{"id":2803,"date":"2020-03-18T21:23:16","date_gmt":"2020-03-19T02:23:16","guid":{"rendered":"https:\/\/ami.advancedrenaleducation.com\/wparep\/?post_type=article&p=1011"},"modified":"2025-09-02T11:18:47","modified_gmt":"2025-09-02T16:18:47","slug":"volume-control","status":"publish","type":"article","link":"https:\/\/ami.advancedrenaleducation.com\/wparep\/asiapacific\/article\/volume-control\/","title":{"rendered":"Volume Control"},"content":{"rendered":"

The intermittent nature of thrice weekly hemodialysis inherently challenges volume management as fluid accumulates in the extracellular space during each interdialytic gap. Patients on conventional intermittent HD therapy often gain several kilograms of fluid between dialysis sessions. Chronic fluid overload has significant impacts on patient symptoms and is a major cause of hypertension, systolic and diastolic dysfunction, increased arterial stiffness and left ventricular hypertrophy, cardiovascular morbidity, and mortality in patients with ESKD. Compared to conventional thrice weekly HD, frequent HD shortens the interdialytic period and reduces fluid oscillations and the burden of volume overload . This approach has the potential to more closely mimic the function of healthy kidneys and stabilize blood pressure.<\/p>\n

To compare the effect of short daily HD to conventional thrice weekly HD, Fagugli et al1<\/sup> studied 12 hypertensive patients in a prospective crossover study. Prior to beginning the study, all patients had been treated with thrice weekly HD for at least 6 months and were randomly assigned to continue with thrice weekly therapy or begin short daily HD, six times per week. Patients in both groups maintained the same weekly treatment length (12 hours) and other parameters in an effort to keep weekly Kt\/V constant. Fluid overload was quantified by repeated measurements of body fluids through bioimpedance analysis. Extracellular water (ECW) content (reported as percentage of total body water) was found to significantly decrease from 52.7% to 47.6% when patients switched to daily HD (Figure 1). Interdialytic weight gain was also reduced during daily HD, from 2.65 to 1.42 kg1<\/sup>.<\/p>\n

 <\/p>\n

\"\"<\/a><\/p>\n

Figure 1: <\/strong>Extracellular volume, reported as the percentage of total body water (left) and interdialytic weight gain (right) decreased when patients switched from conventional, thrice weekly (CHD) to short daily HD (DHD) (Adapted from Fagugli et al1<\/sup>).<\/h6>\n

 <\/p>\n

At around the same time, another frequent HD study \u2013 this time evaluating patients on nocturnal HD \u2013 found no change in extracellular fluid (ECF) volume when 28 patients transferred from conventional hemodialysis (4 hours, thrice weekly) to frequent nocturnal HD six to seven times per week (post-dialysis ECF: initial 17.1 \u00b1 4.0 L, final 16.9 \u00b1 3.8 L)2<\/sup>. To compare the effect of daytime and nocturnal hemodialysis on volume control, the London Daily\/Nocturnal Hemodialysis Study evaluated both treatment schedules within a single center3<\/sup>. In this case-controlled study, patients receiving frequent HD at home \u2013 either short daily (n=11) or long nocturnal (n=12) \u2013 were followed for 18 months, after which they were assessed for ECF volume and several cardiovascular parameters. The authors reported an immediate reduction in weight gain just one week after commencing frequent HD therapy that leveled out over time (Figure 2). The short daily HD group had a significantly decreased interdialytic weight gain by 3 months (p < 0.0005) that persisted for the entire duration of follow up, through 18 months (2.92 kg weight gain at baseline compared with 1.73 kg mean weight gain at 18 months). The nocturnal group did not experience the same drop in inter-HD weight gain, rather there was a transient increase at 6 and 15 months (p < 0.05). The authors speculated that this may have resulted from liberalized fluid intake in nocturnal HD patients, or increased dietary intake due to an overall improvement in health in this patient cohort.<\/p>\n

 <\/p>\n

\"\"<\/p>\n

Figure 2: <\/strong>Changes in interdialytic weight gain for patients on short daily HD, frequent nocturnal HD, and conventional HD. (*: difference from within-group baseline, p < 0.05; open circle: significant between-group difference, p < 0.05). (Adapted from Nesrallah et al3<\/sup>)<\/h6>\n

 <\/p>\n

While it is evident that effective fluid management is associated with improved blood pressure control and cardiovascular outcomes1,4,5<\/sup>, volume control may not be the only factor contributing to the cardiovascular improvements observed in nocturnal HD patients3<\/sup>. Identifying the mechanism \u2013 whether volume-related, hemodynamic-related, and\/or a complex effect related to changes in vasoreactive substance clearance \u2013 will be important for determining the optimal increased frequency of the prescription.<\/p>\n

<\/div>
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References:<\/h4>\n
    \n
  1. Fagugli RM, Reboldi G, Quintaliani G, et al. Short daily hemodialysis: blood pressure control and left ventricular mass reduction in hypertensive hemodialysis patients. Am J Kidney Dis<\/em>. 2001;38(2):371-376. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11479164.<\/li>\n
  2. Chan CT, Floras JS, Miller JA, Richardson RMA, Pierratos A. Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis. Kidney Int<\/em>. 2002;61(6):2235-2239. Available from: https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0085253815484741.<\/li>\n
  3. Nesrallah G, Suri R, Moist L, Kortas C, Lindsay RM. Volume control and blood pressure management in patients undergoing quotidian hemodialysis. Am J Kidney Dis<\/em>. 2003;42(1 Suppl):13-17. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12830438.<\/li>\n
  4. Moissl U, Arias-Guill\u00e9n M, Wabel P, et al. Bioimpedance-guided fluid management in hemodialysis patients. Clinical Journal of the American Society of Nephrology<\/em>. 2013;8(9):1575-1582. Available from: http:\/\/www.pubmedcentral.nih.gov\/articlerender.fcgi?artid=3805085&tool=pmcentrez&rendertype=abstract.<\/li>\n
  5. Machek P, Jirka T, Moissl U, Chamney P, Wabel P. Guided optimization of fluid status in haemodialysis patients. Nephrology Dialysis Transplantation<\/em>. 2010;25(2):538-544. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19793930.<\/li>\n<\/ol>\n

    GMO-001398\u00a0 Rev A \u00a011\/2024<\/span><\/p>\n

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