HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: CJN.02410706v1 2/2/252    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Patel, H. P. Articles by Flynn, J. T. Search for Related Content PubMed PubMed Citation Articles by Patel, H. P. Articles by Flynn, J. T.

A Standard, Noninvasive Monitoring of Hematocrit Algorithm Improves Blood Pressure Control in Pediatric Hemodialysis Patients

Hiren P. Patel^*, Stuart L. Goldstein, John D. Mahan^*, Beth Smith^*, Cheryl B. Fried, Helen Currier, and Joseph T. Flynn

^* Department of Pediatrics, Section of Nephrology, Columbus Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatrics-Renal Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas; and Division of Pediatric Nephrology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York

Address correspondence to: Dr. Hiren P. Patel, Columbus Children's Hospital, Section of Nephrology, 700 Children's Drive, Columbus, OH 43205. Phone: 614-722-4360; Fax: 614-722-6482; E-mail: patelh{at}pediatrics.ohio-state.edu

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 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.