Hypertension and dry weight in hemodialyzed patients
Keywords:
dry weight, hemodialysis, chronic renal failure, hypertension, bioimpedance, extracellular compartmentAbstract
Introduction. Hypertension is the most frequent hemo-dynamic disorder in patients treated with hemodialysis therapy. Over-hydration is one of the most important risk factors leading to arterial hypertension. The assessment of over-hydration and ipso facto, correct evaluation of „dry weight” is an essential part of therapy. Electrical bioimpedance analysis is a tool used for estimating the level of hydration.
Aim. The aim of this study was to assess optimal dry weight in 12 dialyzed patients with arterial hypertension over a period of six months; Study evaluations were performed every two weeks for the first three months and once a month for the final three months of our study. The whole body bioimpedance analysis and the Wizemann Clinical Scale were used in the study.
Material and methods. Our results demonstrated a significant correlation between systolic blood pressure value and the size of extracellular space before hemodialysis in the entire group of patients (r = 0.55; p = 0.001). In the group of patients in which we were able to reduce blood pressure by obtaining optimal dry weight (the whole body electrical bioimpedance and the Wizemann Clinical Scale were used to estimate ECW sizes) to a level allowing termination of their hypotensive medicines, there was also observed a statistically significant correlation between the systolic blood pressure and the size of ECW before hemodialysis (r = 0.40; p = 0.006).
Conclusions. The size of extracellular space calculated with the use of the whole body electrical bioimpedance analysis before dialysis corresponded with the Wizemann Clinical Scale and was a valuable tool in the evaluation of hydration levels. Obtaining the correct body mass (optimal dry weight) resulted in reduction or total termination of hypertensive therapy.
References
1. Santoro A, Mancini E, Paolini F. Blood volume regulation during hemodialysis. Am J Kidney Dis 1998;32(5):739-48.
2. Horl MP, Horl WH. Hemodialysis-associated hypertension: pathophysiology and therapy. Am J Kidney Dis 2002;39(2):227-4.
3. Laurent G. How to keep the dialysis patients normotensive? What is the secret of Tassin? Nephrol Dial Transplant 1997;12(6):1104.
4. Chamney PW, Johner C, Aldridge C, Kramer M. Fluid balance modeling in patients with kidney failure. J Med Eng Technol 1999;23(2):45-52.
5. Wizemann V, Wabel P, Chamney P, Załuska W, Moissl U, Rode C, Małecka-Massalska T, Marcelli D. The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant 2009;24(5):1574-9.
6. Chongthanakorn K, Tiranathanagul K, Susantitaphong P, Praditpornsilpa K, Eiam-Ong S. Effective determination of dry weight by intradialytic bioimpedance analysis in hemodialysis. Blood Purif 2009;27(3):235-41.
7. Wabel P, Chamney P, Moissl U, Jirka T. Importance of whole-body bioimpedance spectroscopy for the management of fluid balance. Blood Purif 2009;27(1):75-80.
8. Henderson LW. Symptomatic hypotension during hemodialysis. Kidney Int 1980;17(5):571-6.
9. Leypoldt JK, Lindsay RM. Hemodynamic monitoring during hemodialysis. Adv Ren Replace Ther 1999;6(3):233-42.
10. Savage T, Fabbian F, Giles M, Tomson CR, Raine AE. Interdialytic weight gain and 48h blood pressure in hemodialysis patients. Nephrol Dial Transplant 1997;12:2308-11.
11. Johansson AC, Haraldsson B, Attaman PO. Body composition in renal failure and the effect of dialysis. Appl Radiat Isot 1998;49(5/6): 665-6.
12. Cai Y, Zimmerman A, Ladefoget S, Secher NH. Can haemodialysis- induced hypotension be predicted? Nephron 2002;92:582-588.
13. Załuska W, Jaroszyński A, Bober E, Małecka T, Kozik J, Książek A. Pomiar przestrzeni wodnych za pomocą techniki bioimpedancji elektrycznej w celu oszacowania wagi oczekiwanej u pacjentów hemodializowanych. Przegl Lek 2000;57(12):707-10.
14. Charra B, Laurent G. Clinical assessment of dry weight. Nephrol Dial Transplant 1996;16-9.
15. Wizemann V, Schilling M. Dilemma of assessing volume state – the use and the limitations of a clinical score. Nephrol Dial Transplant. 1995;10(11):2114-7.
16. Perez-Garcia R, Lopez-Gomez JM, Jofre R. Haemodialysis dose, extracellular volume control and arterial hypertension. Nephrol Dial Transplant 2001;16:98-101.
17. Tattersall J. Bioimpedance analysis in dialysis: state of the art and what we can expect. Blood Purif 2009;27(1):70-4.
18. Yi-Chou Ch, Han-Hsiang Ch, Jui-Chi Y. Postdialysis extracellular volume is rational for evaluating dry weight in hemodialysis patients. Nephron 2002;90:109-10.
19. Schwenk A, Beisenherz A, Romer K. Phase angle from bioelectrical impedance analysis remains an independent predictive marker in HIV- infected patients in the era or highly active antiretroviral treatment. Am J Clin Nutr 2000;72(2):496-501.
20. Spinale FG, Reines HD, Cook MC. Noninvasive estimation of extravascular lung water using bioimpedance. J Surg Res 1989; 47(6):535-40.
21. Bianchi G, Ponticelli C, Bardi U, Redaelli B. Role of the kidney in „salt and water dependent hypertension” of end-stage renal disease. Clin Sci. 1972;42(1):47-55.
22. Locatelli F, Colzani S, D’Amico M. Dry weight and sodium balance. Semin Nephrol 2001;21(3):291-7.
23. Chaignon M, Chen WT, Tarazi RC. Blood pressure response to hemodialysis. Hypertension 1981;3(3):333-9. 395Zdr Publ 2010;120(4)
24. Lins RL, Elseviers M, Rogiers P, Van Hoeyweghen RJ, De Raedt H, Zachee P, Daelemans RA. Importance of volume factors in dialysis- related hypertension. Clin Nephrol 1997;48(1):29-33.
25. Bellizzi V, Minutolo R, Terracciano V. Influence of the cyclic variation of hydration status on hemoglobin levels in hemodialysis patients. Am J Kidney Dis 2002;40(3):549-55.
26. Kushner RF, De Vries P, Gudivaka R. Use of bioelectrical impedance analysis measurements in the clinical management of patients undergoing dialysis. Am J Clin Nutr 1996;64:503S-509S.
27. Fenech M, Maasrani M, Jaffrin MY. Fluid volumes determination by impedance spectroscopy and hematocrit monitoring: Application to pediatric hemodialysis. Artif Organs 2001;25(2):89-98.
