Received July 12, 2006
Accepted on December 17, 2006
A Standard, Noninvasive Monitoring of Hematocrit Algorithm Improves Blood Pressure Control in Pediatric Hemodialysis Patients
Hiren P. Patel *1,
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
1 To whom correspondence should be addressed. E-mail: patelh{at}pediatrics.ohio-state.edu.
 |
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 
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.
