Use of NIMH for determination of dry weight and prevention of dialysis associated morbidity in children.

The majority of hemodialysis (HD) treatments incorporate a prescription for fluid removal targeted to a patients “dry” weight. Hypotension, cramps or headache often complicates fluid removal in children. The purpose of this study was to evaluate whether non-invasive blood volume monitoring by hematocrit could be used for the determination of dry weight and prevention of intra-dialytic complaints in children on chronic HD. Patients and methods: 128 dialysis sessions in 16 patients, aged 3–17 years, were evaluated. Non-invasive monitoring of hematocrit (NIMH) (Crit-lineTM, HemaMetrics) was performed during the whole HD session and expressed as % Δ of blood volume (%BVΔ). Results: Changes in blood volume significantly correlated with the changes of patient's weight during hemodialysis treatments (p = 0.001). Thirty HD sessions were complicated by symptomatic hypotension in 12 patients. Conclusion: Changes in blood volume measured by Crit-line correlate with the changes of patient's weight during hemodialysis treatments. Complicated HD sessions were associated with lower halfway %BVΔ. This indicates that NIMH might be useful for the determination of dry weight and for prevention of intra-dialytic morbidity in children by remodeling of the ultrafiltration profile.