Different methods to manage dry weight in hemodialysis patients

Abstract

Estimating the euvolemia and dry weight of hemodialysis patients still represents a challenge for the nephrologist, since both dehydration and hyperhydration are associated with intradialytic events and cardiovascular complications in the short and long term.

Despite the need for a precise and objective definition of the dry weight for the individual patient on dialysis, this is usually determined on a clinical basis. To obtain greater sensitivity the dosage of natriuretic peptides, Bioelectrical Impedance Analysis (BIA) and, more recently, Lung Ultra-Sound (LUS) can all be used. The BIA allows to estimate the subject’s body composition and, in particular, the distribution of body fluids. The presence of hyperhydration, as determined through the BIA, is predictive of an increased mortality in numerous observational studies.

In recent years, pulmonary ultrasound has taken on an increasingly important role not only within the cardiology and intensive care units, but also in a nephrology setting, especially in dialysis.

The purpose of this article is to analyze the advantages and limitations of the methods that can be used to assess the dry weight of patients undergoing hemodialysis treatment.

 

Keywords: hemodialysis, lung ultra-sound, bioelectrical impedance analysis, overhydration, dry weight

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Introduzione

Nel paziente in emodialisi, sia la disidratazione che l’iperidratazione favoriscono complicanze intra ed extra dialitiche e cardiovascolari sia nel breve che nel lungo termine, ma la stima della volemia e del peso secco dei pazienti rappresenta ancora oggi una sfida per il nefrologo [1]. L’iperidratazione anche subclinica si associa ad ipertensione arteriosa, incremento della rigidità vascolare, ipertrofia ventricolare sinistra e aumentato rischio di eventi e di mortalità cardiovascolare [2]. 
 

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