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Hecking, M; Madero, M; Port, FK; Schneditz, D; Wabel, P; Chazot, C.
Fluid volume management in hemodialysis: never give up!
Kidney Int. 2023; 103(1):2-5 Doi: 10.1016/j.kint.2022.09.021
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Co-Autor*innen der Med Uni Graz
Schneditz Daniel
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Abstract:
Every hemodialysis session starts with the question of how much fluid should be removed, which can currently not be answered precisely. Herein, we first revisit the "probing-dry-weight" concept, using the historical example of Tassin/France (practicing also "long, slow dialysis"): Mortality outcomes were, in the 1980s, better than registry data, but are nowadays similar to European average. In view of the negative primary end point in a recent trial on dry weight assessment, based on lung ultrasound-guided evaluation of fluid excess in the lungs, and a meta-analysis of prospective studies failing to show that bioimpedance-based interventions for correction of volume overload had a direct effect on all-cause mortality, we ask how to ever move forward. Clinical reasoning demands that as much information as possible should be gathered on the fluid status of patients undergoing dialysis. Besides body weight and blood pressure, measurements of bioimpedance and dialysate bolus-derived absolute blood volume can in principle be automatized, whereas lung ultrasound can be obtained routinely. In the era of machine learning, fluid management could consist of flexible target weight prescriptions, adjusted on a daily basis and accounting even for fluctuations in fluid-free body mass. In view of all the negative prospective results surrounding fluid management in hemodialysis, we propose this as a "never-give-up" approach.
Find related publications in this database (using NLM MeSH Indexing)
Humans - administration & dosage
Prospective Studies - administration & dosage
Renal Dialysis - adverse effects, methods
Blood Pressure - administration & dosage
Water-Electrolyte Imbalance - etiology, therapy
Ultrasonography - adverse effects
Electric Impedance - administration & dosage
Kidney Failure, Chronic - complications

Find related publications in this database (Keywords)
absolute blood volume
bioimpedance
fluid overload
hemodialysis
lung ultrasound
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