Timing dry weight in hemodialysis
Achieving and maintaining dry weight is seen as an important goal for hypertensive patients on hemodialysis (HD), as this strategy seems to be an effective means to control and maintain normotension.
In the present study, Malaysian nephrologists aimed to evaluate the optimal time for dry weight assessments in a clinical setting by using bioimpedance spectroscopy (BIS). To the authors’ knowledge, this is the first study to take this approach (Khan A et al, Evaluation of factors affecting time to achieve dry weight among hemodialysis patients using bioimpedance spectroscopy. Ir J Med Sci. 2018; doi: 10.1007/s11845-018-1813-2.).
220 HD patients were included in the study. For these patients, the authors prospectively assessed fluid overload using the Fresenius body composition monitor (BCM). BCM readings were taken at 30 and 45 min postdialysis. At 30 minutes, more than half of patients (54.5%) had achieved a euvolemic state; at 45 minutes, it was 11.4 percent (according to the BCM). In the multivariate analysis, the following two factors had a statistically significant negative association with achieving a euvolemic state at 30 min: vascular access other than arteriovenous fistula (AVF) (OR = 0.286, p = 0.049) and cardiovascular disease (OR = 0.384, p = 0.026). By contrast, receiving HD at Hospital Universiti Sains Malaysia (HUSM) had a statistically significant positive association (OR = 2.705, p value = 0.008).
The authors suggest assessing the hydration status at 45 min postdialysis in all patients or in those patients with identified risk factors for not achieving a euvolemic state at 30 min. This approach should “provide a relatively accurate assessment for most patients”.
Link to the study: https://link.springer.com/article/10.1007%2Fs11845-018-1813-2