Blood Volume Monitoring to Assess Dry Weight in Pediatric Chronic Hemodialysis Patients

Konggrapun Srisuwan MD*, Nattaporn Hongsawong MD*, Adisorn Lumpaopong MD*, Prapaipim Thirakhupt MD*, Yupapin Chulamokha MD*

Affiliation : * Division of Pediatric Nephrology, Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand

Objective : Volume overload from an incorrect assessment of dry weight leads to cardiovascular diseases in chronic hemodialysis patients. Dry weight assessment in pediatric is difficult for a number of reasons including growth. Blood volume monitoring (BVM) has been proposed as an accurate method of estimating dry weight in adult. However, there is very scant data regarding BVM assessment in pediatric. Therefore, the authors conducted a study to compare dry weight, postdialytic body weight, predialytic blood pressure, intradialytic blood pressure, and intra dialytic symptoms between clinical adjustment and BVM method. Material and Method: In pediatric chronic hemodialysis patient, BVM was performed to guide ultrafiltration to adjust dry weight compared with clinical adjustment. Data including dry weight, postdialytic body weight, predialytic blood pressure, intradialytic hypotension, and intradialytic symptoms were analyzed over each 1-month period of treatment course.
Results : Ten patients (5 males/5 females, age 16.552.49 years) were enrolled. Comparing clinical adjustment to assess dry weight with BVM, there were no differences in dry weight (38.387.43 vs. 38.127.58 kg) and postdialytic body weight (38.547.61 vs. 38.237.35) of both methods. Dry weight adjusted by clinical adjustment trends to higher than by BVM (0.140.46 vs. -0.260.57 kg). There is also no difference between predialytic blood pressure of both methods. There is no intradialytic hypotension during the study period. However, intradialytic symptoms in clinical adjustment dry weight is more frequent than BVM method, especially thirst.
Conclusion : The use of BVM tends to decrease dry weight in pediatric chronic hemodialysis patients. Even though, no difference in predialytic blood pressure and intradialytic hypotension. BVM to assess dry weight reduces abnormal intradialytic symptoms, especially thirst. So far, there is no gold standard to access the accurate dry weight in children.

Keywords : Blood volume monitoring, Dry weight, Hemodialysis

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