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The first hour refill index: a promising marker of volume overload in children and young adults on chronic hemodialysis

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Abstract

Background

Volume overload is a known risk factor for cardiovascular complications in children on hemodialysis (HD), but a measurable index of volume overload is still lacking.

Methods

We propose a novel index of pre-HD volume overload based on blood volume (BV) monitoring, the first hour refill index (RI), calculated as the ratio between the ultrafiltration rate indexed for body weight during the first HD hour and the percent BV change at the first hour of the treatment. This parameter was retrospectively calculated in 121 sessions in 11 oligoanuric children and young adults on chronic HD, with median age 14.3 years (range 5.4–22.4), and its association with left-ventricular mass index, pre-HD blood pressure, and number of antihypertensive medications was evaluated.

Results

The median RI was 2.07 ml/kg/h/%. There was a significant correlation between RI and median LVMI (r 0.66, p = 0.028), which was 53.4 g/m2.7 (45.7–64) in patients with a median RI > 2, and 36.6 g/m2.7 (24.9–47) in those with a median RI < 2 ml/kg/h/% (p = 0.01). The number of antihypertensive drugs per patient was significantly higher in patients with a RI > 2 than in those with a RI < 2 ml/kg/h/% (three vs one per patient; p = 0.02) while blood pressure was not significantly different between the two groups.

Conclusions

The ratio between the ultrafiltration rate per body weight and the BV change during the first hour of a HD session could be a promising index of refill capacity and pre-HD volume overload in children and young adults on chronic HD.

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Authors and Affiliations

  1. Pediatric Nephrology, Dialysis, and Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy

    Fabio Paglialonga, Silvia Consolo, Alberto Edefonti & Giovanni Montini

  2. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Giovanni Montini

Authors
  1. Fabio Paglialonga
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  2. Silvia Consolo
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  3. Alberto Edefonti
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  4. Giovanni Montini
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Corresponding author

Correspondence to Fabio Paglialonga.

Ethics declarations

The study was approved by the local Ethical Committee and conformed to the Declaration of Helsinki.

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The authors declare that they have no conflict of interest.

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Paglialonga, F., Consolo, S., Edefonti, A. et al. The first hour refill index: a promising marker of volume overload in children and young adults on chronic hemodialysis. Pediatr Nephrol 33, 1209–1214 (2018). https://doi.org/10.1007/s00467-018-3915-5

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  • DOI: https://doi.org/10.1007/s00467-018-3915-5

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