Nav: Home

Practices related to fluid volume that are important for dialysis patients' health

February 05, 2019

Highlight
  • Certain practices in dialysis facilities related to managing fluid volume and low blood pressure during dialysis are important to patients' health and survival.
Washington, DC (February 5, 2019) -- A new study highlights the importance of regular and careful assessment of dry or target weight and fluid balance in patients undergoing hemodialysis. The study appears in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN).

In patients with kidney failure, dialysis helps remove excess fluid and waste products from the blood. This is important because too much fluid, or volume overload, can cause peripheral edema (swelling of legs) and breathlessness in the short-term, and hypertension (high blood pressure), left ventricular hypertrophy (enlargement of heart), and heart failure in the long-term. Removal of too much fluid, however, can cause cramps, abdominal pain, vomiting, and dizziness; and it can lead to intradialytic hypotension (acute drop in blood pressure during dialysis) which can cause damage to heart muscles and is associated with a higher risk of death.

Indranil Dasgupta, DM, FRCP (Heartlands Hospital, UK) and his colleagues compared the way patients' fluid volume was managed in different dialysis facilities and the effects this had on patient health.

Data were analyzed from 10,250 patients and 270 facilities across 12 countries in the DOPPS (Dialysis Outcomes and Practice Pattern Study). Medical directors of the dialysis centers were sent a questionnaire on fluid volume management of patients on hemodialysis, and the responses to 10 of the 29 questions, deemed most important by the researchers, were analyzed.

The researchers found that having a protocol that specifies how often to assess dry weight was associated with lower rates of all-cause and cardiovascular deaths. Routine postural (lying or sitting and standing) blood pressure measurement was associated with lower all-cause hospitalization and cardiovascular events. Routine use of lower dialysis temperature to prevent or limit intradialytic hypotension was associated with lower cardiovascular death.

The findings emphasize the importance of regular and careful clinical assessment of target weight and fluid balance in patients on hemodialysis.

"Dialysis units should consider how they can make sure every patient has their target weight assessed regularly, ideally before every treatment. This can be done by a doctor or nurse and should include careful measurement of blood pressure," said Dr. Dasgupta.

In an accompanying editorial, Andrew Davenport, MD, FRCP (Royal Free Hospital, UK) noted that the study raises numerous questions. "Answers to some of the subsidiary questions remain to be analyzed, and the responses analyzed so far open up further avenues that require greater exploration," he wrote.
-end-
Study co-authors include G Neil Thomas, PhD, Joanne Clarke, PhD, Alice Sitch, MSc, James Martin, PhD, Brian Bieber, MS, Manfred Hecking, MD, Angelo Karaboyas, MS, Ronald Pisoni, PhD, Friedrich Port, MD, Bruce Robinson, MD, Hugh Rayner, MD.

Disclosures: The authors reported no financial disclosures.

The article, entitled "Associations Between Hemodialysis Facility Practices to Manage Fluid Volume and Intradialytic Hypotension and Patient Outcomes," will appear online at http://cjasn.asnjournals.org/ on February 5, 2019, doi: 10.2215/CJN.08240718.

The accompanying editorial, entitled "Differences in Dialysis Center Practices in Determining Hemodialysis Patient Postdialysis Target Weight and Patient Survival and Hospitalizations," will appear online at http://cjasn.asnjournals.org/ on February 5, 2019.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has more than 20,000 members representing 131 countries. For more information, please visit http://www.asn-online.org or contact the society at 202-640-4660.

American Society of Nephrology

Related Blood Pressure Articles:

Do you really have high blood pressure?
A study by researchers at the University of Montreal Hospital Research Centre (CRCHUM) shows that more than half of family doctors in Canada are still using manual devices to measure blood pressure, a dated technology that often leads to misdiagnosis.
Why do we develop high blood pressure?
Abnormally high blood pressure, or hypertension, may be related to changes in brain activity and blood flow early in life.
For some, high blood pressure associated with better survival
Patients with both type 2 diabetes and acute heart failure face a significantly lower risk of death but a higher risk of heart failure-related hospitalizations if they had high systolic blood pressure on discharge from the hospital compared to those with normal blood pressure, according to a study scheduled for presentation at the American College of Cardiology's 66th Annual Scientific Session.
$9.4 million grant helps scientists explore how cell death from high blood pressure fuels even higher pressure
It's been known for decades that a bacterial infection can raise your blood pressure short term, but now scientists are putting together the pieces of how our own dying cells can fuel chronically high, destructive pressure.
Blood pressure diet improves gout blood marker
A diet rich in fruits, vegetables, low-fat dairy and reduced in fats and saturated fats (the DASH diet), designed decades ago to reduce high blood pressure, also appears to significantly lower uric acid, the causative agent of gout.
New tool to improve blood pressure measurement
Oxford University researchers have developed a prediction model that uses three separate blood pressure readings taken in a single consultation and basic patient characteristics to give an adjusted blood pressure reading that is significantly more accurate than existing models for identifying hypertension.
Blood vessels sprout under pressure
It is blood pressure that drives the opening of small capillaries during angiogenesis.
Better blood pressure control -- by mobile phone
An interactive web system with the help of your mobile phone can be an effective tool for better blood pressure control.
Time to reassess blood-pressure goals
High blood pressure or hypertension is a major health problem that affects more than 70 million people in the US, and over one billion worldwide.
With help from pharmacists, better blood pressure costs $22
A pharmacist-physician collaboration in primary-care offices effectively and inexpensively improved patients' high blood pressure.

Related Blood Pressure Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...