Dry-Weight

Agarwal, Rajiv; Weir, Matthew R.

doi:10.2215/cjn.01760210

Cited by 145 publications

(102 citation statements)

References 35 publications

(32 reference statements)

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“…Paradoxically, among HD patients, a greater use of antihypertensive medications is associated with a higher BP. 130 However, causality must not be assumed. It is more likely that excessive antihypertensive medication may interfere with achievement of dry weight.…”

Section: Pharmacologic Treatmentmentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

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157

156

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Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. Hypertension is common among patients with ESRD. In this review, we discuss the diagnosis, epidemiology, and management of hypertension among dialysis patients. We also review areas of existing controversies and briefly discuss the issue of hypertension in pediatric dialysis patients. EPIDEMIOLOGYThe prevalence, treatment, and control of hypertension among people on hemodialysis (HD) have used varying definitions to diagnose hypertension. The epidemiology differs based on how BP is measured: either before and after dialysis or using ambulatory BP recordings. Epidemiology with Routine BP MeasurementsThe prevalence of hypertension (defined as 1-week average predialysis systolic BP [SBP] measurements .150 mmHg or diastolic BP [DBP].85 mmHg or the use of antihypertensive medications) was 86% among 2535 clinically stable adult HD patients participating in a multicenter trial. 1 Among hypertensive patients, 12% did not receive antihypertensive drugs, 58% were treated but not controlled, and only 30% were controlled. The use of antihypertensive drugs has been reported to vary from 59% to 83%. [2][3][4][5] Furthermore, even among children on long-term HD, similar findings have been reported. 6 Several studies have confirmed greater antihypertensive drug use to be associated with poorer control. 7,8 It should be noted that antihypertensive drug use per se do not lead to worse BP control; in the absence of adequate volume control, increasing antihypertensive drug use may simply reflect difficult-to-control BP. Epidemiology Using Ambulatory BP MeasurementsThe prevalence of hypertension (defined by either a 44-hour interdialytic ambulatory BP of $135/85 mmHg or the prescription of any antihypertensive agent) was 86% among 369 chronic HD patients. 8 Although hypertension was being treated with antihypertensive drugs in 89% of patients, it was adequately controlled only in 38%. The independent determinants of poor control were the use of antihypertensive drugs and an expanded extracellular volume state. If patients were volume overloaded, nearly 80% became hypertensive when medications were Published online ahead of print. Publication date available at www.jasn.org.

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Section: Pharmacologic Treatmentmentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

Self Cite

157

156

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“…Finally, it must be kept in mind that antihypertensive medications may cause vasodilation and impede fluid removal from patients on HD despite volume overload [23]. Consequently, their use should be avoided where possible.…”

Section: Managing Idwg: Safely Achieving the Desired Ultrafiltrationmentioning

confidence: 99%

“…The dialysate sodium prescription should be adjusted to determine the dialysate-to-plasma sodium diffusive gradient [3,13]. Besides restricting interdialytic dietary salt intake, restricting dialysate sodium can reduce thirst, limit IDWG, assist in the achievement of dry weight and optimize blood pressure control [23]. It should also be noted that both volume overload and aggressive fluid removal can induce circulatory stress and multiorgan injury: euvolaemia achieved by rapid ultrafiltration can be potentially dangerous, even though it may appear to be well tolerated [4,17,24].…”

Section: Idwg: the Role Of Dialysate Sodiummentioning

confidence: 99%

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

Fischbach¹,

Zaloszyc²,

Shroff

2015

Pediatr Nephrol

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Despite multiple advances in haemodialysis (HD) technology over the years, the morbidity and mortality of HD patients remain unacceptably high. Cardiovascular disease is the most common cause of death, and left ventricular hypertrophy (LVH), seen in two-thirds of children on dialysis, is a significant contributor. The importance of volume control is increasingly recognized by nephrologists and now considered to be as important as urea kinetics, both in the day-to-day management and the long-term outcome of dialysis patients. The results published by Paglialonga et al. (10.1007/s00467-014-3005-2) in this issue of Pediatric Nephrology clearly demonstrate that there is a significant correlation between interdialytic weight gain (IDWG) and LVH in oligoanuric children on chronic HD and that children with an IDWG of >4 % are at high risk of LVH. One common practice to achieve euvolaemia is to prescribe very high ultrafiltration rates. However, both volume overload and aggressive fluid removal can induce circulatory stress and multi-organ injury. In adults, ultrafiltration rates of >1.24 % body weight per hour, even if well tolerated, are associated with a significant increase in mortality. Nephrologists should be aware of the risk of a high ultrafiltration rate, especially if tolerance is obtained by a positive dialysate-to-plasma sodium gradient. Haemodiafiltration, which allows for higher ultrafiltration rates with greater intradialytic haemodynamic stability, or more frequent and longer dialysis sessions allow for safe and effective fluid removal.

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“…3 It is an inexact clinical science. The clinical examination is not always helpful to assess volume.…”

mentioning

confidence: 99%

“…Although strategies such as reducing dialysate sodium concentration to reduce thirst and interdialytic weight gain may help some, symptomatology with weight reduction during dialysis remains a significant problem in many patients. 3 Volume may be more effectively removed with linear sodium modeling or sequential ultrafiltration. The latter technique often requires more dialysis time, which may limit its applicability in some patients.…”

mentioning

confidence: 99%