At the recent conference on Pediatric and Home Dialysis,Bernard Charra of France presented a paper entitled "Volume Control in HD Patients". His major points were: Cardiovascular Disease is due mainly to poor blood pressure control in the HD patient,establishing and maintaining a normal extracellular volume(ECV)is first and mandatory to achieve normotension, and assessment and achievement of a Dry Weight allows for drug free blood pressure control in most HD patients.
I would be very interested in hearing your comments on volume monitoring during dialysis and its impact on co-morbidities both during and after the treatment.
Thanks.

Is the Charra ariticle that you mention available on the web?

If we are getting our patients down to their dry wts each treatment, why are we still having blood pressure problems? We are very careful at not letting pts leave above their dry weights.

Lauren B.
The article will soon be available for you on ur web site: www.crit-line.com. For your information we have at least 20 published papers available for you. Please let me know if what is available does not answer your questions. I will assist you in any way.
Thanks,
Nancy

Dear Renal Wiz,
I won't touch the pun associated with your user name! Unfortunately, what you don't know can hurt you. We think we have patients at their dry weights, but I would be wiling to challange you to prove that. We really don't know patients' dry weights because we don't have a window into their vasculature. Volume monitoring where the delta hematocrit is measured allows you the opportunity to do just that. You can make a clinical intervention before the patient becomes symptomatic. The dialysis world is headed in this direction. Thank you for your question. Let me know if we can help.

quote:

Originally posted by renal wiz:
If we are getting our patients down to their dry wts each treatment, why are we still having blood pressure problems? We are very careful at not letting pts leave above their dry weights.

Hi Renal Wiz! Can you tell me how you determine patients' dry weights? In our unit we keep removing fluids until patients become symptomatic (cramps or hypotension or complaints of not feeling well)and then we say, "oops, the weight above this one is his EDW". MD's basically order it this way too, "Remove fluids as tolerated". So we really have no idea if this is the patient's true dry weight until that patient becomes symptomatic. If we have a window into the patient's intravascular system, then we'll know if he's truly dry or still wet.*

dear CJ Velasco,
Volume Monitoring does allow you to have an "open window" into the patients' vasculature. It takes the guess work out of fluid removal and allows the practioner to get the patient closer to his/her real "dry weight".