TY - GEN
T1 - Consequences of overhydration and the need for dry weight assessment
AU - Raimann, J.
AU - Liu, L.
AU - Ulloa, D.
AU - Kotanko, P.
AU - Levin, N.
PY - 2008
Y1 - 2008
N2 - Despite significant progress in the fields of dialysis technology and medical therapy, mortality of hemodialysis (HD) patients remains high. Chronic overhydration is a major contributor to the high cardiovascular morbidity and mortality observed in HD patients. The difficulty of measuring excess fluid accurately and the determination of 'dry weight' are reflected in the abundant literature on overhydration. Data indicate that a significant proportion of HD patients are not at 'dry weight'. Considering its impact on cardiovascular diseases, the relation between excess fluid, sodium, interdialytic weight gain, hypertension and cardiac diseases needs more attention. Clearly the reduction of sodium intake is of prime importance. This can be achieved by a reduction of dietary sodium intake, individualized dialysate sodium concentration, avoidance of sodium profiling and use of hypertonic saline during dialysis. These measures are expected to result in less thirst and consecutive water intake, thereby facilitating achieving dry weight (DW). In concert, the application of new tools for DW assessment such as continuous intradialytic bioimpedance spectroscopy measurement, means to prevent intradialytic symptoms (e.g. glucose bolus instead of hypertonic saline; improved hemodynamic stability by reduced dialysate temperature) may be operative in reducing morbidity and mortality in HD patients.
AB - Despite significant progress in the fields of dialysis technology and medical therapy, mortality of hemodialysis (HD) patients remains high. Chronic overhydration is a major contributor to the high cardiovascular morbidity and mortality observed in HD patients. The difficulty of measuring excess fluid accurately and the determination of 'dry weight' are reflected in the abundant literature on overhydration. Data indicate that a significant proportion of HD patients are not at 'dry weight'. Considering its impact on cardiovascular diseases, the relation between excess fluid, sodium, interdialytic weight gain, hypertension and cardiac diseases needs more attention. Clearly the reduction of sodium intake is of prime importance. This can be achieved by a reduction of dietary sodium intake, individualized dialysate sodium concentration, avoidance of sodium profiling and use of hypertonic saline during dialysis. These measures are expected to result in less thirst and consecutive water intake, thereby facilitating achieving dry weight (DW). In concert, the application of new tools for DW assessment such as continuous intradialytic bioimpedance spectroscopy measurement, means to prevent intradialytic symptoms (e.g. glucose bolus instead of hypertonic saline; improved hemodynamic stability by reduced dialysate temperature) may be operative in reducing morbidity and mortality in HD patients.
UR - http://www.scopus.com/inward/record.url?scp=48049120684&partnerID=8YFLogxK
U2 - 10.1159/000130414
DO - 10.1159/000130414
M3 - Conference contribution
C2 - 18451664
AN - SCOPUS:48049120684
SN - 9783805585668
T3 - Contributions to Nephrology
SP - 99
EP - 107
BT - Hemodialysis - From Basic Research to Clinical Trials
A2 - Ronco, Claudio
A2 - Cruz, Dinna
ER -