NIKKISO

Fewer complications

Haemo-Master

Innovations for Human Care.

NIKKISO

Haemo-Master optionComplications during dialysis treatments

HypotensionsVarious eomplieations ean oeeur during a dialysis treatment. Ineidents during dialysis ses-sions oeeur in approximately 30 % of all treatments.

Headaches

Roughly half of all episodes during dialysis treatments are eaused by hypotensions. Themajority of these problems are eaused by the seemingly neeessary fluid extraetion.

Gramping

Complications during dialysis treatment

Intracellulararea

approx. 60 %

Plasmaapprox. 7 %

The balaneing of body fluid IS an essential requírernent duríng díalysís

Exeessive fluids are ultra-fíltered from the intravaseular area (plasma) via the dialyzer. Onlyapproximately 7 % of the total body fluid, however, is found in this area. The ultra-filtrationvolume is ehosen so that a defined "dry weight" is reaehed. Natural fluetuations in the dryweight and in the patient refilling rate ean lead to undesired reduetions in plasma volumeand therefore in a blood pressure drop.

Interstitial fluidsapprox. 31 %

Oistribution of fluids in the human body

The Haemo-Master option reduces complications during treatments

Measuring prineiple of the Haemo-Master

The relative blood volume is measured via an infrared measuringseetion during the dialysis treatment, and is displayed graphieallyon the sereen.

Transmitter

Receiver

-;:- --,-- t o 160

II I~.n

Nm. ZElTChJ I LI

The Haemo-Master measuring principle and measuring chamber OBB-05 screen with the trend in the blood volume average (dBv)

with the Haemo-Master option

Innovations for Human Care.

Treatment without Haemo-MasterBlood volume trends without requlation

If the patient takes nourishment during the treatment, changesposition ar if the refill rate is too low, then this can lead to mas-sive undesired reductions in the blood volume.

The dialysis patienťs body often reacts to this with a drop inblood pressure. For the patient, this can result in headaches,cramping or hypotension, amongst other problems.

2- ------- ---

o

-4

~iO -6'O

-8------

-10

-12

-14o 30 60 90 120 150 180

Treatment time (min)

210 240 270

Literature

Daugirdas JT:

Pathophysiology 01 Dialysis hypotension: An UpdateAm. J. Kidney Dis.: 2001; 38: 811-817

Lopot F, Kotyk P, Blaha J, et al.:

Use 01 continuous blood volume monitoMng to detect inade-quately high dry weightInt. J. Artiř, Org; 1996; 19: 411-414

Steuer R, Bell D, Conis J:

Incidence 01 high prescribed dry weights and intradialytic-morbidity as detected by continuous volume monitoringNephrol. Dial. Transpl.; 1996; 11: 197

Steuer RR, Conis JM:

The incidence 01 hypovolemic morbidity in hemodialysisDiaI. & Transpiant.; 1996; 25: 272-281

Leypoldt J, Cheung A, Delmez J, et 81.:

Relationship between volume status and blood pressureduMng chronic hemodialysisKidney Int.; 2002; 61: 266-275

KramerM:

Anwendung von Feedbacksystemen zur Kreislaufstabilisie-rung in der NierenersatztherapieJ. nephrol. Team; 2000; 3: 145-156

Wojke R, Baldamus G. Ries W, et 81.:

Is symptomatic Hypotension predictable by changes in bloodvolume?B100d PuMI.; 1999; 17: 218

Barth C, Boer W, Garzoni D, et al.:

8ymptomatic Hypotension and blood volumeBlood PuM!.; 2001; 19: 84

Schneditz O, Roob J, Oswald M, et 81.:

Nature and rate 01 vascular relilling during hemodialysis andultrafiltrationKidney Int.; 1992; 42: 1425-1433

Koomans H:

Improving blood pressure stability by blood volume-regulateduttrařlltratíon, a lecture in session clinical support throughtechnical devices in HOEOTA; 2001

Ronco G, Bellomo R, Ricci Z:Hemodynamic response to Iluid withdrawaí in overhydratedpatients treated w~h intermittent ultraříltration and slow conti-nuous ultrafiltration: Role 01 blood volume monitoringCardlology; 2001; 96: 196-201

Treatment with Haemo-MasterBloOOvolume trend with dynamic regulation

For each patient an individual chart for the ideal blood volumechanges is established. The Haemo-Master continually meas-ures the relative blood-volume during the dialysis treatment.This is the basis for the automatic regulation of the conductiv-ity and ultra-filtration rate (UF rate).

The intelligent interplay of the regulation of the conductivity andUF rate adapts the blood-volume-changes to the ideal trend.This means it is possible to prevent drops in blood pressurefrom occurring during the dialysis treatment.

2 Ideal blood volume á~rage trends during\ treatments with Haemo-Master

-2

-8

-10 --------="'---=:;::;:;;;::=====::::::=

-12---------------------------------------

300

-14 -------------------------------------------------

o 30 60 90 120 150 180

Treatment lime (min)

210 240 270 300

Regulation of the UF rateIf the blood volume changes vary Irom the prior established ideal trend, then theUF rate is altered correspondingly.This change in the UF rate has an immediate stabilising effect on the bloodvolume changes.

1,60

1,28 I--i-H--~.o------------------

:[ 0,96

~LL

::> 0,64

0,32

0,00 L- -'---L--L __ -1L -L

O 30 90 210 240 270 30060 120 150 180

Treatment time (min)

Regulatlon of conductiviryThe blood volume changes during the haemodialysis are determined by thedifference between the UF rale and refilling rate. Manipulalion 01 Ihe refillingrate can be achieved directty, to a limiled extent, via a dynamic conduclivitycontrol,

14.5 ----------------------------------------.-------

14,0

13.0 I

12,5O 90 120 150 180

Treatment lime (min)210 240 270 30030 60

NIKKISO

Local service,global coverageA,d"'"

Manufacturer

For further information please eontaet our loeal partner.

sales subsidiary (Hamburg, Germany)

• produetion facility (Hanover, Germany)

• loeal partner

EU representative Loca! partner

NIKKISO CO., LTD.43-2, Ebisu 3-chome, Shibuya-kuTokyo 150-8677, Japan

Telephone: +81-3-3443-3727Fax: +81-3-3470-0681

Website: www.nikkiso.co.jp

NIKKISO Europe GmbHDesbrocksriede 10-30855 Langenhagen

Telephone: +49 (O) 511 - 67 9999 - OFax: +49 (O) 511 - 67 9999 - 11

Email:Website:

info@nikkiso-europe.euwww.nikkiso-europe.eu