| Budget Amount *help |
¥3,300,000 (Direct Cost: ¥3,300,000)
Fiscal Year 2002: ¥600,000 (Direct Cost: ¥600,000)
Fiscal Year 2001: ¥500,000 (Direct Cost: ¥500,000)
Fiscal Year 2000: ¥2,200,000 (Direct Cost: ¥2,200,000)
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| Research Abstract |
Clinicians who manage maintenance hemodialysis patients are always suffered from the setting the dry weight. As for setting the dry weight, the cardiac size is the most useful index, however, other index such as human atrial natriuretic peptide, left atrial dimension, the diameter of inferior vena cava can be useful. The aim of this study is to make the flow chart to decide the dry weight.
As for setting dry weight, we should know the hemodynamic changes during hemodialysis. We have examined the changes of circulating blood volume by monitoring hematocrit continuously by CLIT-LINE. As a result, in constant water removal, blood volume decreased linearly, at a rate of 3% of blood volume per 1% body weight water removal. However, in cases with hyponatremia and/or hypoproteinemia, the blood volume decreased markedly in the first 30 min. Moreover, the equipment of CLIT-LINE is expensive, therefore we utilized the protein concentration to know the circulating plasma volume. We nominate the new index of PWI (Plasma-water index) which is defined the ratio of the change in circulating plasma volume (%ΔCPV) by water removal (%ΔBW).
I) PWI<2.0 1) stable blood pressure : down of dry weight,
2) blood pressure decrease : find another reason to cause hemodialysis induced hypotention.
II) PWI 2.0-4.0 1) stable blood pressure : good dry weight,
2) blood pressure decrease : find another reason to cause hemodialysis induced hypotention.
III) PWI>4.0 1) dry weight should be up.
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