Topic: Volume First (session was on March 28, 2015)
Drs. Steven Brunelli, Rajiv Agarwal and myself discussed the importance of volume overload in patients on long-term hemodialysis and several important points were made:
- A driver of the unacceptable mortality in ESRD patients is volume excess which contributes to hypertension and cardiovascular events
- High interdialytic weight gains are associated with poor outcomes
- Ultrafiltration rates > 10 mL/kg/hour are associated with poor outcomes
- Missing target weight is associated with poor outcomes
- Myocardial stunning may be one mechanism whereby high ultrafiltration rates lead to increased cardiovascular mortality
- Volume reduction through ultrafiltration can decrease blood pressure in up to 70-90% of patients
- In the DRIP trial, even modest (0.9 kg) weight losses were associated with a mean of 7 mm systolic blood pressure fall
- Home blood pressure monitoring is a useful tool and correlates better with outcomes than in-center blood pressure
- Goal home blood pressure that seems optimal is 125-145 mm systolic
- Numerous techniques for assessment of dry weight are available but none are optimal and require serial measurements with understanding of the limitations.
Post written by Dr. Mitchell Rosner, Feature Editor for AJKD’s In Translation.
Check out more AJKD blog coverage of the NKF’s 2015 Spring Clinical Meetings!