Conclusion: The results indicate that the residual pressure component (RPC) is a promising operational indicator that could help explain transmembrane pressure dynamics and improve the understanding of the contribution of unmeasured dialysate pressure during hemodialysis. However, adopting this indicator in clinical practice requires validation through prospective, multicenter studies.
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