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Published in: Pediatric Nephrology 3/2009

01-03-2009 | Original Article

Blood volume monitoring to adjust dry weight in hypertensive pediatric hemodialysis patients

Authors: Cengiz Candan, Lale Sever, Mahmut Civilibal, Salim Caliskan, Nil Arisoy

Published in: Pediatric Nephrology | Issue 3/2009

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Abstract

The aim of this study was to adjust dry weight by short-term blood volume monitoring (BVM)-guided ultrafiltration and evaluate the effects of optimizing dry weight on blood pressure (BP) control and intradialytic symptoms (IDS) in a group of hypertensive hemodialysis (HD) patients. The study was performed in four sequential phases, each of which lasted for 1 week, on nine hypertensive HD patients (six girls, age 16.9 ± 3.1 years). In phase I, patients were observed by BVM. In phase II, BVM was used to guide ultrafiltration to adjust dry weight. Antihypertensive drugs were gradually tapered or withheld in phase III, when the patients were hypotensive and/or their IDS increased. In phase IV, this particular weight was maintained without any intervention. Pre- and post-HD body weight, pre-HD, post-HD, 30 min after HD casual BP values, and IDS in each HD session were recorded. The BP was also assessed by 44-h ambulatory BP monitoring (ABPM), which is an ideal method to determine BP changes throughout the interdialytic period at the beginning of phase I and at the end of phase IV. There was a decrease in mean dry weight, all casual systolic BPs, and systolic/diastolic ABPM at the end of the study (all p ≤ 0.05). Antihypertensive drugs were stopped in five patients and reduced in two during phase III of the study. The IDS was more frequent (36%) in phase IV than in phase I (16%); however, this increase did not reach statistical significance. The results of this study suggest that short-term BVM guided-ultrafiltration may be a useful tool to diagnose volume overload and to adjust dry weight and, consequently, to achieve a better control of BP in pediatric HD patients.
Literature
1.
go back to reference Mitsnefes M, Stablein D (2005) Hypertension in pediatric patients on long-term dialysis: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Am J Kidney Dis 45:309–315CrossRef Mitsnefes M, Stablein D (2005) Hypertension in pediatric patients on long-term dialysis: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Am J Kidney Dis 45:309–315CrossRef
2.
go back to reference Parekh RS, Carroll CE, Wolfe RA, Port FK (2002) Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr 141:191–197CrossRef Parekh RS, Carroll CE, Wolfe RA, Port FK (2002) Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr 141:191–197CrossRef
3.
go back to reference Van De Voorde RG, Barletta GM, Chand DH, Dresner IG, Lane J, Leiser J, Lin JJ, Pan CG, Patel H, Valentini RP, Mitsnefes MM (2007) Blood pressure control in pediatric hemodialysis: the Midwest Pediatric Nephrology Consortium Study. Pediatr Nephrol 22:547–553CrossRef Van De Voorde RG, Barletta GM, Chand DH, Dresner IG, Lane J, Leiser J, Lin JJ, Pan CG, Patel H, Valentini RP, Mitsnefes MM (2007) Blood pressure control in pediatric hemodialysis: the Midwest Pediatric Nephrology Consortium Study. Pediatr Nephrol 22:547–553CrossRef
4.
go back to reference Hörl MP, Hörl WH (2002) Hemodialysis-associated hypertension: pathophysiology and therapy. Am J Kidney Dis 39:227–244CrossRef Hörl MP, Hörl WH (2002) Hemodialysis-associated hypertension: pathophysiology and therapy. Am J Kidney Dis 39:227–244CrossRef
5.
go back to reference Jaeger JQ, Mehta RL (1999) Assessment of dry weight in hemodialysis: an overview. J Am Soc Nephrol 10:392–403PubMed Jaeger JQ, Mehta RL (1999) Assessment of dry weight in hemodialysis: an overview. J Am Soc Nephrol 10:392–403PubMed
6.
go back to reference Ishibe S, Peixoto AJ (2004) Methods of assesment of volume status and intercompartmental fluid shifts in hemodialysis patients: implications in clinical practice. Semin Dial 17:37–43CrossRef Ishibe S, Peixoto AJ (2004) Methods of assesment of volume status and intercompartmental fluid shifts in hemodialysis patients: implications in clinical practice. Semin Dial 17:37–43CrossRef
7.
go back to reference Leypoldt JK, Cheung AK (1998) Evaluating volume status in hemodialysis patients. Adv Ren Replace Ther 5:64–74CrossRef Leypoldt JK, Cheung AK (1998) Evaluating volume status in hemodialysis patients. Adv Ren Replace Ther 5:64–74CrossRef
8.
go back to reference Leypoldt JK, Lindsay RM (1999) Hemodynamic monitoring during hemodialysis. Adv Ren Replace Ther 6:233–242CrossRef Leypoldt JK, Lindsay RM (1999) Hemodynamic monitoring during hemodialysis. Adv Ren Replace Ther 6:233–242CrossRef
9.
go back to reference De Vries JP, Kouw PM, Nardo JM, Van der Meer NJ, Olthof CG, Oe LP, Donker AJ, De Vries PM (1993) Non-invasive monitoring of blood volume during hemodialysis: its relation with post-dialytic dry weight. Kidney Int 44:851–854CrossRef De Vries JP, Kouw PM, Nardo JM, Van der Meer NJ, Olthof CG, Oe LP, Donker AJ, De Vries PM (1993) Non-invasive monitoring of blood volume during hemodialysis: its relation with post-dialytic dry weight. Kidney Int 44:851–854CrossRef
10.
go back to reference Steuer RR, Leypoldt JK, Cheung AK, Senekjian HO, Conis JM (1996) Reducing symptoms during hemodialysis by continuously monitoring the hematocrit. Am J Kidney Dis 27:525–532CrossRef Steuer RR, Leypoldt JK, Cheung AK, Senekjian HO, Conis JM (1996) Reducing symptoms during hemodialysis by continuously monitoring the hematocrit. Am J Kidney Dis 27:525–532CrossRef
11.
go back to reference Steuer RR, Conis JM (1996) The incidence of hypovolemic morbidity in hemodialysis. Dial Transplant 25:272–274 Steuer RR, Conis JM (1996) The incidence of hypovolemic morbidity in hemodialysis. Dial Transplant 25:272–274
12.
go back to reference Wilkie ME, Lindley EJ, Edwards L, Roebuck AF, Warwick G, Brown CB (1996) Improved ultrafiltration control using an on-line blood volume monitor (BVM). Nephrol Dial Transplant 11:A202 Wilkie ME, Lindley EJ, Edwards L, Roebuck AF, Warwick G, Brown CB (1996) Improved ultrafiltration control using an on-line blood volume monitor (BVM). Nephrol Dial Transplant 11:A202
13.
go back to reference Steuer RR, Germain MJ, Leypoldt JK, Cheung AK (1998) Enhanced fluid removal guided by blood volume monitoring during hemodialysis. Artif Organs 22:627–632CrossRef Steuer RR, Germain MJ, Leypoldt JK, Cheung AK (1998) Enhanced fluid removal guided by blood volume monitoring during hemodialysis. Artif Organs 22:627–632CrossRef
14.
go back to reference Rodriguez HJ, Domenici R, Diroll A, Goykhman I (2005) Assessment of dry weight by monitoring changes in blood volume during hemodialysis using Crit-Line. Kidney Int 68:854–861CrossRef Rodriguez HJ, Domenici R, Diroll A, Goykhman I (2005) Assessment of dry weight by monitoring changes in blood volume during hemodialysis using Crit-Line. Kidney Int 68:854–861CrossRef
15.
go back to reference Jain SR, Smith L, Brewer ED, Goldstein SL (2001) Non-invasive intravascular monitoring in the pediatric hemodialysis population. Pediatr Nephrol 16:15–18CrossRef Jain SR, Smith L, Brewer ED, Goldstein SL (2001) Non-invasive intravascular monitoring in the pediatric hemodialysis population. Pediatr Nephrol 16:15–18CrossRef
16.
go back to reference Michael M, Brewer ED, Goldstein SL (2004) Blood volume monitoring to achieve target weight in pediatric hemodialysis patients. Pediatr Nephrol 19:432–437CrossRef Michael M, Brewer ED, Goldstein SL (2004) Blood volume monitoring to achieve target weight in pediatric hemodialysis patients. Pediatr Nephrol 19:432–437CrossRef
17.
go back to reference Goldstein SL, Smith JM, Currier H (2003) Noninvasive interventions to decrease hospitalization and associated costs for pediatric patients receiving hemodialysis. J Am Soc Nephrol 14:2127–2131CrossRef Goldstein SL, Smith JM, Currier H (2003) Noninvasive interventions to decrease hospitalization and associated costs for pediatric patients receiving hemodialysis. J Am Soc Nephrol 14:2127–2131CrossRef
18.
go back to reference Patel HP, Goldstein SL, Mahan JD, Smith B, Fried CB, Currier H, Flynn JT (2007) A standard, noninvasive monitoring of hematocrit algorithm improves blood pressure control in pediatric hemodialysis patients. Clin J Am Soc Nephrol 2:252–257CrossRef Patel HP, Goldstein SL, Mahan JD, Smith B, Fried CB, Currier H, Flynn JT (2007) A standard, noninvasive monitoring of hematocrit algorithm improves blood pressure control in pediatric hemodialysis patients. Clin J Am Soc Nephrol 2:252–257CrossRef
19.
go back to reference Leypoldt JK, Cheung AK, Steuer RR, Harris DH, Conis JM (1995) Determination of circulating blood volume by continuously monitoring hematocrit during hemodialysis. J Am Soc Nephrol 6:214–219PubMed Leypoldt JK, Cheung AK, Steuer RR, Harris DH, Conis JM (1995) Determination of circulating blood volume by continuously monitoring hematocrit during hemodialysis. J Am Soc Nephrol 6:214–219PubMed
20.
go back to reference National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576CrossRef National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576CrossRef
21.
go back to reference Soergel M, Kirschstein M, Busch C, Danne T, Gellermann J, Holl R, Krull F, Reichert H, Reusz GS, Rascher W (1997) Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr 130:178–184CrossRef Soergel M, Kirschstein M, Busch C, Danne T, Gellermann J, Holl R, Krull F, Reichert H, Reusz GS, Rascher W (1997) Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr 130:178–184CrossRef
22.
go back to reference Fischbach M, Edefonti A, Schröder C, Watson A (2005) Hemodialysis in children: general practical guidelines. Pediatr Nephrol 20:1054–1066CrossRef Fischbach M, Edefonti A, Schröder C, Watson A (2005) Hemodialysis in children: general practical guidelines. Pediatr Nephrol 20:1054–1066CrossRef
23.
go back to reference Cohen EP (2000) Hypertension in chronic hemodialysis: viewing a paradox, and some notes on therapy. Dial Transplant 29:535–539 Cohen EP (2000) Hypertension in chronic hemodialysis: viewing a paradox, and some notes on therapy. Dial Transplant 29:535–539
24.
go back to reference Sankaranarayanan N, Sergio Santos FF, Peixoto AJ (2004) Blood pressure measurement in dialysis patients. Adv Chronic Kidney Dis 11:134–142CrossRef Sankaranarayanan N, Sergio Santos FF, Peixoto AJ (2004) Blood pressure measurement in dialysis patients. Adv Chronic Kidney Dis 11:134–142CrossRef
25.
go back to reference Mitra S, Chandna SM, Farrington K (1999) What is hypertension in chronic hemodialysis? The role of interdialytic blood pressure monitoring. Nephrol Dial Transplant 14:2915–2921CrossRef Mitra S, Chandna SM, Farrington K (1999) What is hypertension in chronic hemodialysis? The role of interdialytic blood pressure monitoring. Nephrol Dial Transplant 14:2915–2921CrossRef
26.
go back to reference Mitsnefes MM, Kimball TR, Daniels SR (2003) Office and ambulatory blood pressure elevation in children with chronic renal failure. Pediatr Nephrol 18:145–149CrossRef Mitsnefes MM, Kimball TR, Daniels SR (2003) Office and ambulatory blood pressure elevation in children with chronic renal failure. Pediatr Nephrol 18:145–149CrossRef
27.
go back to reference Mailloux LU, Haley WE (1998) Hypertension in ESRD patient: pathophysiology, therapy, outcomes, and future directions. Am J Kidney Dis 32:705–719CrossRef Mailloux LU, Haley WE (1998) Hypertension in ESRD patient: pathophysiology, therapy, outcomes, and future directions. Am J Kidney Dis 32:705–719CrossRef
28.
go back to reference Sorof JM, Brewer ED, Portman RJ (1999) Ambulatory blood pressure monitoring and interdialytic weight gain in children receiving chronic hemodialysis. Am J Kidney Dis 33:667–674CrossRef Sorof JM, Brewer ED, Portman RJ (1999) Ambulatory blood pressure monitoring and interdialytic weight gain in children receiving chronic hemodialysis. Am J Kidney Dis 33:667–674CrossRef
29.
go back to reference Özkahya M, Töz H, Ünsal A, Özerkan F, Asçı G, Gürgün C, Akçiçek F, Dorhout Mees EJ (1999) Treatment of hypertension in dialysis patients by ultrafiltration: role of cardiac dilatation and time factor. Am J Kidney Dis 34:218–221CrossRef Özkahya M, Töz H, Ünsal A, Özerkan F, Asçı G, Gürgün C, Akçiçek F, Dorhout Mees EJ (1999) Treatment of hypertension in dialysis patients by ultrafiltration: role of cardiac dilatation and time factor. Am J Kidney Dis 34:218–221CrossRef
30.
go back to reference Movilli E, Gaggia P, Zubani R, Camerini C, Vizzardi V, Parrinello G, Savoldi S, Fischer MS, Londrino F, Cancarini G (2007) Association between high ultrafiltration rates and mortality in uraemic patients on regular haemodialysis. A 5-year prospective observational multicentre study. Nephrol Dial Transplant 22:3547–3552CrossRef Movilli E, Gaggia P, Zubani R, Camerini C, Vizzardi V, Parrinello G, Savoldi S, Fischer MS, Londrino F, Cancarini G (2007) Association between high ultrafiltration rates and mortality in uraemic patients on regular haemodialysis. A 5-year prospective observational multicentre study. Nephrol Dial Transplant 22:3547–3552CrossRef
31.
go back to reference Hothi DK, Harvey E, Goia CM, Geary D (2008) Blood-volume monitoring in paediatric haemodialysis. Pediatr Nephrol 23:813–820CrossRef Hothi DK, Harvey E, Goia CM, Geary D (2008) Blood-volume monitoring in paediatric haemodialysis. Pediatr Nephrol 23:813–820CrossRef
32.
go back to reference Fiscbach M, Terzic J, Laugel V, Dheu C, Menouer S, Helms P, Livolsi A (2004) Daily on-line hemodiafiltration: a pilot trial in children. Nephrol Dial Transplant 19:2360–2367CrossRef Fiscbach M, Terzic J, Laugel V, Dheu C, Menouer S, Helms P, Livolsi A (2004) Daily on-line hemodiafiltration: a pilot trial in children. Nephrol Dial Transplant 19:2360–2367CrossRef
33.
go back to reference Charra B, Bergström J, Scribner BJ (1998) Blood pressure control in dialysis patients: importance of the lag phenomenon. Am J Kidney Dis 32:720–724CrossRef Charra B, Bergström J, Scribner BJ (1998) Blood pressure control in dialysis patients: importance of the lag phenomenon. Am J Kidney Dis 32:720–724CrossRef
Metadata
Title
Blood volume monitoring to adjust dry weight in hypertensive pediatric hemodialysis patients
Authors
Cengiz Candan
Lale Sever
Mahmut Civilibal
Salim Caliskan
Nil Arisoy
Publication date
01-03-2009
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 3/2009
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-008-0985-9

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