title: Euvolemia in hemodialysis patients: a potentially dangerous goal?
abstract: Dialysis patients have high mortality rate and the leading cause of death is cardiovascular disease. Uremic cardiomyopathy differs from that due to conventional atherosclerosis, where cardiovascular changes result in ineffective circulation and lead to tissue ischemia. Modern dialysis has significant limitations with fluid management probably the most challenging. Current evidence suggests that both volume overload and aggressive fluid removal can induce circulatory stress and multi-organ injury. Furthermore, we do not have accurate volume assessment tools. As a result, targeting euvolemia might result in more harm than benefit with conventional hemodialysis therapy. Therefore, it might be time to consider a degree of permissive over-hydration until we have better tools to both determine ideal weight and improve current renal replacement therapy so that the process of achieving it is not so fraught with the current dangers.
authors.affiliation: Department of Medicine, Division of Nephrology, Western University and London Health Sciences Centre, London, Canada; Department of Medical Biophysics, Western University, London, Canada; Department of Pediatrics, Western University, London, Canada.
authors.forename: Shih-Han S
authors.initials: SH
authors.lastname: Huang
authors.forename: Guido
authors.initials: G
authors.lastname: Filler
authors.forename: Robert
authors.initials: R
authors.lastname: Lindsay
authors.forename: Chris W
authors.initials: CW
authors.lastname: McIntyre
mesh_terms: D001826:Body Fluids; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000209:etiology*; D005440:Fluid Therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects*; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000517:prevention & control*