Relative plasma volume monitoring during hemodialysis AIDS the assessment of dry weight
Arjun D Sinha, Robert P Light, Rajiv Agarwal, Arjun D Sinha, Robert P Light, Rajiv Agarwal
Abstract
Among hemodialysis patients, the assessment of dry weight remains a matter of clinical judgment because tests to assess dry weight have not been validated. The objective of this study was to evaluate and validate relative plasma volume (RPV) monitoring as a marker of dry weight. We performed RPV monitoring using the Crit-Line monitor at baseline and at 8 weeks in 150 patients participating in the Dry-Weight Reduction in Hypertensive Hemodialysis Patients Trial. The intervention group of 100 patients had dry weight probed, whereas 50 patients served as time controls. RPV slopes were defined as flat when they were less than the median (1.33% per hour) at the baseline visit. Among predominantly (87%) black hemodialysis patients, we found that flat RPV slopes suggest a volume-overloaded state for the following reasons: (1) probing dry weight in these patients led to steeper slopes; (2) those with flatter slopes at baseline had greater weight loss; (3) both baseline RPV slopes and the intensity of weight loss were found to be important for subsequent change in RPV slopes; and, most importantly, (4) RPV slopes predicted the subsequent reduction in interdialytic ambulatory systolic blood pressure. Those with the flattest slopes had the greatest decline in blood pressure on probing dry weight. Both baseline RPV slopes and the change in RPV slopes were important for subsequent changes in ambulatory systolic blood pressure. We conclude that RPV slope monitoring is a valid method to assess dry weight among hypertensive hemodialysis patients.
Trial registration: ClinicalTrials.gov NCT00067665.
Figures
![Figure 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2819307/bin/nihms172859f1.jpg)
Figure 2
Relationship between post-dialysis weight in…
Figure 2
Relationship between post-dialysis weight in the two groups by phases of trial and…
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Weight loss and baseline RPV…
Figure 3
Weight loss and baseline RPV slope are both important in modulating the change…
Figure 4
Magnitude of change in 44-hour…
Figure 4
Magnitude of change in 44-hour interdialytic ambulatory systolic BP with ultrafiltration is dependent…
- Relative plasma volume monitoring and blood pressure control: an overlooked opportunity to achieve dry weight in the hemodialysis patient.Weir MR. Weir MR. Hypertension. 2010 Feb;55(2):226-7. doi: 10.1161/HYPERTENSIONAHA.109.146084. Epub 2009 Dec 28. Hypertension. 2010. PMID: 20038745 No abstract available.
- Determinants and short-term reproducibility of relative plasma volume slopes during hemodialysis.Anand S, Sinha AD, Agarwal R. Anand S, et al. Clin J Am Soc Nephrol. 2012 Dec;7(12):1996-2001. doi: 10.2215/CJN.04190412. Epub 2012 Sep 20. Clin J Am Soc Nephrol. 2012. PMID: 22997342 Free PMC article.
- Home blood pressure measurements for managing hypertension in hemodialysis patients.Agarwal R, Satyan S, Alborzi P, Light RP, Tegegne GG, Mazengia HS, Yigazu PM. Agarwal R, et al. Am J Nephrol. 2009;30(2):126-34. doi: 10.1159/000206698. Epub 2009 Feb 27. Am J Nephrol. 2009. PMID: 19246891 Free PMC article.
- Hypervolemia is associated with increased mortality among hemodialysis patients.Agarwal R. Agarwal R. Hypertension. 2010 Sep;56(3):512-7. doi: 10.1161/HYPERTENSIONAHA.110.154815. Epub 2010 Jul 12. Hypertension. 2010. PMID: 20625076 Free PMC article.
- Dry-weight: a concept revisited in an effort to avoid medication-directed approaches for blood pressure control in hemodialysis patients.Agarwal R, Weir MR. Agarwal R, et al. Clin J Am Soc Nephrol. 2010 Jul;5(7):1255-60. doi: 10.2215/CJN.01760210. Epub 2010 May 27. Clin J Am Soc Nephrol. 2010. PMID: 20507951 Free PMC article. Review.
- Systolic and diastolic hypertension among patients on hemodialysis: Musings on volume overload, arterial stiffness, and erythropoietin.Georgianos PI, Agarwal R. Georgianos PI, et al. Semin Dial. 2019 Nov;32(6):507-512. doi: 10.1111/sdi.12837. Epub 2019 Aug 28. Semin Dial. 2019. PMID: 31463996 Free PMC article. Review.
- Hidden risks associated with conventional short intermittent hemodialysis: A call for action to mitigate cardiovascular risk and morbidity.Canaud B, Kooman JP, Selby NM, Taal M, Maierhofer A, Kopperschmidt P, Francis S, Collins A, Kotanko P. Canaud B, et al. World J Nephrol. 2022 Mar 25;11(2):39-57. doi: 10.5527/wjn.v11.i2.39. World J Nephrol. 2022. PMID: 35433339 Free PMC article. Review.
- Feasibility of Dialysate Bolus-Based Absolute Blood Volume Estimation in Maintenance Hemodialysis Patients.Krenn S, Schmiedecker M, Schneditz D, Hödlmoser S, Mayer CC, Wassertheurer S, Omic H, Schernhammer E, Wabel P, Hecking M. Krenn S, et al. Front Med (Lausanne). 2022 Feb 10;9:801089. doi: 10.3389/fmed.2022.801089. eCollection 2022. Front Med (Lausanne). 2022. PMID: 35223900 Free PMC article.
- Machine Learning Analysis of Time-Dependent Features for Predicting Adverse Events During Hemodialysis Therapy: Model Development and Validation Study.Liu YS, Yang CY, Chiu PF, Lin HC, Lo CC, Lai AS, Chang CC, Lee OK. Liu YS, et al. J Med Internet Res. 2021 Sep 7;23(9):e27098. doi: 10.2196/27098. J Med Internet Res. 2021. PMID: 34491204 Free PMC article.
- Management of acute intradialytic cardiovascular complications: Updated overview (Review).Timofte D, Tanasescu MD, Balan DG, Tulin A, Stiru O, Vacaroiu IA, Mihai A, Popa CC, Cosconel CI, Enyedi M, Miricescu D, Papacocea RI, Ionescu D. Timofte D, et al. Exp Ther Med. 2021 Mar;21(3):282. doi: 10.3892/etm.2021.9713. Epub 2021 Jan 26. Exp Ther Med. 2021. PMID: 33603889 Free PMC article. Review.
- Relationship between doses of antihypertensive drugs and left ventricular mass index changes in hemodialysis patients in a Japanese cohort.Kitamura F, Yamaguchi M, Katsuno T, Nobata H, Iwagaitsu S, Sugiyama H, Kinashi H, Banno S, Ando M, Kubo Y, Kawade Y, Shigejiro I, Ito Y, Ishimoto T, Ito Y. Kitamura F, et al. Ren Fail. 2021 Dec;43(1):188-197. doi: 10.1080/0886022X.2021.1872626. Ren Fail. 2021. PMID: 33459126 Free PMC article.
- Evaluation Study
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
- Validation Study
- Adult
- Aged
- Blood Pressure Monitoring, Ambulatory / methods
- Blood Volume Determination
- Body Weight*
- Case-Control Studies
- Comorbidity
- Female
- Humans
- Hypertension / diagnosis*
- Hypertension / epidemiology
- Hypovolemia / diagnosis
- Kidney Failure, Chronic / diagnosis
- Kidney Failure, Chronic / epidemiology
- Kidney Failure, Chronic / therapy*
- Male
- Middle Aged
- Plasma Volume / physiology*
- Probability
- Renal Dialysis / adverse effects
- Renal Dialysis / methods*
- ClinicalTrials.gov/NCT00067665
- Full Text Sources
- Other Literature Sources
- Medical
![Figure 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2819307/bin/nihms172859f2.jpg)
![Figure 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2819307/bin/nihms172859f3.jpg)
Figure 4
Magnitude of change in 44-hour…
Figure 4
Magnitude of change in 44-hour interdialytic ambulatory systolic BP with ultrafiltration is dependent…
![Figure 4](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2819307/bin/nihms172859f4.jpg)
Source: PubMed