Nephrology Dialysis Transplantation, Vol 14, Issue 1 121-124, Copyright © 1999 by Oxford University Press
C Chazot, B Charra, C Vo Van, G Jean, T Vanel, E Calemard, J Terrat, M Ruffet and G Laurent
Background: The goal of haemodialysis treatment in
end-stage renal disease (ESRD) patients is to correct the complications of
the uraemic condition. Among the main complications are fluid overload and
subsequent hypertension that are corrected by achievement of 'dry weight'.
We report in this study the evolution of post-dialysis body-weight and
blood pressure in patients who began their HD treatment in our unit.
Methods: We studied the monthly evolution of
post-dialysis body-weight (expressed as a percentage of predialysis
body-weight at the first HD treatment) and predialysis mean arterial
pressure (MAP) over 24 months in 61 patients (21 females; mean age 59.8
years; 20% diabetic), treated with cellulosic membranes for 8h, 3 times a
week. Results: The post-dialysis body-weight decreased
between the onset of HD and month 2 (M2) (-4.40±0.52%). Then it
went up, reaching -1.56±0.96% at M6, +0.3±1.27% at
M12, +1.27±1.38% at M18 and +1.64±1.33% at M24. The
post-dialysis body-weight increased by 6% between M2 and M24. The mean
arterial pressure (MAP) decreased from 111.3±2.5 mmHg at M0 to
94.4±1.7 at M6, and then remained stable after M6. Between M2
and M6 the post-dialysis body-weight increased, whereas the predialysis MAP
continued to decline. The incidence of hypotension episodes was maximal
during the first 4 months of HD treatment.
Conclusions: After the second month of dialysis
treatment, the simultaneous increase of post-dialysis body-weight and
decrease of pre-dialysis MAP are related to the effects of two processes,
i.e. increased weight as the result of anabolism induced by the HD
treatment on the one hand and normalization of blood pressure by fluid
removal on the other. Continuous clinical assessment of the patient is
necessary to provide adequate prescription of post-dialysis body-weight.
During the first months of HD treatment, the nephrologist, like Janus, is a
double-faced gatekeeper: he must be willing to decrease post-dialysis
weight to achieve 'dry weight' and to normalize blood pressure, but he must
also be prepared to increase it to compensate for anabolism and to avoid
episodes of hypotension. Key words: dry weight;
post-dialysis body-weight; blood pressure; haemodialysis; cellulosic
membrane
ORIGINAL ARTICLES
The Janus-faced aspect of 'dry weight'
Centre de Rein Artificiel, 42, Avenue du Mai 1945, F-69160 Tassin France; Corresponding author
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