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Symonides B, Lewandowski J, Małyszko J. Resistant hypertension in dialysis. Nephrol Dial Transplant 2023; 38:1952-1959. [PMID: 36898677 DOI: 10.1093/ndt/gfad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Indexed: 03/12/2023] Open
Abstract
Hypertension is the most common finding in chronic kidney disease patients, with prevalence ranging from 60% to 90% depending on the stage and etiology of the disease. It is also a significant independent risk factor for cardiovascular disease, progression to end-stage kidney disease and mortality. According to the current guidelines, resistant hypertension is defined in the general population as uncontrolled blood pressure on three or more antihypertensive drugs in adequate doses or when patients are on four or more antihypertensive drug categories irrespective of the blood pressure control, providing that antihypertensive treatment included diuretics. The currently established definitions of resistant hypertension are not directly applicable to the end-stage kidney disease setting. The diagnosis of true resistant hypertension requires confirmation of adherence to therapy and confirmation of uncontrolled blood pressure values by ambulatory blood pressure measurement or home blood pressure measurement. In addition, the term "apparent treatment-resistant hypertension," defined as an uncontrolled blood pressure on three or more antihypertensive medication classes, or use of four or more medications regardless of blood pressure level was introduced. In this comprehensive review we focused on the definitions of hypertension, and therapeutic targets in patients on renal replacement therapy, including the limitations and biases. We discussed the issue of pathophysiology and assessment of blood pressure in the dialyzed population, management of resistant hypertension as well as available data on prevalence of apparent treatment-resistant hypertension in end-stage kidney disease. To conclude, larger sample-size and even higher quality studies about drug adherence should be conducted in the population of patients with the end-stage kidney disease who are on dialysis. It also should be determined how and when blood pressure should be measured in the group of dialysis patients. Additionally, it should be stated what the target blood pressure values in this group of patients really are. The definition of resistant hypertension in this group should be revisited, and its relationship to both subclinical and clinical endpoints should be established.
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Affiliation(s)
- Bartosz Symonides
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Lewandowski
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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Tang W, Xue T, Lu XH, Luo YJ, Wang T. Factors Contributing to Formation of Edema in Volume Overloaded Continuous Ambulatory Peritoneal Dialysis Patients. Perit Dial Int 2020; 31:160-7. [PMID: 21282372 DOI: 10.3747/pdi.2010.00055] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BackgroundVolume control is critical for the success of peritoneal dialysis (PD) but dry weight in PD has been difficult to obtain. Edema free is, in general, accepted clinically as a target for volume control in PD patients. However, PD patients can be free of edema despite significant volume overload. The present study investigates the possible factors that influence the formation of pitting edema in volume-overloaded PD patients.MethodsIn this cross-sectional study, patients’ fluid status was evaluated by multifrequency bioelectrical impedance spectroscopy analysis. Values for overhydration were obtained. Patients with overhydration ≥ 2.0 kg were considered volume overloaded and were eligible for inclusion. From 1 March 2009 to 1 December 2009, a total of 96 patients on continuous ambulatory PD were included. Endothelial function was evaluated by flow-mediated dilatation (FMD). Other clinical indicators, such as blood pressure, dialysis adequacy, nutrition status, and biochemical parameters, were recorded. Patients were divided into 2 groups based on edema status: the edema group ( n = 35 volume-overloaded patients with bilateral pitting edema) and the non-edema group ( n = 61 volume-overloaded patients without bilateral pitting edema).ResultsOverhydration in the edema group was significantly higher than in the non-edema group (4.28 ± 1.75 kg vs 3.12 ± 0.81 kg, p < 0.001), whereas both FMD and serum albumin in the edema group were significantly lower than in the non-edema group (6.65% ± 5.2% vs 10.3% ± 5.1%, p = 0.001; 37.6 ± 4.2 g/L vs 39.3 ± 3.5 g/L, p = 0.047, respectively). Edema status (edema = 1, non-edema = 0) was positively correlated with overhydration ( r = 0.341, p < 0.001), gender (male = 1, female = 2: r = 0.184, p = 0.072), and total fluid removal ( r = 0.188, p = 0.074) and negatively correlated with endothelial function, as assessed by FMD ( r = -0.33, p = 0.001), and serum albumin ( r = -0.18, p = 0.055). Logistic regression analysis showed that FMD [odds ratio (OR) 0.90, 95% confidence interval (CI) 0.81 - 0.99; p = 0.036], gender (male = 1, female = 2: OR 4.06, 95% CI 1.23 - 13.35; p = 0.021), overhydration (OR 3.06, 95% CI 1.53 - 6.13; p = 0.002), and serum albumin (OR 0.86, 95% CI 0.75 - 0.99; p = 0.035) were independent factors affecting the edema status of the study population.ConclusionOur study showed that endothelial function (assessed by FMD), gender, serum albumin, and over hydration are independent determinants of edema status in PD patients. This may explain why some PD patients can maintain free of edema despite significant volume overload.
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Affiliation(s)
- Wen Tang
- Division of Nephrology, Peking University Third Hospital, Beijing
| | - Tian Xue
- Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xin-Hong Lu
- Division of Nephrology, Peking University Third Hospital, Beijing
| | - Ya-Jun Luo
- Division of Nephrology, Peking University Third Hospital, Beijing
| | - Tao Wang
- Division of Nephrology, Peking University Third Hospital, Beijing
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Zhu F, Kaysen GA, Sarkar S, Finkelstein FO, Carter M, Levin NW, Hoenich NA. Evaluation of one year of frequent dialysis on fluid load and body composition using calf bioimpedance technique. Physiol Meas 2019; 40:055004. [PMID: 31035269 DOI: 10.1088/1361-6579/ab1d8f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The primary aim of this study was to evaluate the effect of increased frequency of dialysis (FHD) on change in fluid status and body composition using segmental bioimpedance. APPROACH Twelve stable HD patients were switched from 3 times/week to 6 times/week HD (FHD). Systolic blood pressure (SBP), body mass and body mass index (BMI) were measured pre- and post-HD. Calf resistance (R 5) at 5 kHz was measured using a multifrequency bioimpedance device (Hydra 4200). Calf resistivity (ρ = R 5 * area/length), normalized resistivity (CNR = ρ/BMI) and calf extracellular volume (cECV) were calculated. Fat mass was measured by Futrex body composition analyzers (Futrex 6100, Futrex Tech, Inc.). All measurements were performed at baseline (BL) and monthly for up to one year. MAIN RESULTS Nine patients completed one year of FHD. Compared to BL, body weight and cECV decreased, and CNR increased significantly by the first month but did not change thereafter. SBP pre-HD decreased significantly by the end of the first month with further reduction until month 12. Additionally, antihypertensive medication decreased significantly from baseline by month 4 and remained stable from month 6 throughout the rest of the study. The post-HD CNR in five of nine patients reached the range of normal (>18.5 10-2 * Ohm * m3 kg-1 for males and >19.1 10-2 * Ohm * m3 kg-1 for females) after 1 year FHD. In patients who returned to 3 times/week dialysis, CNR decreased significantly in the first week, and this was associated with increases in body weight and SBP. SIGNIFICANCE Reduction of fluid overload with no alteration of body composition was observed in this study. Accordingly, improving fluid status was confirmed by reducing BP and use of antihypertensive drugs together with increase in CNR. Measurement of fluid status by CNR in hemodialysis patients is a new method to quantitatively assess hydration potentially creating a target for volume of fluid removal.
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Affiliation(s)
- Fansan Zhu
- Renal Research Institute, 315 East 62nd Street, New York, NY 10065, United States of America. Author to whom any correspondence should be addressed
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Casagrande G, Teatini U, Romei Longhena G, Miglietta F, Fumero R, Costantino ML. A New Method to Evaluate Patient Characteristic Response to Ultrafiltration during Hemodialysis. Int J Artif Organs 2018; 30:377-84. [PMID: 17551900 DOI: 10.1177/039139880703000504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Several factors are involved in the pathogenesis of dialysis discomfort interfering with optimal fluid removal and reducing the efficacy of the treatment; the most important one is a decrease in blood volume caused by an imbalance between ultrafiltration (UF) and plasma refilling (PR) rates. Objectives. This study is aimed at devising a method to tailor the dialysis therapy to each individual patient, by analyzing the relationship between PR and UF during the sessions in stable patients and widening the knowledge of fluid exchanges during the treatment. Methods. Thirty stable patients undergoing maintenance hemodialysis were enrolled. Three dialysis sessions were monitored for each patient; systemic pressure, blood composition, blood volume % variation, weight loss and conductivity were recorded repeatedly. A Plasma Refilling Index (PRI), defined and calculated by means of parameters measured throughout the dialysis, was introduced as a novel instrument to study plasma refilling phenomena. Results. The PRI provides understanding of patient response (in terms of plasma refilling) to the set UF. In the monitored sessions, the PRI trend is found to be characteristic of each patient; a PRI course that is at variance with the characteristic trend is a signal of inadequate or unusual dialysis scheduling. Moreover, statistical analysis highlights two different PRI trends during the first hour and during the rest of the treatment, suggesting the presence of different treatment phases. Conclusion. The main advantage of the PRI index is that it is non-invasive peculiar to each patient and easy to compute in a dialysis routine based on online data recorded by the monitor. A deviation from the characteristic trend may be a warning for the clinician. The analysis of the PRI trend also suggests how to modulate UF as a function of interstitial to intravascular fluid removal balance during dialysis.
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Affiliation(s)
- G Casagrande
- Laboratory of Biological Structure Mechanics (LaBS), Department of Structural Engineering, Politecnico di Milano, Milan, Italy.
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Comparison of multiple fluid status assessment methods in patients on chronic hemodialysis. Int Urol Nephrol 2016; 49:525-532. [PMID: 27943170 DOI: 10.1007/s11255-016-1473-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 11/29/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE Control of hydration status is an important constituent of adequate and efficient hemodialysis (HD) treatment. Nevertheless, there are no precise clinical indices for early recognition of small changes in fluid status of patients undergoing chronic hemodialysis therapy. This study aimed to evaluate and compare the widely used and reliable method of indexed inferior vena cava diameter (IVCDi) with established and more recently available techniques (bioelectrical impedance analysis [BIA], continuous blood volume monitoring [Crit-line], and the B-line score [BLS] with lung ultrasonography) for estimating the hydration status of patients on HD. METHODS Fifty-three patients undergoing chronic HD thrice weekly were included in the study. Evaluation of hydration status methods (IVCDi, BLS, BIA, and Crit-line) was performed thrice weekly before and after HD. Receiver operating characteristic curve analysis was performed to evaluate the discriminative power of (methods) the BLS, BIA, and Crit-line for predicting over- and underhydration of patients, as determined by the reference method, IVCDi. RESULTS BLS showed the most promising results in predicting overhydration, as determined by IVCDi, compared with BIA and Crit-line and presented a sensitivity of 77% and specificity of 74%. The accuracy of the BLS was higher than that of BIA (0.81 vs. 0.71, p = 0.032) and Crit-line (0.61, p = 0.001). BLS also showed more promising results in predicting underhydration, as determined by IVCDi, than BIA and Crit-line and presented a sensitivity of 78% and a specificity of 73%. The accuracy of the BLS was higher than that of BIA (0.83 vs. 0.76, p = 0.035) and Crit-line (0.50, p < 0.001). CONCLUSIONS The BLS is a useful and easily performed technique that has recently become available for accurate evaluation of dry weight and fluid status in patients with end-stage renal disease undergoing chronic HD. This method might help recognize asymptomatic lung congestion in these patients.
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Albayrak Cosar A, Cinar Pakyuz S. Scale development study: The Fluid Control in Hemodialysis Patients. Jpn J Nurs Sci 2015; 13:174-82. [PMID: 26009806 DOI: 10.1111/jjns.12083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/23/2015] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to develop a valid and reliable measurement instrument to identify knowledge, behaviors, and attitudes of hemodialysis (HD) patients about fluid control as these patients are inadequate in ensuring and sustaining fluid control. METHODS The sample of this methodological study consisted of 276 HD patients who are being treated in two public and two private hemodialysis centers. The validity of the scale was assessed through content validity, construct validity, and similar scale validity, and its reliability through item analysis, internal consistency coefficient and test-retest. For the content validity of the scale, expert views were assessed, and opinions of a Turkish language specialist were obtained. RESULTS According to the exploratory factor analysis, the scale had 24 items and three subdimensions, namely, knowledge, behavior, and attitude. The total variance explained was found to be 51.15%. Cronbach's alpha reliability coefficient of the Fluid Control in Hemodialysis Patients Scale (FCHPS) turned out to be 0.88 and Cronbach's alpha for its subdimensions were 0.92, 0.80, and 0.67, respectively. The correlation value between test and retest was 0.94 (P < 0.001). A moderate significant correlation (r = 0.58, P < 0.001) was found between the scale scores and the scores of the Dialysis Diet and Fluid Restrictions Non-adherence Questionnaire. CONCLUSION The FCHPS that was developed has good validity and reliability. This scale can be used to measure knowledge, behavior, and attitude of hemodialysis patients about fluid restriction.
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Affiliation(s)
| | - Sezgi Cinar Pakyuz
- Department of Internal Medicine, Celal Bayar University School of Sciences Nursing, Manisa, Turkey
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Zhu F, Levin NW. Estimation of Body Composition and Normal Fluid Status Using a Calf Bioimpedance Technique. Blood Purif 2015; 39:25-31. [DOI: 10.1159/000368937] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aims of this study in hemodialysis (HD) patients were: 1. To evaluate the relationship of calf bioimpedance with total body composition and fluid status as measured by gold standard methods. 2. To investigate the ability of calf normalized resistivity (CNR) to predict the normal fluid status (dry weight: DW) in a prospective study. In the body composition study (n = 41), fluid status (ECVBr/FFMMRI), muscle mass (MMMRI), and total adipose tissue (TATMRI) were measured by dilution (D2O and Br) and MRI methods three hours prior to HD treatment. Calf extracellular and intracellular resistance, resistivity, and CNR were measured with a multi-frequency bioimpedance device (Hydra 4200). In the fluid status study (n = 32 with 429 measurements), a nonlinear model based on the differences in CNR between patients and healthy subjects was established to predict DWcBIS previously determined by a separate continuous calf bioimpedance spectroscopy (cBIS) method. CNR significantly correlated with a gold standard hydration marker (ECVBr/FFMMRI). Calf body composition models were highly correlated with MMMRI (R2 = 0.85) and TATMRI (R2 = 0.85). DWcBIS prediction was validated with a CNR model in the degree of differences of 0.94 ± 0.18, 0.39 ± 0.7 and -0.02 ± 0.8 kg from DWcBIS when post HD fluid overload was 1.8 ± 1.2, 1.15 ± 0.8 and 0.54 ± 0.5 kg, respectively. These differences are not considered to be clinically significant. Conclusion: This practical method of calf bioimpedance is useful to predict body composition and normal fluid status in dialysis patients.
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Probing the dry weight by bioimpedance: the resistance stabilization test. J Nephrol 2014; 28:517-20. [PMID: 25480486 DOI: 10.1007/s40620-014-0159-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
Probing dry weight (DW) was largely dependent on clinical subjective estimate until recently. New bedside non-invasive tools have been developed with the aim of providing more objective information on volume status and guiding physicians in the quest for DW. Among them, bioimpedance appears to be very promising in the achievement of this goal. We have developed a test aimed to assess DW in complicated hemodialysis (HD) patients and named it "RE.sistance S.tabilization T.est" (RE.S.T.). It is based on the following four items: 1. one or more HD sessions lasting 6 h with ultrafiltration (UF) rate ≤0.5 kg/h are planned; 2. bioimpedance measurements are determined injecting 800 μA at 50 kHz alternating sinusoidal current with a standard tetrapolar technique. Resistance (R) is recorded at the start of the treatment (R0) and every 15 min (Rt) during HD until the end of the 6-h session; 3. DW is defined as that achieved at the time point at which three consecutive R0/Rt ratios show in-between changes ±1% despite ongoing UF; 4. if at the end of the 6-h HD session R stabilization is not attained, a new 6-h HD treatment with UF rate ≤0.5 kg/h is planned until a bioimpedance DW (according to the item 3) is obtained. As said, we are applying RE.S.T. to assess DW in complicated HD patients. Here we report a paradigmatic case which illustrates quite brilliantly its clinical usefulness. The patient was admitted to our nephrology ward with a hypertensive crisis, a very large drug regimen notwithstanding. His DW was reduced by 5 kg after four 6-h HD sessions probing his DW by means of RE.S.T. He was discharged with a normal blood pressure and no need for anti-hypertensive drugs. In conclusion, RE.S.T. appears to be a (the) brilliant solution in solving the old problem of DW in HD patients.
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Jian Y, Li X, Cheng X, Chen Y, Liu L, Tao Z, Zuo L. Comparison of bioimpedance and clinical methods for dry weight prediction in maintenance hemodialysis patients. Blood Purif 2014; 37:214-20. [PMID: 24902760 DOI: 10.1159/000362109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/04/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bioelectrical impedance analysis (BIA) is a promising technique to evaluate dry weight. We compared the dry weight calculated by the three BIA equations Carlo Basile (CB) , Yanna Dou (YD) and the body composition spectroscopy (BCS) with clinical evaluation in maintenance hemodialysis (MHD) patients. METHODS The dry weight of enrolled MHD patients (DWClin) was evaluated under strict clinical surveillance. The whole-body resistances at 50 kHz, intra- and extracellular resistances were measured to calculate the dry weight (DWCB, DWYD and DWBCS) using each of the three equations. RESULTS Neither DWCB nor DWBCS were statistically different compared to DWClin (DWCB 63.2 ± 17.2 vs. 63.1 ± 16.1 kg; DWBCS 62.8 ± 16.8 vs. 63.1 ± 16.1 kg, p > 0.05). DWYD was significantly lower than DWClin (DWYD 62.0 ± 16.1 vs. 63.1 ± 16.1 kg, p < 0.05). The bias between DWCB and DWClin was the smallest among these three methods (ΔDWCB -0.1 ± 1.4 kg; ΔDWYD 1.1 ± 2.9 kg; ΔDWBCS 0.3 ± 1.8 kg). CONCLUSION The CB equations have better consistency with clinical dry weight in MHD patients.
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Affiliation(s)
- Yusu Jian
- Institute of Nephrology, Peking University First Hospital, Beijing, PR China
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Formulation of a dry weight bioimpedance index in hemodialysis patients. Int J Artif Organs 2012; 34:1075-84. [PMID: 22183521 DOI: 10.5301/ijao.5000017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2011] [Indexed: 11/20/2022]
Abstract
Hydration status has a major impact on hemodialysis (HD) patients. Overhydration is related to hypertension, pulmonary and peripheral edema, and other cardiovascular events; while dehydration is related to hypotension, and other severe ischemic symptoms. All result in increased morbidity and mortality. Bioimpedance has been newly developed to measure the amount of water in the body. Several predictive equations were used, taken from demographic and anthropometric data. The purpose of this study was to evaluate the body composition of HD patients and to propose a hydration index. We performed bioimpedance measures with the Tanita TBF-300 scale, which calculates Total Body Water (TBW). The tool was reliable, with good reproducibility. However, we found significant differences between weight variations (dW) and TBW variations (dTBW) during HD sessions. This paper proposes a hydration index (I=dW-dTBW), with the hypothesis that dry weight is reached when I=0, while I>0 or I<0 indicate overhydrated or dehydrated, respectively. In this study, the changes in the index corresponded to the variations in weight and hydration state. We conclude that impedancemetry is a currently available technique that can be used to estimate TBW in HD patients. Although the index has to be improved by complementary studies, it may be a good guide to assess the dry weight achieved.
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Palmer BF, Henrich WL. Recent advances in the prevention and management of intradialytic hypotension. J Am Soc Nephrol 2008; 19:8-11. [PMID: 18178796 DOI: 10.1681/asn.2007091006] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Intradialytic hypotension continues to play a significant role in the morbidity and in some cases the mortality associated with maintenance hemodialysis. Greater precision in the determination of dry weight using bioimpedance technology and biofeedback systems designed to prevent rapid fluctuations in blood volume have recently been shown to decrease the frequency of this complication. Pharmacologic strategies designed to maintain peripheral vascular resistance in patients with insufficient release of endogenous vasoconstrictors continue to be explored. The sudden development of intradialytic hypotension may respond to specific antagonists to hypotensive mediators.
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Affiliation(s)
- Biff F Palmer
- Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Basile C, Vernaglione L, Di Iorio B, Bellizzi V, Chimienti D, Lomonte C, Rubino A, D'Ambrosio N. Development and Validation of Bioimpedance Analysis Prediction Equations for Dry Weight in Hemodialysis Patients. Clin J Am Soc Nephrol 2007; 2:675-80. [PMID: 17699481 DOI: 10.2215/cjn.00240107] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Accurate assessment of hydration status and specification of dry weight (DW) are major problems in the clinical treatment of hemodialysis (HD) patients. Bioelectrical impedance analysis (BIA) has been recognized as a noninvasive and simple technique for the determination of DW in HD patients. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS This study was designed to develop and validate BIA prediction equations for DW in HD patients. It included white adults (1540 disease-free adults with normal body mass index [BMI] and 456 prevalent and 27 incident HD patients). All participants underwent at least one single-frequency BIA measurement (800 muA and 50 kHz alternating sinusoidal current with a standard tetrapolar technique). The BIA variable measured was resistance (R). Data of 1463 (95% of the cohort) disease-free individuals with normal BMI (prediction sample) were used to establish best-fitting BIA prediction equations of body weight. The latter were cross-validated in the residual 5% subset (77 individuals) of the same cohort (validation sample). RESULTS Multiple regression analysis showed a significant relationship among body weight, R, age, and height in 739 men (R(2) = 0.82, P < 0.0001) and among body weight, R, and height in 724 women (R(2) = 0.68, P < 0.0001) in the prediction sample. The Bland Altman analysis showed a mean difference between predicted and measured body weight of 0.3 +/- 1.0 kg (95% confidence interval +/- 2.0 kg) in the validation sample. The BIA prediction equations that were obtained in disease-free individuals with normal BMI were applied to a cohort of 456 prevalent HD patients: The mean difference between achieved and estimated DW was 0.1 +/- 1.0 kg (P = 0.53) in men and -0.3 +/- 1.0 (P = 0.76) in women. Finally, BIA prediction equations were tested in a cohort of 27 incident HD patients. The mean difference between predicted and achieved DW was -0.6 +/- 1.0 kg (P = 0.76) in men and 0.6 +/- 1.0 (P = 0.50) in women. CONCLUSIONS This study was able to develop and validate BIA prediction equations for DW in HD patients. They seem to be a promising tool; however, they still need external validation.
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Affiliation(s)
- Carlo Basile
- Nephrology and Dialysis Units, Miulli General Hospital, Italy.
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Charra B, Chazot C. Analyse critique des méthodes de mesures du volume extra-cellulaire en dialyse. Nephrol Ther 2007; 3 Suppl 2:S112-20. [DOI: 10.1016/s1769-7255(07)80018-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kuhn C, Kuhn A, Rykow K, Osten B. Extravascular lung water index: A new method to determine dry weight in chronic hemodialysis patients. Hemodial Int 2006; 10:68-72. [PMID: 16441830 DOI: 10.1111/j.1542-4758.2006.01177.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To assess the dry weight of chronic hemodialysis (HD) patients, the extravascular lung water index (ELWI) as a volume parameter was investigated to identify fluid overload. Forty-two patients (30 males, 12 females) with a mean age of 55.7+/-13.0 years who were clinically not overhydrated were connected to the PiCCO system before starting HD treatment. We determined ELWI (normal range 3-7 mL/kg) and the following parameters: global end-diastolic volume index (GEDI, normal range 680-800 mL/m(2)) and intrathoracic blood volume index (ITBI, normal range 850-1000 mL/m(2)) before and after HD to assess the volume status. Brain natriuretic peptide (BNP), aldosterone, and renin as vasoactive hormones were measured at the beginning and at the end of HD treatment as well. In 28 of the 42 patients (67%), elevated values of ELWI were found, indicating interstitial volume overload. There were significant correlations between ELWI and cardiac function index (p=0.003; Pearson's coefficient -0.451), global ejection fraction (p=0.012; Pearson's coefficient -0.389), ITBI (p=0.004; Pearson's coefficient 0.437), and GEDI (p=0.004; Pearson's coefficient 0.437). No significant relations among ELWI and mean arterial pressure (MAP), BNP, aldosterone, and renin were found. In conclusion, the use of ELWI is safe in chronic HD patients and identifies fluid-overloaded patients, who show no obvious signs of hypervolemia. The determination of ELWI is an excellent method to quantify the exact volume in chronic HD patients.
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Affiliation(s)
- Christian Kuhn
- Department of Internal Medicine II, University of Halle-Wittenberg, Halle, Germany.
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Ishibe S, Peixoto AJ. Methods of assessment of volume status and intercompartmental fluid shifts in hemodialysis patients: implications in clinical practice. Semin Dial 2004; 17:37-43. [PMID: 14717810 DOI: 10.1111/j.1525-139x.2004.17112.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Determining dry weight and assessing extracellular fluid volume in hemodialysis (HD) patients is one of the greatest challenges to practicing nephrologists. The clinical examination has limited accuracy, so different strategies have been investigated to aid in this evaluation. Biochemical markers of volume overload (ANP, BNP, cGMP) are fraught with excessive variability and poor correlation with volume status. Inferior vena cava ultrasound is effective, but cumbersome and costly. Bioimpedance measurements of intra- and extracellular water have significant shortcomings when used as isolated measurements, but can be useful in following trends over time and have been shown to improve intradialytic symptoms and blood pressure control. Continuous blood volume monitoring is helpful in preventing intradialytic hypotension and may help identify patients who are volume overloaded and need increased ultrafiltration. In this review we discuss these different techniques and other developments in the evaluation of dry weight and volume status, which may enhance our ability to improve patient stability and well-being during HD sessions.
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Affiliation(s)
- Shuta Ishibe
- Section of Nephrology, Yale University School of Medicine, New Haven, USA
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Dorhout Mees EJ. Searching for the stone of wisdom. Nephrol Dial Transplant 2003; 18:2679; author reply 2679-80. [PMID: 14605301 DOI: 10.1093/ndt/gfg424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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