Hydration measurement by bioimpedance spectroscopy and blood pressure management in children on hemodialysis

Abstract

Hypertension is not always related to overhydration. Therefore, BIS should restrict the practice of "probing dry weight" in hypertensive children. Moreover, sodium dialytic balance needs to be considered to improve BP management.

The interdialytic weight gain: a simple marker of left ventricular hypertrophy in children on chronic haemodialysis

“…without symptomatic intradialytic hypotension) that allows the patient to maintain a normal interdialytic blood pressure, ideally without the use of antihypertensive medications [3,6]. Despite technological advances in intradialytic relative plasma volume monitoring [9,10] and bioimpedance analysis [11,12], the assessment of dry weight in children remains challenging [6]. However, these new technical tools provide objective measures to corroborate the clinical assessment of dry weight by the dialysis team.…”

“…The bioimpedance body analysis is a reproducible and objective assessment of hydration and has been extensively studied in adults [14,15] and children [11,12] on dialysis. However, defining the dry weight from the total body water assessment, the most common parameter obtained from bioimpedance body analysis, can be difficult.…”

“…However, defining the dry weight from the total body water assessment, the most common parameter obtained from bioimpedance body analysis, can be difficult. The relationship between blood pressure and volume status is highly variable in adults [14] and children [12] on HD: extracellular volume assessment by bioimpedance analysis clearly demonstrates that blood pressure in the dialysis population is not always volume dependent (Fig. 1) [12,14].…”

“…The relationship between blood pressure and volume status is highly variable in adults [14] and children [12] on HD: extracellular volume assessment by bioimpedance analysis clearly demonstrates that blood pressure in the dialysis population is not always volume dependent (Fig. 1) [12,14]. Systolic hypertension can be the result of extracellular overhydration, but also occurs in the case of extracellular underhydration.…”

“…Systolic hypertension can be the result of extracellular overhydration, but also occurs in the case of extracellular underhydration. Conversely, hypotension is also not simply volume dependent [12,14]. Thus, physicians should be aware that a high blood pressure at the start of dialysis does not always imply extracellular overhydration and, therefore, cannot always be managed with increased ultrafiltration [12,14].…”