Non-invasive intravascular monitoring in the pediatric hemodialysis population

Assessment of dry weight in pediatric hemodialysis (HD) patients is difficu lt, since small fluid shifts may result in dialysis-associated morbidity (D AM) and children may not verbalize complaints. Achieving dry weight is crit ical since chronic fluid overload can result in hypertension and left ventr icular hypertrophy. To determine if non-invasive monitoring of hematocrit ( NIVM) is useful in preventing DAM in pediatric HD patients, we reviewed 200 HD treatments performed with or without NIVM (no NIVM). DAM was defined as an "event" (e.g., hypotension, headache, cramping) that required nursing i ntervention. Patient age, weight, and gender were similar in both groups. D esired ultrafiltration was obtained in both groups. The event rate was lowe r in NIVM than no NIVM for all treatments (0.22 vs. 0.3, P=0.07) and signif icantly lower in patients <35 kg (0.25 vs. 0.47, P=0.01). The second event rate (fraction of treatments with one event that had a subsequent event occ urring at least 15 min later) was lower with NIVM (P<0.01). For the NIVM gr oup, events in the first 90 min occurred when blood volume changed >8% per hour; 71% of events (43/60) at 90-240 min occurred when blood volume change d >4% per hour. NIVM decreases DAM in pediatric HD patients, especially tho se <35 kg. Ultrafiltration with blood volume change <8% per hour is safe in the 1st h and <4% after 1 h reduces DAM in children.