1
|
Schoutteten MK, Lindeboom L, Brys A, Lanssens D, Smeets CJP, De Cannière H, De Moor B, Peeters J, Heylen L, Van Hoof C, Groenendaal W, Kooman JP, Vandervoort PM. Comparison of whole body versus thoracic bioimpedance in relation to ultrafiltration volume and systolic blood pressure during hemodialysis. J Appl Physiol (1985) 2023; 135:1330-1338. [PMID: 37767559 DOI: 10.1152/japplphysiol.00600.2022] [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: 10/10/2022] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 09/29/2023] Open
Abstract
In contrast to whole body bioimpedance, which estimates fluid status at a single point in time, thoracic bioimpedance applied by a wearable device could enable continuous measurements. However, clinical experience with thoracic bioimpedance in patients on dialysis is limited. To test the reproducibility of whole body and thoracic bioimpedance measurements and to compare their relationship with hemodynamic changes during hemodialysis, these parameters were measured pre- and end-dialysis in 54 patients during two sessions. The resistance from both bioimpedance techniques was moderately reproducible between two dialysis sessions (intraclass correlations of pre- to end-dialysis whole body and thoracic resistance between session 1 and 2 were 0.711 [0.58-0.8] and 0.723 [0.6-0.81], respectively). There was a very high to high correlation between changes in ultrafiltration volume and changes in whole body thoracic resistance. Changes in systolic blood pressure negatively correlated to both bioimpedance techniques. Although the relationship between changes in ultrafiltration volume and changes in resistance was stronger for whole body bioimpedance, the relationship with changes in blood pressure was at least comparable for thoracic measurements. These results suggest that thoracic bioimpedance, measured by a wearable device, may serve as an interesting alternative to whole body measurements for continuous hemodynamic monitoring during hemodialysis.NEW & NOTEWORTHY We examined the role of whole body and thoracic bioimpedance in hemodynamic changes during hemodialysis. Whole body and thoracic bioimpedance signals were strongly related to ultrafiltration volume and moderately, negatively, to changes in blood pressure. This work supports the further development of a wearable device measuring thoracic bioimpedance longitudinally in patients on hemodialysis. As such, it may serve as an innovative tool for continuous hemodynamic monitoring during hemodialysis in hospital or in a home-based setting.
Collapse
Affiliation(s)
- Melanie K Schoutteten
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Health Research, imec the Netherlands, Eindhoven, The Netherlands
| | - Lucas Lindeboom
- Department of Health Research, imec the Netherlands, Eindhoven, The Netherlands
| | - Astrid Brys
- Division of Geriatrics, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dorien Lanssens
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Christophe J P Smeets
- Department of Future Health, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Health Research, imec the Netherlands, Eindhoven, The Netherlands
| | - Hélène De Cannière
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Bart De Moor
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Nephrology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Jacques Peeters
- Department of Nephrology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Line Heylen
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Nephrology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Chris Van Hoof
- Imec Belgium, Leuven, Belgium
- Department of Electrical Engineering, Elektronische Circuits en Systemen, Katholieke Universiteit Leuven-ESAT, Leuven, Belgium
| | | | - Jeroen P Kooman
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Pieter M Vandervoort
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Health Research, imec the Netherlands, Eindhoven, The Netherlands
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium
| |
Collapse
|
2
|
Haroon S, Tan JN, Lau T, Chan SY, Davenport A. Segmental bioimpedance in pregnant end stage renal failure patient for dry weight titration and volume management (case report). BMC Nephrol 2023; 24:308. [PMID: 37875806 PMCID: PMC10598990 DOI: 10.1186/s12882-023-03360-6] [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: 06/29/2023] [Accepted: 10/04/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Volume assessment, dry weight titration, and blood pressure control in pregnant kidney failure patients are often challenging, with physiological fluid accumulation in the trunk and lower limbs and an increased risk of preeclampsia. We used segmental bioimpedance in the volume management of our kidney failure patient on haemodialysis. CASE PRESENTATION We report a case of a female patient on maintenance haemodiafiltration with no residual kidney function for whom we used segmental bioimpedance to guide dry weight adjustment. At different gestational periods, we targeted a different extracellular to total body water ratio according to body segments. This allowed us to support her high-risk pregnancy, identify her as probably developing preeclampsia and trigger a plan for closer monitoring and delivery during the third trimester when she had rapid weight gain. CONCLUSION Segmental bioimpedance is a practical, simple, and non-invasive test that can be performed at the dialysis unit and is useful as an adjunct decision-making tool in the management of pregnant dialysis patients.
Collapse
Affiliation(s)
- Sabrina Haroon
- Division of Nephrology, University Medicine Cluster, National University Hospital Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore, Republic of Singapore.
| | - Jia Neng Tan
- Division of Nephrology, University Medicine Cluster, National University Hospital Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore, Republic of Singapore
| | - Titus Lau
- Division of Nephrology, University Medicine Cluster, National University Hospital Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore, Republic of Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynecology, School of Medicine, National University Hospital and Yong Loo Lin, National University of Singapore, Singapore, Republic of Singapore
| | - Andrew Davenport
- Department of Renal Medicine, University College London, Royal Free Hospital, London, UK
| |
Collapse
|
3
|
Davenport A. Why is Intradialytic Hypotension the Commonest Complication of Outpatient Dialysis Treatments? Kidney Int Rep 2023; 8:405-418. [PMID: 36938081 PMCID: PMC10014354 DOI: 10.1016/j.ekir.2022.10.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
Intradialytic hypotension (IDH) is the most frequent complication of hemodialysis (HD) treatments with a frequency of 10% to 12% for patients with chronic kidney disease attending for outpatient treatments and is associated with both temporary ischemic stress to vital organs, including the heart and brain, and increased patient mortality. Although there have been many different definitions of IDH over the years, an absolute nadir systolic blood pressure (SBP) has the strongest association with patient outcomes. The unifying pathophysiology is one of reduced effective blood volume, resulting in lower plasma tonicity, and if this cannot be adequately compensated for by activation of neurohumeral systems, then arteriolar tone and blood pressure fall. The risk factors for developing IDH are numerous, ranging from patient-related factors, including age and comorbidity with reduced cardiac reserve, to patient compliance with dietary and lifestyle advice, to reactions with the extracorporeal circuit and medications, choice of dialysate composition and temperature, setting of postdialysis target weight, ultrafiltration rate, and profiling. Advances in dialysis machine technology by providing real time estimates of the effective circulating volume and adjusting dialysate composition to maintain vascular tonicity are being developed, but currently require more sophisticated biofeedback loops to be clinically effective in preventing IDH. While awaiting advances in artificial intelligence, the clinician continues to rely on patient education to limit interdialytic weight gains, frequent assessment of the postdialysis target weight, adjusting dialysate composition and temperature, introducing convective therapies to increase thermal losses, and altering dialysis session duration and frequency to reduce ultrafiltration rate requirements.
Collapse
Affiliation(s)
- Andrew Davenport
- Department of Renal Medicine, Royal Free Hospital, Faculty of Medical Sciences, University College London, London, UK
- Correspondence: Andrew Davenport, UCL Department of Nephrology, Royal Free Hospital, University College London, Rowland Hill Street, London NW3 2PF, UK.
| |
Collapse
|