{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:02:29Z","timestamp":1789448549242,"version":"build-2803163510"},"reference-count":28,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015699","name":"Fresenius Medical Care","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100015699","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/05rs7tq63","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Ultrafiltration (UF) during hemodialysis is typically prescribed as a fixed treatment goal and delivered using a largely constant ultrafiltration rate throughout the session. We evaluated whether Adaptive Ultrafiltration (Adaptive UF), a physiological closed-loop control strategy guided by continuous relative blood volume (RBV) monitoring, could improve RBV target attainment while individualizing fluid removal within predefined treatment constraints. Methods: We performed a paired patient-specific in silico study using 119,472 historical hemodialysis treatments from 11,246 U.S. patients. Treatment-specific plasma refill rate profiles were derived from recorded RBV and ultrafiltration data. For each historical treatment, a corresponding Adaptive UF treatment was simulated and compared with the corresponding originally delivered treatment. Outcomes included the percentage of time within a predefined favorable RBV target region, UF delivery, and operational performance. Results: Mean time within the RBV target region increased from 36.3% with historically delivered treatments to 56.4% with Adaptive UF, showing an absolute improvement of 20.2 percentage points (95% CI, 19.9\u201320.5); target attainment improved in 90.0% of patients. Mean area outside the target range decreased from 280.7 to 139.5 RBV %\u2013minutes. Mean achieved UF volume increased by 296.4 mL, although treatment-level UF delivery was bidirectional, increasing in 83.1% and decreasing in 16.9% of treatments. UF rates remained below 13 mL\/kg\/h in all simulations, and 99.4% of treatments remained within predefined UF volume limits. Conclusions: Adaptive UF improved intradialytic RBV target attainment and individualized UF delivery within predefined treatment constraints. Prospective studies are required to determine whether these physiological improvements translate into clinical benefit.<\/jats:p>","DOI":"10.3390\/jcm15187078","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:09:51Z","timestamp":1789387791000},"page":"7078","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Toward Precision Fluid Management in Hemodialysis: Adaptive Ultrafiltration Guided by Continuous Relative Blood Volume Monitoring"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6321-2367","authenticated-orcid":false,"given":"Doris H.","family":"Fuertinger","sequence":"first","affiliation":[{"name":"Renal Research Institute LLC, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3219-067X","authenticated-orcid":false,"given":"Felix J.","family":"Meigel","sequence":"additional","affiliation":[{"name":"Renal Research Institute LLC, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Aiyuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Fresenius Medical Care North America, Waltham, MA 02451, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Sabrina","family":"Casper","sequence":"additional","affiliation":[{"name":"Renal Research Institute LLC, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Sheng-Han","family":"Yueh","sequence":"additional","affiliation":[{"name":"Renal Research Institute LLC, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Kevin","family":"Ho","sequence":"additional","affiliation":[{"name":"Fresenius Medical Care North America, Waltham, MA 02451, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2491","DOI":"10.1681\/ASN.2016121341","article-title":"Chronic Fluid Overload and Mortality in ESRD","volume":"28","author":"Zoccali","year":"2017","journal-title":"J. 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