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Chronic Fluid Overload in Hemodialysis (pp. 91-104) $100.00
Authors:  (Fahad Aziz and Madhukar Misra)
Chronic fluid overload (CFO) is common in dialysis patients and is associated with
high mortality. CFO puts patients at high risk of uncontrolled hypertension, pulmonary
edema, heart failure and frequent hospital admissions for urgent dialysis. It also leads to
higher ultrafiltration requirements. More importantly, adverse hemodynamic effects of
rapid ultrafiltration lead to intra-dialytic hypotension and contribute to higher
cardiovascular morbidity and mortality. Owing to its low sensitivity, accurate clinical
assessment of CFO is difficult in routine practice. Available techniques for objective
assessment of CFO include blood volume monitoring, bioelectrical impedance analysis and
lung ultrasound. However, none of these methods has been validated in large trials. CFO
in hemodialysis (HD) patients is preventable by increasing dialysis session tolerance, either
by prolonging HD session length and/or by increasing HD frequency. Given its importance,
proper management of CFO is increasingly recognized as a marker of optimal HD. It is
vital that we develop a structured strategy for the prevention and management of CFO. 

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Chronic Fluid Overload in Hemodialysis (pp. 91-104)