Dry-weight: a concept revisited in an effort to avoid medication-directed approaches for blood pressure control in hemodialysis patients.
OBJECTIVE
Achieving and maintaining dry-weight appears to be an effective but forgotten strategy in controlling and maintaining normotension among hypertensive patients on hemodialysis.


METHODS
Qualitative review of literature to define dry-weight and its utility in achieving blood pressure control.


RESULTS
The concept of dry-weight has evolved over time and its definition has changed. One such definition defines dry-weight as the lowest tolerated postdialysis weight achieved via gradual change in postdialysis weight at which there are minimal signs or symptoms of hypovolemia or hypervolemia. Although clinical examination does not perform well in detecting latent increase in dry-weight, several technologies such as relative plasma volume monitoring and body impedance analysis are emerging that may help in assessing dry-weight in the future. Sodium restriction is a modifiable risk factor that can lead to better blood pressure (BP) control. However, dietary sodium restriction requires lifestyle modifications that are difficult to implement and even harder to sustain over the long term. Restricting dialysate sodium is a simpler but underexplored strategy that can reduce thirst, limit interdialytic weight gain, and assist the achievement of dry-weight. Achievement of dry-weight can improve interdialytic BP, reduce pulse pressure, and limit hospitalizations.


CONCLUSIONS
Avoiding medication-directed control of BP may enhance the opportunity to probe dry-weight, facilitate removal of volume, and limit the risk for pressure-volume overload, which may be a significant concern leading to myocardial remodeling in the hemodialysis patient. Probing dry-weight among patients with ESRD has the potential to improve dismal cardiovascular outcomes.
Agarwal
Rajiv
R
Division of Nephrology, Department of Medicine, Indiana University School of Medicine, and Roudebush VA Medical Center, 1481 West 10th Street, 111N, Indianapolis, IN 46202, USA. ragarwal@iupui.edu
Weir
Matthew R
MR
D000328:Adult; D000959:Antihypertensive Agents / Q000009:adverse effects*; D001794:Blood Pressure; D001811:Blood Volume Determination; D001823:Body Composition; D001834:Body Water / Q000378:metabolism; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D004039:Diet, Sodium-Restricted; D017097:Electric Impedance; D015312:Hemodialysis Solutions / Q000737:chemistry / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D010953:Plasma Volume; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D009626:Terminology as Topic; D014882:Water-Electrolyte Balance
D000959:Antihypertensive Agents; D015312:Hemodialysis Solutions