Clinical Determination of Dry Body Weight

Charra, Bernard; Gadrey, Jean; Hurot, Jean-Marc; Terrat, Jean-Claude; Vanel, Thierry; Vo-Van, Cyril; Maazoun, Foued; Chazot, Charles

doi:10.1002/hdi.2001.5.1.42

Cited by 11 publications

(44 citation statements)

References 65 publications

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“…The lowest mortality related to cardiovascular causes is reported from the Centre de Rein artificial, Tassin, France [56] , where long duration hemodialysis is practiced. Long-term mortality in this center is lower in patients with lower mean blood pressures.…”

Section: Blood Pressure Control and Duration Of Dialysismentioning

confidence: 99%

“…It may take several weeks of normovolemia for the intracellular sodium to escape. Regardless of the mechanism, the normalization of blood pressure by volume control is tricky, requires patience and a good understanding of the problem [56,63,64] . Several groups have tried to lower extracellular volume and blood pressure without lengthening dialysis duration by dietary measures and low dialysate sodium [65] .…”

Section: Blood Pressure Control By Dietary Measures and Low Dialysatementioning

confidence: 99%

“…Long-term mortality in this center is lower in patients with lower mean blood pressures. In addition, gentle ultrafiltration and proper estimation of dry body weight allows the achievement of good blood pressure control in the majority of patients [56] . Hypotension, in patients dialyzed thrice weekly for 8 h, is a strong indicator that the patient weight dropped below the true dry body weight [56] .…”

Section: Blood Pressure Control and Duration Of Dialysismentioning

confidence: 99%

“…In addition, gentle ultrafiltration and proper estimation of dry body weight allows the achievement of good blood pressure control in the majority of patients [56] . Hypotension, in patients dialyzed thrice weekly for 8 h, is a strong indicator that the patient weight dropped below the true dry body weight [56] . With rapid ultrafiltration, hypotension is dependent mostly on hypovolemia, which occurs long before the dry body weight is achieved.…”

Section: Blood Pressure Control and Duration Of Dialysismentioning

confidence: 99%

“…Although a multitude of approaches has been tried [53] , the most common was application of a high ultrafiltration rate and high sodium concentration at the beginning of dialysis with a gradual or stepwise decrease in dialysate sodium concentrations and ultrafiltration rates throughout the dialysis session [54] . Whereas short-term studies showed improvement in the incidence of hypotensive episodes, a careful study of sodium balance showed that improvement was related to a positive sodium balance, leading to chronic volume overload, hypertension, myocardial hypertrophy, and increased cardiovascular mortality [55,56] .…”

Section: Stratagems To Reduce Idh Without Prolonging Dialysis Durationmentioning

confidence: 99%

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Treatment Time and Ultrafiltration Rate Are More Important in Dialysis Prescription than Small Molecule Clearance

Twardowski

2006

Blood Purif

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Chronic hemodialysis sessions, as developed in Seattle in the 1960s, were long procedures with minimal intra- and interdialytic symptoms. Over the next three decades, dialysis duration was shorten to 4, 3, even 2 h in thrice weekly schedules. This method spread rapidly, particularly in the United States, after the National Cooperative Dialysis Study suggested that the time of dialysis is of minor importance as long as urea clearance multiplied by dialysis time and scaled to total body water (Kt/V_urea) equals 0.95–1.0. This number was later increased to 1.3, but the assumption that hemodialysis time is of minimal importance remained unchanged. However, Kt/V_urea measures only the removal of low molecular weight substances and does not consider the removal of larger molecules. Nor does it correlate with the other important function of hemodialysis, namely ultrafiltration. Rapid ultrafiltration is associated with cramps, nausea, vomiting, headache, fatigue, hypotensive episodes during dialysis, and hangover after dialysis; patients remain fluid overloaded with subsequent poor blood pressure control leading to left ventricular hypertrophy, diastolic dysfunction, and high cardiovascular mortality. Kt/V_urea should be abandoned as a measure of dialysis quality. The formula suggests that it is possible to decrease t as long as K is proportionately increased, but this is not true. Time of dialysis should be adjusted in such a way that patients would not suffer from symptoms related to rapid ultrafiltration, would not have other uremic symptoms and most patients would have blood pressure controlled without antihypertensive drugs.

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Section: Blood Pressure Control and Duration Of Dialysismentioning

confidence: 99%

Section: Blood Pressure Control By Dietary Measures and Low Dialysatementioning

confidence: 99%