Premium
Volume Control in Hemodialysis Patients
Author(s) -
Charra Bernard,
Chazot Charles,
Hurot Jean-Marc,
Jean Guillaume,
Terrat Jean-Claude,
Vanel Thierry,
Laurent Guy
Publication year - 2000
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.2000.4.1.68
Subject(s) - medicine , hemodialysis , blood pressure , dialysis , weight gain , volume overload , blood volume , ultrafiltration (renal) , saline , dry weight , extracellular fluid , intensive care medicine , cardiology , confounding , body weight , heart failure , extracellular , chemistry , botany , chromatography , biology , microbiology and biotechnology
Cardiovascular disease is the main cause of the high mortality of dialysis patients and is largely due to poor control of blood pressure. Establishing and maintaining normal extracellular volume (ECV) is required to achieve normotension. The dry weight concept links ECV and blood pressure by a simple clinical relationship. Dry weight is the ideal postdialysis weight that allows a constantly normal blood pressure to be maintained without using antihypertensive medications. Maintenance of normal ECV requires control of salt intake to reduce interdialytic weight gain ( i.e ., saline overload) combined with the diffusive and convective removal of salt and water from the body during dialysis sessions. Several problems are to be faced when using the dry weight method. Clinical evaluation must take into account the following confounding factors: weight varies with nutrition, clinical symptoms are unspecific and sometimes discordant, and there is a lag time between ECV and blood pressure changes. On the other hand, achievement of dry weight is hampered by dialysis times that are too short (and weight gains that are too high), by antihypertensive medications, and by poor heart conditions. A longer session time allows for a slower, easier, and more comfortable ultrafiltration.