Effects of Hemodialysis and Saline Loading on Body Fluid Compartments, Plasma Renin Activity and Blood Pressure in Patients on Chronic Hemodialysis

Leenen, F. H. H.; Galla, Stephen J.; Geyskes, G. G.; Murdaugh, H. V.; Shapiro, Alvin P.

doi:10.1159/000180782

Cited by 25 publications

(5 citation statements)

References 8 publications

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“…intradialytic) response of blood pressure to fluid volume changes do not detect this correlation. [10][11][12] But this lack of immediate correlation may well be explained by the large number of clinical experiences indicating a lag time of several days or weeks between a volume change and a succeeding blood pressure change, as referred by Charra. 13 Antihypertensive medications today are very effective in lowering blood pressures, especially in case of normal volume state.…”

Section: Background Relevance Of Fluid Status Normalizationmentioning

confidence: 99%

Detection limit of methods to assess fluid status changes in dialysis patients

Kraemer

Rode

Wizemann

2006

Kidney International

116

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Technical systems for an accurate and practicable fluid management of dialysis patients are urgently needed, since current clinical methods are partially subjective, imprecise, and time consuming. Such new systems should not only allow the determination of the target normohydration weight, but also must be able to detect clinically relevant changes in fluid volume ( approximately 1 l). This study focuses on the systematic analysis of the detection limit of several candidate methods for fluid management. In a cohort of 16 new dialysis patients, several candidate methods were applied in parallel during each treatment of the initial weight reduction phase: the measurement of vena cava diameter (VCD), vena cava collapsibility index (CI), the blood volume drop during an ultrafiltration (UF) bolus (Deltarelative blood volume (RBV)-), the rebound after the UF bolus (DeltaRBV+), and the extracellular fluid volume determined with whole body bioimpedance spectroscopy (BIS). A clinical reference method was used to manage the fluid status of patients. All methods showed significant correlations with predialysis weight. The detection limits W(lim) of candidate methods for changes in fluid status were assessed as W(lim)=0.87 kg+/-0.64 kg (BIS), 1.74 kg+/-1.56 kg (VCD), 2.3 kg+/-1.0 kg (DeltaRBV-), 7.4 kg+/-8.5 kg (CI), 40 kg+/-108 kg (DeltaRBV+). Only BIS shows a satisfactorily low detection limit W(lim), whereas W(lim) was rated as critical for the VCD and DeltaRBV- methods, and as unacceptable for the CI and DeltaRBV+ methods. Bioimpedance spectroscopy appears to be the most promising method for a practical fluid management system in dialysis.

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Section: Background Relevance Of Fluid Status Normalizationmentioning

confidence: 99%

Detection limit of methods to assess fluid status changes in dialysis patients

Kraemer

Rode

Wizemann

2006

Kidney International

116

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“…Renin and angiotensin II levels per se are widely variable in dialysis patients and not necessarily related to blood pressure levels [35]. However, circulating levels of renin and angiotensin appear to be inappropriately activated in relation to the volume status and exchangeable sodium levels, at least in a subset of dialysis patients [35,36]. In dialysis patients who responded with an increase in blood pressure to short-term volume loading, the decrease in renin and angiotensin II levels tended to be lower compared to the patients in whom blood pressure did not change [12].…”

Section: Volume Sodium and Pressor Systems In Hemodialysis Patientsmentioning

confidence: 99%

Role of Sodium and Volume in the Pathogenesis of Hypertension in Dialysis Patients

Kooman

Sande²,

Leunissen³

2004

Blood Purif

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Volume and sodium excess is the predominant factor in the pathogenesis of hypertension in dialysis patients. However, except for anephric patients, the relationship between volume status, blood pressure, and hemodynamics is not straightforward, but may vary between subgroups of patients. In general, the sensitivity of blood pressure to changes in the volume/sodium status appears to be increased in patients with end-stage renal disease. The blood pressure response to changes in the sodium/volume status may be influenced by disturbances in the activity of and response to various neurohumoral mechanisms, such as the renin-angiotensin and sympathetic nervous systems, Na-K-ATP-ase inhibitors, and the nitric oxide system. Regarding these aspects, there might be a parallel with salt-sensitive (essential) hypertension. Preliminary data showed a beneficial effect of sodium removal beyond changes in the volume status. Also of interest is the fact that prolonging dialysis time may improve blood pressure control without clear changes in the fluid status. It is hypothesized that a reduction in exchangeable sodium, by increased diffusive transport of sodium, in combination with increased removal of vasopressor substances, might be partly responsible for the observed blood pressure changes during long dialysis times. In conclusion, sodium and volume overload and neurohumoral factors coincide in the pathogenesis of hypertension in dialysis patients. Nevertheless, their exact relationship has not yet been elucidated and deserves further study.

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“…In patients with ESRD, it has indeed been observed that circulating levels of renin and angiotensin are inappropriately increased in response to the fluid status of the patient, whereas also the normally reciprocal relation-ship between total exchangeable sodium and the activity of the RAAS was found to be disturbed which may result in an inappropriate increase in systemic vascular resistance [18,29]. Nevertheless, other authors [30] observed a normal response of the RAAS to salt and water loading and removal. Therefore, there appear to be large intraindividual differences in the relation between salt/volume and the activity of the RAAS.…”

Section: The Raas and Hypertension In Chronic Renal Failurementioning

confidence: 99%

Salt and Hypertension in End-Stage Renal Disease

1998

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Salt and fluid overload play an important role in the pathogenesis of hypertension in patients with end-stage renal disease. However, in the individual patient, the relation between salt loading and blood pressure response is variable and appears to be influenced by various neurohumoral regulatory mechanisms. This may also have implications for the pathogenesis of structural cardiovascular abnormalities in patients with end-stage renal disease.

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Effects of Hemodialysis and Saline Loading on Body Fluid Compartments, Plasma Renin Activity and Blood Pressure in Patients on Chronic Hemodialysis

Cited by 25 publications

References 8 publications

Detection limit of methods to assess fluid status changes in dialysis patients

Detection limit of methods to assess fluid status changes in dialysis patients

Role of Sodium and Volume in the Pathogenesis of Hypertension in Dialysis Patients

Salt and Hypertension in End-Stage Renal Disease

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