Dry-Weight
- 1 July 2010
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Journal of the American Society of Nephrology
- Vol. 5 (7), 1255-1260
- https://doi.org/10.2215/cjn.01760210
Abstract
Background and objectives: Achieving and maintaining dry-weight appears to be an effective but forgotten strategy in controlling and maintaining normotension among hypertensive patients on hemodialysis. Methods: Qualitative review of literature to define dry-weight and its utility in achieving blood pressure control. Results: The concept of dry-weight has evolved over time and its definition has changed. One such definition defines dry-weight as the lowest tolerated postdialysis weight achieved via gradual change in postdialysis weight at which there are minimal signs or symptoms of hypovolemia or hypervolemia. Although clinical examination does not perform well in detecting latent increase in dry-weight, several technologies such as relative plasma volume monitoring and body impedance analysis are emerging that may help in assessing dry-weight in the future. Sodium restriction is a modifiable risk factor that can lead to better blood pressure (BP) control. However, dietary sodium restriction requires lifestyle modifications that are difficult to implement and even harder to sustain over the long term. Restricting dialysate sodium is a simpler but underexplored strategy that can reduce thirst, limit interdialytic weight gain, and assist the achievement of dry-weight. Achievement of dry-weight can improve interdialytic BP, reduce pulse pressure, and limit hospitalizations. Conclusions: Avoiding medication-directed control of BP may enhance the opportunity to probe dry-weight, facilitate removal of volume, and limit the risk for pressure-volume overload, which may be a significant concern leading to myocardial remodeling in the hemodialysis patient. Probing dry-weight among patients with ESRD has the potential to improve dismal cardiovascular outcomes.Keywords
This publication has 35 references indexed in Scilit:
- Relative Plasma Volume Monitoring During Hemodialysis Aids the Assessment of Dry WeightHypertension, 2010
- Decreased pulse pressure during hemodialysis is associated with improved 6-month outcomesKidney International, 2009
- Cardiovascular Protection With Antihypertensive Drugs in Dialysis PatientsHypertension, 2009
- Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trialsThe Lancet, 2009
- Dry-Weight Reduction in Hypertensive Hemodialysis Patients (DRIP)Hypertension, 2009
- The effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume statusNephrology Dialysis Transplantation, 2009
- The mortality risk of overhydration in haemodialysis patientsNephrology Dialysis Transplantation, 2009
- On the Importance of Pedal Edema in Hemodialysis PatientsClinical Journal of the American Society of Nephrology, 2008
- Effect of Frequent Nocturnal Hemodialysis vs Conventional Hemodialysis on Left Ventricular Mass and Quality of LifeJama-Journal Of The American Medical Association, 2007
- Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patientsKidney International, 2004