Relationship between volume status and blood pressure during chronic hemodialysis

Abstract

HD treatment generally reduces BP, and these reductions in BP are associated with intradialytic decreases in both body weight and plasma volume. The absolute predialysis and postdialysis BP levels are influenced differently by acute intradialytic decreases in body weight and acute intradialytic decreases in plasma volume; these parameters provide different information regarding volume status and may be dissociated from each other. Therefore, evaluation of volume status in chronic HD patients requires, at minimum, assessments of both interdialytic fluid accumulation (or the intradialytic decrease in body weight) and postdialysis volume overload.

Intradialytic Hypotension and Risk of Cardiovascular Disease

“…On the basis of the KDOQI definition, IDH occurs in approximately 20%-30% of all HD sessions (4). IDH mainly occurs during dialysis when plasma fluid removal through ultrafiltration outpaces the rate of refilling (5). Although all patients undergoing HD are at risk of IDH due to the change in blood volume caused by ultrafiltration, some patients are at greater risk, including elderly individuals (aged .65 years), those with diabetes, those who are CV compromised, and those who present with low predialysis systolic BP (,100 mmHg) (6).…”

Control of Blood Pressure and Anti Hypertensive Drug Profile in End Stage Renal Disease Patients Undergoing Maintenances Hemodialysis: An Observation and a Retrospective Study

“…For instance, in a subset of patients from the hemo Study, pre-and post-dialysis BP were differently influenced by acute decrease in weight (an indicator of interdialytic fluid gain) and plasma volume (an indicator of postdialysis volume status). 17 In this study, the pre-and post-dialysis BP was associated with larger intradialytic decreases in bodyweight but smaller intradialytic reductions in plasma volume. Each kilogram reduction in bodyweight during HD was associated with 2.95 and 1.65 mMHg higher pre-dialysis and post-dialysis systolic BP, respectively.…”

“…This suggests most relevant contributory factors in control of BP in patients undergoing HD, are effective dry weight and cardiac status. 17 …”

The pathogenesis of hypertension in end stage renal disease; the importance of the sodium and volume control

“…Hemodiyaliz hastalarında-ki hipertansiyonun patofizyolojisinde volüm yü-künün rolüne dair, tartışmalı ve çelişkili sonuçlar bildirilmektedir. Leypoldt ve arkadaşları, plazma volümü ve vücut ağırlığının azalması ile prediyaliz ve post diyaliz sistolik kan basıncındaki azalma arasındaki korelasyonu ortaya çıkarmışlardır (8). Lins ve arkadaşlarının yapmış olduğu çalışmada intradiyalitik sistolik kan basıncındaki düşmeyi göstermesi açısından, intradiyalitik plazma volü-mü, intradiyalitik vücut ağırlık kaybından daha doğru bir gösterge olarak bulunmuştur (9).…”