**10. References**


**15** 

*2Gambro S.p.A.* 

*1Germany 2,3Italy* 

*Policlinico S. Orsola-Malpighi* 

**Blood Volume Regulation** 

*1Department Nephrology and Dialysis-PDA Rostock* 

*3Department of Nephrology, Dialysis and Hypertension* 

Roland E. Winkler1, Fabio Grandi2 and Antonio Santoro3

Cardiovascular death remains the most frequent cause of mortality of dialysis population. Among the risk factor of cardiovascular mortality low blood pressure has been investigated by several authors even though not all the author conclude that low blood pressure per se, not adjusted for concomitant factors like age, and the presence of diabetes can be seen as independent predictor of mortality (Tisler et al., 2003; Iseki et al., 1997; Port et al., 1999). In particular, the presence of low blood pressure and the intradialytic fall in the systolic and diastolic blood pressure seems to predict mortality in the dialysis population (Sohji et al., 2004). Some other authors found that not only low predialysis systolic blood pressure but also high values (J shape theory) expose patients at higher risk of mortality (Port et al, 1999). Nevertheless, the fall in systolic blood pressure seems to be to date the most common intradialytic complication accounting for up to 30 % of dialysis related symptoms, despite the several improvement of dialysis techniques in terms of biocompatibility of the material used, more convection and quality of dialysis fluid. But hypertension is indeed the most

Predialysis hypertension does not prevent hypotension episodes and not having targets for blood pressure control will not necessarily reduce its onset. When improved control of blood pressure is desired, modifications to the dialysis treatment itself should be considered

Hypo- as well hypertension are then the most challenging complications which dialysis has to face with. Several strategies are available to prevent hypo and hypertension like longer or more frequent dialysis regimen, diffusive-convective therapies, and assessment of dry body weight. Not all of them can be used in routine practice due to infrastructural or financial constraints while some others give in a certain extent opposite's effects like assessment of dry body weight beneficial for the hypertensive status, but which can lead to an increase of intradialytic symptoms (Davenport et al., 2008). Among the tools today available, the biofeedback systems, those devices able to adapt the operative condition of dialysis to the dynamic changes of the patients status along the dialysis, seems to be promising for contributing a step forward in the patients well-being (Locatelli et al., 2005) Among these devices the Hemocontrol Biofeedback System (HBS) has been extensively studied by several

frequent chronic co morbidity affecting dialysis patients.

as part of the management strategy (Davenport et al., 2008).

**1. Introduction** 

