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:10.1111/hdi.2001.5.1.42

Cited by 21 publications

(65 citation statements)

References 82 publications

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“…During the period between 1982 and 1987, hemodialysis mortality in the United States was found to be 22% higher than in Europe and 40% higher than in Japan [51]. In addition, gentle ultrafiltration and proper estimation of dry body weight allows the achievement of good blood pressure control in the majority of patients [48]. Long-term mortality in this center is lower in patients with lower mean blood pressure.…”

Section: Blood Pressure Control and Duration Of Dialysismentioning

confidence: 92%

“…7, No. Myocardial hypertrophy and left ventricular dilatation, consequences of chronic hypertension, lead to dialysis intolerance and an increased mortality after a few years [48]. Neutral sodium balance during profiling failed to improve dialysis tolerance in a group of stable chronic hemodialysis patients [47].…”

Section: Fallacies Of High-speed Hemodialysismentioning

confidence: 99%

“…It seems that the general trend has been to avoid the simplest solution, looking instead for more complicated methods. This method is still practiced in Tassin, France, where dialysis sessions last 8 hr [48]. These episodes occurred almost exclusively in patients whose target weight was set below the true dry body weight.…”

Section: Fallacies Of High-speed Hemodialysismentioning

confidence: 99%

“…It is less frequent in Europe and Japan where dialysis time is longer. The lowest mortality related to cardiovascular causes is reported from Centre de rein artificial, Tassin, France [48], where longduration hemodialysis is practiced. The lowest mortality related to cardiovascular causes is reported from Centre de rein artificial, Tassin, France [48], where longduration hemodialysis is practiced.…”

Section: Blood Pressure Control and Duration Of Dialysismentioning

confidence: 99%

“…The lowest mortality related to cardiovascular causes is reported from Centre de rein artificial, Tassin, France [48], where longduration hemodialysis is practiced. Hypotension, in patients dialyzed thrice weekly for 8 hr, is a strong indicator that the patient weight dropped below the true dry body weight [48]. In addition, gentle ultrafiltration and proper estimation of dry body weight allows the achievement of good blood pressure control in the majority of patients [48].…”

Section: Blood Pressure Control and Duration Of Dialysismentioning

confidence: 99%

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Fallacies of High‐Speed Hemodialysis

Twardowski

2003

Hemodialysis International

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Chronic hemodialysis sessions, as developed in Seattle in the 1960s, were long procedures with minimal intra- and interdialytic symptoms. Financial and logistical pressures related to the overwhelming number of patients requiring hemodialysis created an incentive to shorten dialysis time to four, three, and even two hours per session in a thrice weekly schedule. This method spread rapidly, particularly in the United States, after the National Cooperative Dialysis Study suggested that 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 remained unchanged that hemodialysis time is of minimal importance as long as it is compensated by increased urea clearance. Patients accepted short dialysis as a godsend, believing that it would not be detrimental to their well-being and longevity. However, Kt/V(urea) measures only removal of low molecular weight substances and does not consider removal of larger molecules. Besides, it does not correlate with the other important function of hemodialysis, namely ultrafiltration. Whereas patients with substantial residual renal function may tolerate short dialysis sessions, the patients with little or no urine output tolerate short dialyses poorly because the ultrafiltration rate at the same interdialytic weight gain is inversely proportional to dialysis time. 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, left ventricular hypertrophy, diastolic dysfunction, and high cardiovascular mortality. Short, high-efficiency dialysis requires high blood flow, which increases demands on blood access. The classic wrist arteriovenous fistula, the access with the best longevity and lowest complication rates, provides "insufficient" blood flow and is replaced with an arteriovenous graft fistula or an intravenous catheter. Moreover, to achieve high blood flows, large diameter intravenous catheters are used; these fit veins "too tightly," so predispose the patient to central-vein thrombosis. Longer hemodialysis sessions (5-8 hrs, thrice weekly), as practiced in some centers, are associated with lower complication rates and better outcomes. Frequent dialyses (four or more sessions per week) provide better clinical results, but are associated with increased cost. It is my strong belief that a wide acceptance of longer, gentler dialysis sessions, even in a thrice weekly schedule, would improve overall hemodialysis results and decrease access complications, hospitalizations, and mortality, particularly in anuric patients.

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Section: Blood Pressure Control and Duration Of Dialysismentioning

confidence: 92%

Section: Fallacies Of High-speed Hemodialysismentioning

confidence: 99%

Section: Fallacies Of High-speed Hemodialysismentioning

confidence: 99%

Section: Blood Pressure Control and Duration Of Dialysismentioning

confidence: 99%