**3.3 Avoidance of ECF volume depletion**

Observational data from NECOSAD Study suggest that episodes of volume depletion were an independent risk factor for the loss of RRF (Termorshuizen, Korevaar et al, 2003).1 In a study by Gunal et al (Gunal AI, Duman et al, 2001) strict volume control in 47 PD patients led to 6% decrease in left ventricular hypertrophy and 28% decrease in mean urine volume in the 19 patients with RRF. Subclinical hypovolemia, even in presence of normal blood pressure, can lead to a decrease in RRF as a result of overzealous ECF volume depletion. Diuretics have been shown to increase urine volume and sodium removal, but do not affect the solute clearance (Moist, Port et al, 2000; van Olden, Guchelaar et al, 2003), and can be used, where appropriate, to provide better control of volume balance. As mentioned above, the extended use of loop diuretics may help to prolong diuresis and preserve RRF. Correction of fluid volume excess by combining dietary salt restriction and gentle ultrafiltration is a simple and effective approach to control hypertension and to reverse LVH (Konings, Kooman et al, 2003).
