Adjustment of Dry Weight by Extra Cellular Volume to Improve Blood Pressure Control and Reduce Dialysis Complications in Hemodialysis Patients

由細胞外體積調整乾體重以改善血液透析病人的血壓控制和併發症

陳幸復(Sing-Fu Chen) ； 陳逸洲(Yi-Chou Chen) ； 陳漢湘(Han-Hsiang Chen) ； 葉瑞圻(Jui-Chi Yeh)

《Acta Nephrologica》 17卷1期 (2003/03) Pp. 17-24

摘要

In most instances, the patient’s postdialysis dry weight is empirically estimated by trial and error. Multi-frequency bio impedance analysis (BIA) provides accurate data on body composition. Extracellular volume (ECV) change measured by BIA is a useful tool to determine the dry weight of hemodialysis patients. The purpose of our study was to compare the ECV and clinical characteristics of hemodialysis patients, matching the subjects for blood pressure and dialysis status, and to adjust dry weight in these patients to evaluate changes in ECV, blood pressure, and dialysis status. 74 normal subjects and 121 stable chronic hemodialysis patients were included. The correlation of ECV to blood pressure and dialysis complications in the hemodialysis patients group was analyzed. Dry weight was adjusted according to the patients’ ECV, and a BIA exam was repeated 4 months later. The ECV as a percentage of weight (ECV%) of hypertensive patients was significantly higher than that of normotensive patients (24.29±3.56% vs. 21.50±2.38%, p＜0.00l). The ECV% had an independent effect on blood pressure (p＜0.001) and dialysis complications (p＜0.00l). All patients with excessive ECV% developed hypertension, but not every hypertensive patient had excessive ECV%. No excessive ECV% was found for any normotensive patient. The ECV% of asymptomatic patients was significantly higher than that of symptomatic patients (24.18±3.39% vs. 21.78±2.86%, p＜0.001). Furthermore, some hypertensive patients with symptoms of dialysis complications still had excessive ECV%. The dry weight decreased in 8 hypertensive patients with excessive ECV%. ECV% (29.80±2.03% vs. 27.10±2.99%, p＜O. 001) and blood pressure (159±7/97±4 vs. 137±10/86±8 mmHg, p=0.006 for systolic and p=0.004 for diastolic) decreased. Symptoms of dialysis complications in twenty normotensive patients showed improvement upon elevation of dry weight. In conclusion, ECV in hypertensive patients should be assessed to optimize dry weight and correct hypertension. If normotensive patients have dialysis complications, their dry weight can be increased until their symptoms show improvement or hypertension develops.

關鍵字

乾體重 ； 細胞外體積 ； 血液透析 ； 生物阻抗分析

並列摘要

In most instances, the patient’s postdialysis dry weight is empirically estimated by trial and error. Multi-frequency bio impedance analysis (BIA) provides accurate data on body composition. Extracellular volume (ECV) change measured by BIA is a useful tool to determine the dry weight of hemodialysis patients. The purpose of our study was to compare the ECV and clinical characteristics of hemodialysis patients, matching the subjects for blood pressure and dialysis status, and to adjust dry weight in these patients to evaluate changes in ECV, blood pressure, and dialysis status. 74 normal subjects and 121 stable chronic hemodialysis patients were included. The correlation of ECV to blood pressure and dialysis complications in the hemodialysis patients group was analyzed. Dry weight was adjusted according to the patients’ ECV, and a BIA exam was repeated 4 months later. The ECV as a percentage of weight (ECV%) of hypertensive patients was significantly higher than that of normotensive patients (24.29±3.56% vs. 21.50±2.38%, p＜0.00l). The ECV% had an independent effect on blood pressure (p＜0.001) and dialysis complications (p＜0.00l). All patients with excessive ECV% developed hypertension, but not every hypertensive patient had excessive ECV%. No excessive ECV% was found for any normotensive patient. The ECV% of asymptomatic patients was significantly higher than that of symptomatic patients (24.18±3.39% vs. 21.78±2.86%, p＜0.001). Furthermore, some hypertensive patients with symptoms of dialysis complications still had excessive ECV%. The dry weight decreased in 8 hypertensive patients with excessive ECV%. ECV% (29.80±2.03% vs. 27.10±2.99%, p＜O. 001) and blood pressure (159±7/97±4 vs. 137±10/86±8 mmHg, p=0.006 for systolic and p=0.004 for diastolic) decreased. Symptoms of dialysis complications in twenty normotensive patients showed improvement upon elevation of dry weight. In conclusion, ECV in hypertensive patients should be assessed to optimize dry weight and correct hypertension. If normotensive patients have dialysis complications, their dry weight can be increased until their symptoms show improvement or hypertension develops.

並列關鍵字

dry weight ； extracellular volume ； hemodialsis ； bioimpedance analysis