title: A standard, noninvasive monitoring of hematocrit algorithm improves blood pressure control in pediatric hemodialysis patients.
abstract: Accurate dry weight assessment is difficult in pediatric hemodialysis patients but is essential to prevent chronic fluid overload, hypertension, and cardiovascular morbidity. A noninvasive monitoring (NIVM) of hematocrit-guided ultrafiltration algorithm was studied prospectively in 20 pediatric hemodialysis patients. The algorithm targeted the first 50% of total goal ultrafiltration to be removed during the first hour of dialysis with a maximum blood volume change of 8 to 12% per hour. The second 50% was removed during the remaining treatment time with a maximum blood volume change of 5% per hour. Data that were collected at baseline and 6 mo included weight, BP, number of antihypertensive medications, 24-h ambulatory BP monitoring (ABPM), echocardiogram, and ultrafiltration-associated symptoms. Sixteen of 20 enrolled patients completed the study. No difference was seen between baseline and 6-mo weight, predialysis casual BP, nighttime ABPM, or left ventricular mass index. There was a decrease in postdialysis casual systolic BP, daytime ABPM, number of antihypertensive medications prescribed, and rate of intradialytic events related to ultrafiltration (all P < or = 0.05). Adoption of a standardized NIVM-guided algorithm led to (1) improved ABPM profiles, (2) decreased antihypertensive medication burden, and (3) decreased ultrafiltration-associated symptoms. Wider use of NIVM-guided ultrafiltration may decrease cardiovascular morbidity in pediatric hemodialysis patients.
authors: Department of Pediatrics, Section of Nephrology, Columbus Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio 43205, USA. patelh@pediatrics.ohio-state.edu
authors: Hiren P
authors: HP
authors: Patel
authors: Stuart L
authors: SL
authors: Goldstein
authors: John D
authors: JD
authors: Mahan
authors: Beth
authors: B
authors: Smith
authors: Cheryl B
authors: CB
authors: Fried
authors: Helen
authors: H
authors: Currier
authors: Joseph T
authors: JT
authors: Flynn
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001794:Blood Pressure; D002648:Child; D005260:Female; D006400:Hematocrit; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D006435:Renal Dialysis