Caner KABASAKAL1

Abstract: Hypervolemia is supposed to be the principal factor in hypertension in chronic hemodialysis adults. In this study, the role of intensive ultrafiltration (UF) treatment to reduce hypertension due to hypervolemia in hemodialysis children was investigated. The inferior vena cava (IVC) was also evaluated as an index of UF therapy. Twenty-three hemodialysis children with the mean age 10.6±3.1 years were classified due to their blood pressure status. IVC measurements were performed with 2-D echocardiography and inferior vena cava index (IVCI) was calculated as diameter of inferior vena cava (mm) / body surface area (m2). UF therapy was applied to each hypervolemic patient for four successive days and all of the patients were followed up for 4 weeks. Plasma levels of atrial natriuretic peptide (RIA), noradrenalin (high performance liquid chromotography) and plasma renin activity (RIA) of three patients having persistent hypertension were investigated. IVCI and plasma atrial natriuretic peptide levels of 12 healthy children were studied as a control group. At the begining of the study, 11 patients had hypertension and 14 patients had high IVCI. 14 hypervolemic children had UF therapy. Eleven patients responded to UF therapy and had normal blood pressures. After 4 weeks of follow up period 12, patients were again found to have hypertension. Following UF, hypertension was persisted in 3 of them. Since IVCI and ANP levels of these three patients were high, hypervolemia or some other factors was thought to be responsible for hypertension. Volume overload was found to be the most important factor in the pathogenesis of HT in hemodialysis children. UF was effective in reducing hypertension. IVCI might be a reliable parameter to control ultrafiltration therapy in the management of hypervolemic hemodialysis children