THE CLINICAL IMPORTANCE OF HYPERVOLEMIA IN PATIENTS WITH END-STAGE RENAL FAILURE

Except for causing hypertension, hypervolemia as a separate risk factor has attracted little attention in patients with end-stage renal failure. We investigated the effect of volume reduction on several clinical and echocardiographical parameters in 14 patients. Ten were on hemodialysis, two on peritoneal dialysis and two on conservative treatment. Selection criteria were either cardiothoracic index>0.50 on chest x-ray, and/or hypertension unresponsive to a test dose of 25 mg of captopril which we consider a proof of "hypervolemia" even in the absence of clear cardiomegaly. 

During 12(8 day treatment period(ultrafiltration andlor diuretic) a striking weight loss was achieved in all pts(4.9(3.1 kg) while blood pressure normalised despite stopping all previously used antihypertensive drugs. Exercise capacity increased by 100%, while hematocrit and serum albumin level showed marked increases(%24± 2, % 28± 3; 3.4± 0.5 grldl, 3.9± 0.5 grldl). Echocardiography values for left atrium, left ventricle and vena cava diameters decreased in all pts, cardiothoracic index decreased also in those with previous values "within the normal range".

In conclusion, cardiomegaly and negative response to captopril in hypertension often indicate hypervolemia; even with normal blood pressure correction of hypervolemia can greatly benefit patients. Echocardio graphic assesment(increased left atrial volume) is very helpful in doubtful cases. Low hematocrit and albumin levels may not only indicate insufficient dialysis but also insufficient ultrafiltration.