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Hussein U, Cimini M, Handelman GJ, Raimann JG, Liu L, Abbas SR, Kotanko P, Levin NW, Finkelstein FO, Zhu F. Identification of fluid overload in elderly CKD Patients using bioimpedance techniques. J Appl Physiol (1985) 2022; 133:205-213. [PMID: 35652832 DOI: 10.1152/japplphysiol.00645.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Diagnosis of fluid overload (FO) in early stage is essential to manage chronic kidney disease (CKD) patients' fluid balance and to prevent cardiovascular disease (CVD). However, identification of fluid status in CKD patient is largely dependent on physician's clinical acumen. The ratio of fluid overload to extracellular volume (FO/ECV) has been used as a reference to assess fluid status. The primary aim of this study was to compare FO/ECV with other bioimpedance methods and clinical assessment in CKD patients. Whole body ECV, intracellular volume (ICV), total body water (TBW) and calf normalized resistivity (CNR) were measured (Hydra 4200). Thresholds of FO utilizing CNR and ECV/TBW were derived by receiver operator characteristic (ROC) analysis based on data from pooled CKD patients and healthy subjects (HS). Clinical assessments of FO in CKD patients were performed by nephrologists . CKD (stage 3 and stage 4) patients (n=50) and HS (n=189) were studied. The thresholds of FO were ≤ 14.3 (10-2 Ωm3/kg) for females and ≤ 13.1 (10-2 Ωm3/kg) for males using CNR and ≥ 0.445 in females and ≥ 0.434 in males using ECV/TBW. FO was diagnosed in 78%, 62% and 52% of CKD patients by CNR, FO/ECV and ECV/TBW, respectively while only 24% of CKD patients were diagnosed to be FO by clinical assessment . The proportion of FO in non-dialysis CKD patients was largely underestimated by clinical assessment compared to FO/ECV, CNR and ECV/TBW. CNR, and FO/ECV methods were more sensitive than ECV/TBW in identifying fluid overload in these CKD patients.
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Affiliation(s)
- Usama Hussein
- Renal Research Institute, New Haven, New Haven, CT, United States
| | - Monica Cimini
- Renal Research Institute, New Haven, New Haven, CT, United States
| | - Garry J Handelman
- Renal Research Institute, New York, NY, United States.,University of Massachusetts, Lowell, MA, United States
| | | | - Li Liu
- Renal Research Institute, New York, NY, United States.,Renal Division, Peking University First Hospital, Beijing, China
| | - Samer R Abbas
- Renal Research Institute, New York, NY, United States
| | - Peter Kotanko
- Renal Research Institute, New York, NY, United States.,Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nathan W Levin
- Renal Research Institute, New York, NY, United States.,Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Fredric O Finkelstein
- Renal Research Institute, New Haven, New Haven, CT, United States.,Yale University, New Haven, CT, United States
| | - Fansan Zhu
- Renal Research Institute, New York, NY, United States
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Alexandrou ME, Balafa O, Sarafidis P. Assessment of Hydration Status in Peritoneal Dialysis Patients: Validity, Prognostic Value, Strengths, and Limitations of Available Techniques. Am J Nephrol 2020; 51:589-612. [PMID: 32721969 DOI: 10.1159/000509115] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The majority of patients undergoing peritoneal dialysis (PD) suffer from volume overload and this overhydration is associated with increased mortality. Thus, optimal assessment of volume status in PD is an issue of paramount importance. Patient symptoms and physical signs are often unreliable indexes of true hydration status. SUMMARY Over the past decades, a quest for a valid, reproducible, and easily applicable technique to assess hydration status is taking place. Among existing techniques, inferior vena cava diameter measurements with echocardiography and natriuretic peptides such as brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were not extensively examined in PD populations; while having certain advantages, their interpretation are complicated by the underlying cardiac status and are not widely available. Bioelectrical impedance analysis (BIA) techniques are the most studied tool assessing volume overload in PD. Volume overload assessed with BIA has been associated with technique failure and increased mortality in observational studies, but the results of randomized trials on the value of BIA-based strategies to improve volume-related outcomes are contradictory. Lung ultrasound (US) is a recent technique with the ability to identify volume excess in the critical lung area. Preliminary evidence in PD showed that B-lines from lung US correlate with echocardiographic parameters but not with BIA measurements. This review presents the methods currently used to assess fluid status in PD patients and discusses existing data on their validity, applicability, limitations, and associations with intermediate and hard outcomes in this population. Key Message: No method has proved its value as an intervening tool affecting cardiovascular events, technique, and overall survival in PD patients. As BIA and lung US estimate fluid overload in different compartments of the body, they can be complementary tools for volume status assessment.
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Affiliation(s)
- Maria-Eleni Alexandrou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Olga Balafa
- Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece,
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Montgomery LD, Montgomery RW, Gerth WA, Bodo M, Stewart JM, Loughry M. Segmental Intracellular, Interstitial, and Intravascular Volume Changes during Simulated Hemorrhage and Resuscitation: A Case Study. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2019; 10:40-46. [PMID: 33584881 PMCID: PMC7531216 DOI: 10.2478/joeb-2019-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Indexed: 06/12/2023]
Abstract
This paper describes a new combined impedance plethysmographic (IPG) and electrical bioimpedance spectroscopic (BIS) instrument and software that will allow noninvasive real-time measurement of segmental blood flow, intracellular, interstitial, and intravascular volume changes during various fluid management procedures. The impedance device can be operated either as a fixed frequency IPG for the quantification of segmental blood flow and hemodynamics or as a multi-frequency BIS for the recording of intracellular and extracellular resistances at 40 discrete input frequencies. The extracellular volume is then deconvoluted to obtain its intravascular and interstitial component volumes as functions of elapsed time. The purpose of this paper is to describe this instrumentation and to demonstrate the information that can be obtained by using it to monitor segmental compartment volume responses of a pig model during simulated hemorrhage and resuscitation. Such information may prove valuable in the diagnosis and management of rapid changes in the body fluid balance and various clinical treatments.
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Affiliation(s)
| | | | | | - Michael Bodo
- Walter Reed Army Institute of Research, Silver Spring, MD, USA Current position: Tulane University School of Medicine, New Orleans, LA, USA
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Abbas SR, Thijssen S, Penne EL, Raimann JG, Liu L, Sipahioglu MH, Seibert E, Wang Y, Chen Y, Xiao Q, Levin NW, Kotanko P, Zhu F. Effect of Change in Fluid Status Evaluated by Bioimpedance Techniques on Body Composition in Hemodialysis Patients. J Ren Nutr 2017; 28:183-190. [PMID: 29158062 DOI: 10.1053/j.jrn.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/01/2017] [Accepted: 09/15/2017] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This prospective study uses calf bioimpedance spectroscopy (cBIS) to guide the attainment of dry weight (DWcBIS) in chronic hemodialysis (HD) patients. The primary aim of this study was to evaluate whether body composition is altered when fluid status is reduced to DWcBIS. METHODS Target post-HD weight was gradually reduced from baseline (BL) until DWcBIS was achieved. DWcBIS was defined as the presence of both flattening of the curve of extracellular resistance and the attainment calf normalized resistivity in the normal range during the dialysis treatment. Extracellular volume (ECV), intracellular volume, and total body water (TBW) were measured using whole body BIS (Hydra 4200). Fluid overload, lean body mass, and fat mass were calculated according to a body composition model. RESULTS Seventy-three patients enrolled and 60 completed the study (55 ± 13 years, 49% male). Twenty-eight patients (25% diabetes) achieved DWcBIS, whereas 32 patients (47% diabetes) did not. Number of treatment measurements were 16 ± 10 and 12 ± 13 studies per patient in the DWcBIS and non-DWcBIS groups, respectively. Although significant decreases in body weight and ECV were observed, lean body mass and FM did not differ significantly in both groups from BL to the end of study. ECV, ECV/TBW, and fluid overload were higher in the non-DWcBIS than in the DWcBIS group both at BL and at the end of study. Ratios of intradialytic changes in calf normalized resistivity, ECV, and ECV/TBW to ultrafiltration volume were significantly lower in diabetic than in non-diabetic patients. CONCLUSIONS This study shows that decreasing fluid status by gradual reduction of post-HD weight in both DWcBIS and Non-DWcBIS groups did not affect body composition significantly over a period of about 4 weeks.
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Affiliation(s)
| | | | - Erik L Penne
- Research Group, Renal Research Institute, New York; Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Li Liu
- Research Group, Renal Research Institute, New York; Institute of Nephrology, Peking University First Hospital, Beijing, China
| | - Murat H Sipahioglu
- Research Group, Renal Research Institute, New York; Kayseri University Hospital, Kayseri, Turkey
| | - Eric Seibert
- Research Group, Renal Research Institute, New York; Internal Medicine II, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Yuqi Chen
- University of California, Santa Barbara
| | | | - Nathan W Levin
- Research Group, Renal Research Institute, New York; Icahn School of Medicine at Mount Sinai, New York
| | - Peter Kotanko
- Research Group, Renal Research Institute, New York; Icahn School of Medicine at Mount Sinai, New York
| | - Fansan Zhu
- Research Group, Renal Research Institute, New York.
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Hecking M, Rayner H, Wabel P. What are the Consequences of Volume Expansion in Chronic Dialysis Patients? Semin Dial 2015; 28:242-7. [DOI: 10.1111/sdi.12355] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Hugh Rayner
- Heart of England; NHS Foundation Trust; Birmingham United Kingdom
| | - Peter Wabel
- Fresenius Medical Care, Research and Development; Bad Homburg Germany
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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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Oei EL, Fan SL. Practical aspects of volume control in chronic kidney disease using whole body bioimpedance. Blood Purif 2015; 39:32-6. [PMID: 25660496 DOI: 10.1159/000368953] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fluid status is an independent predictor of mortality in dialysis patients. Current methods of fluid assessment have several limitations. SUMMARY An ideal method should be cheap, portable, easy to perform without extensive training, reproducible and determines patients' excess or deficit of total body water. Bioimpedance analysis (BIA) fulfils many of these criteria and can give additional information on fat and lean tissue composition. The accuracy and precision of BIA has been shown to be equivalent to the 'gold standard' direct estimation techniques. KEY MESSAGES Although there remains some concern about its validity in dialysis patients, fluid overload determined by BIA has been shown to predict mortality. BIA-guided fluid management appears superior to conventional fluid management in achieving clinically important outcomes such as reduction in blood pressure, left ventricular mass index, and arterial stiffness. Accurate setting of dry weight might also help preserve residual renal function by limiting episodes of dehydration. Nevertheless, as with all new technologies, there are issues that still need to be resolved. This will be achieved only with larger prospective interventional studies to explore its specific roles in dialysis cohorts.
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Affiliation(s)
- Elizabeth L Oei
- Department of Renal Medicine and Transplantation, Singapore General Hospital, Singapore, Singapore
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Bogónez-Franco P, Nescolarde L, McAdams E, Rosell-Ferrer J. Multifrequency right-side, localized and segmental BIA obtained with different bioimpedance analysers. Physiol Meas 2014; 36:85-106. [PMID: 25501588 DOI: 10.1088/0967-3334/36/1/85] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study is to compare two commercial bioimpedance analysers, BioparHom Z-Métrix and Impedimed SFB7, measuring the impedance of three different body segments. The segments measured were 'right-side' (or 'whole-body'), 'segmental right-lower limb' and 'localized longitudinal right-quadriceps'. The comparison was made on electrical models of each segment, including electrode-skin impedance, and in vivo on nine healthy volunteers. Both devices are designed to measure right-side impedances and, in the present study, as the length of the segment investigated decreased, the accuracy of the impedance measured was found to decrease. The accuracy of the devices was calculated via measurements performed on RC networks of known values. It was found that adding electrode-skin contact impedances in the electrical model affected the accuracy by both devices.
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Affiliation(s)
- P Bogónez-Franco
- INSA INL UMR 5270, Bat. Leonard de Vinci, 21 Avenue Jean Capelle, 69621 Villeurbanne Cedex, France
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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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Davies SJ, Davenport A. The role of bioimpedance and biomarkers in helping to aid clinical decision-making of volume assessments in dialysis patients. Kidney Int 2014; 86:489-96. [DOI: 10.1038/ki.2014.207] [Citation(s) in RCA: 198] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/21/2014] [Accepted: 04/17/2014] [Indexed: 11/09/2022]
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Hypervolemia for hypertension pathophysiology: a population-based study. BIOMED RESEARCH INTERNATIONAL 2014; 2014:895401. [PMID: 25177700 PMCID: PMC4142663 DOI: 10.1155/2014/895401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/26/2014] [Accepted: 06/30/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Hypertension and hypervolemia relationship was proven among renal disease, although it is not known in normal population. Present study determines the fluid distribution defects in relation to blood pressure. MATERIAL AND METHODS In a population-based survey in Turkey demographics, height, weight, blood pressure, urine analysis, and serum creatinine measurements were recorded. Bioimpedance measured with the Body Composition Monitor. RESULTS Total 2034 population of 71.6% male, mean age 47 ± 12.6 (18-89) years, systolic blood pressure (SBP) 134.7 ± 20, diastolic blood pressure 77.9 ± 11.6 mmHg. Body mass index (BMI) was 28.5 ± 4.5 (15.8-50.6) kg/m(2); overhydration was 0.05 ± 1.05 L. There was a correlation between extracellular water (ECW)/height and SBP (r = 0.21, P < 0.001). Receiver operating characteristic (ROC) curve with the performance of 0.60 (P < 0.001) that showed cut-off value of ECW/height was 10.06 L/m, with the 69% sensitivity and 45% specificity for SBP: 140 mmHg values. Risk factors for high SBP were increase of ECW/Height, age, BMI and presence of diabetes. ECW/height, SBP, and fat tissue index (FTI) increased in BMI categories (low, normal, and obese) and in diabetics. SBP and FTI were lower in smokers. CONCLUSIONS High blood pressure may be accompanied by increased extracellular volume indices. In the future volume status assessment could be of use in evaluating the effectiveness of pharmacological intervention in the treatment of hypertension.
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Kocyigit I, Sipahioglu MH, Orscelik O, Unal A, Celik A, Abbas SR, Zhu F, Tokgoz B, Dogan A, Oymak O, Kotanko P, Levin NW. The association between arterial stiffness and fluid status in peritoneal dialysis patients. Perit Dial Int 2014; 34:781-90. [PMID: 24385328 DOI: 10.3747/pdi.2013.00057] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES In this study our aim was to evaluate the relationship between degree of fluid status and arterial stiffness measured by pulse wave velocity (PWV) in peritoneal dialysis (PD) patients. Fluid status was determined by different methods including fluid overload measured by bioimpedance (Body Composition Monitor, BCM), calf normalized resistivity (CNR), plasma N-terminal fragment of B-type natriuretic peptide (NT-proBNP) and extracellular to intracellular water ratio (ECW/ICW). METHODS Sixty PD patients were evaluated. They were stratified into normo- and hypervolemic groups according to their fluid overload (FO). CNR was calculated from resistance at 5 kHz using calf bioimpedance spectroscopy. Arterial stiffness was assessed by PWV. Additionally, all patients underwent transthoracic echocardiography and had levels of NT-proBNP measured. RESULTS PWV was higher in the hypervolemic compared to normovolemic patients (9.99 ± 2.4 m/sec vs 7.48 ± 2.3 m/sec, p < 0.001). Hypervolemic patients had higher NT-proBNP levels (3065 ± 981 pg/mL vs 1095 ± 502 pg/mL, p < 0.001), a higher ratio of ECW/ICW; (0.93 ± 0.11 vs 0.81 ± 0.08, p < 0.001) and lower CNR (13.7 ± 2.4 vs 16.0 ± 3.3 W m(3)/kg(*)10(-2), p = 0.005). NT-pro BNP level, ECW/ICW ratio, relative FO, and left ventricular (LV) mass index were positively and CNR negatively correlated with PWV. Relative FO and CNR independently predicted PWV in multivariate analysis adjusted for age, duration of PD, body mass index and mean arterial pressure. CONCLUSIONS Arterial stiffness is increased in fluid-overloaded PD patients. Our results indicated that fluid status is an independent predictor of PWV.
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Affiliation(s)
- Ismail Kocyigit
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Murat Hayri Sipahioglu
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Ozcan Orscelik
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Aydin Unal
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Ahmet Celik
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Samer R Abbas
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Fansan Zhu
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Bulent Tokgoz
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Ali Dogan
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Oktay Oymak
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Peter Kotanko
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Nathan W Levin
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
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Abbas SR, Liu L, Sipahioglu MH, Rosales L, Carter M, Kotanko P, Levin NW, Zhu F. Comparison of Bioimpedance Techniques to Detect Changes in Fluid Status in Hemodialysis Patients. Blood Purif 2014; 37:48-56. [DOI: 10.1159/000356830] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 10/28/2013] [Indexed: 11/19/2022]
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14
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Daugirdas JT. Bioimpedance technology and optimal fluid management. Am J Kidney Dis 2013; 61:861-4. [PMID: 23684491 DOI: 10.1053/j.ajkd.2013.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 03/13/2013] [Indexed: 11/11/2022]
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Hecking M, Karaboyas A, Antlanger M, Saran R, Wizemann V, Chazot C, Rayner H, Hörl WH, Pisoni RL, Robinson BM, Sunder-Plassmann G, Moissl U, Kotanko P, Levin NW, Säemann MD, Kalantar-Zadeh K, Port FK, Wabel P. Significance of interdialytic weight gain versus chronic volume overload: consensus opinion. Am J Nephrol 2013; 38:78-90. [PMID: 23838386 DOI: 10.1159/000353104] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 04/04/2013] [Indexed: 12/13/2022]
Abstract
Predialysis volume overload is the sum of interdialytic weight gain (IDWG) and residual postdialysis volume overload. It results mostly from failure to achieve an adequate volume status at the end of the dialysis session. Recent developments in bioimpedance spectroscopy and possibly relative plasma volume monitoring permit noninvasive volume status assessment in hemodialysis patients. A large proportion of patients have previously been shown to be chronically volume overloaded predialysis (defined as >15% above 'normal' extracellular fluid volume, equivalent to >2.5 liters on average), and to exhibit a more than twofold increased mortality risk. By contrast, the magnitude of the mortality risk associated with IDWG is much smaller and only evident with very large weight gains. Here we review the available evidence on volume overload and IDWG, and question the use of IDWG as an indicator of 'nonadherence' by describing its association with postdialysis volume depletion. We also demonstrate the relationship between IDWG, volume overload and predialysis serum sodium concentration, and comment on salt intake. Discriminating between volume overload and IDWG will likely lead to a more appropriate management of fluid withdrawal during dialysis. Consensually, the present authors agree that this discrimination should be among the primary goals for dialysis caretakers today. In consequence, we recommend objective measures of volume status beyond mere evaluations of IDWG.
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Affiliation(s)
- Manfred Hecking
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
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Seibert E, Müller SG, Fries P, Pattmöller J, Kuss O, Heine GH, Girndt M, Schneider G, Kotanko P, Zhu F, Levin NW, Kuhlmann MK. Calf bioimpedance spectroscopy for determination of dry weight in hemodialysis patients: effects on hypertension and left ventricular hypertrophy. Kidney Blood Press Res 2013; 37:58-67. [PMID: 23548813 DOI: 10.1159/000343400] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Dry weight estimation in hemodialysis patients is still a substantial problem. Despite meticulous clinical assessment, fluid overload is common, leading to hypertension and left ventricular hypertrophy (LVH). Segmental calf bioimpedance spectroscopy (cBIS) is a novel tool for dry weight assessment. Here we tested the hypothesis, that its clinical routine use reduces arterial hypertension and left ventricular mass. METHODS Left ventricular mass (determined by magnetic resonance imaging), blood pressure and antihypertensive medication (defined daily doses, ddd) were assessed at baseline (BL). Thereafter post-dialytic target weight was reduced until cBIS-defined dry weight was reached (DW). During a 6-month follow up, DW was re-evaluated monthly by cBIS and end-dialytic weight was adjusted correspondingly. At the end, left ventricular mass, blood pressure and antihypertensive medication were determined a 3rd time (follow-up, FU). RESULTS Eleven out of 15 patients were available for analysis after 6 months. Left ventricular mass showed a declining trend during the study period (Mean±SD; BL 145±54 g; DW 142±55 g; FU 137±52 g; p=0.61, linear mixed model). Comparable results were obtained for systolic blood pressure (BL 158±18 mmHg; DW 144±19 mmHg; FU 149±21 mmHg; p=0.07), and antihypertensive medication (BL 3.28±2.82ddd; DW 2.86±2.81ddd; FU 3.36±3.05ddd; p=0.37). CONCLUSIONS We conclude that attainment of dry weight assessed by cBIS tends to reduce left ventricular mass and blood pressure while antihypertensive medication remains unchanged. While the study was underpowered, its results provide an important hypothesis generating data basis for the design of larger studies.
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Affiliation(s)
- Eric Seibert
- Internal Medicine II, Martin-Luther-University Medical Centre, Halle, Germany.
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Raimann JG, Levin NW. Pneumatic compression devices to avoid intradialytic morbid events. Nephrol Dial Transplant 2012. [PMID: 23188747 DOI: 10.1093/ndt/gfs521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Rahimian R, Fakhfouri G, Rasouli MR, Nouri M, Nezami BG, Paydar MJ, Asadi-Amoli F, Dehpour AR. Effect of pioglitazone on sciatic nerve ischemia/reperfusion injury in rats. Pediatr Neurosurg 2009; 45:126-31. [PMID: 19307747 DOI: 10.1159/000209287] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 12/08/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Evaluation of the effect of pioglitazone on sciatic nerve ischemia/reperfusion (I/R) injury in rat. METHOD Sixty rats were divided into 10 groups (n = 6). Treatment groups received 15 mg/kg pioglitazone intraperitoneally 1 h before induction of I/R by clamping the right common iliac and femoral arteries for 3 h. After certain time intervals of reperfusion (0 h, 3 h, 1, 4, and 7 days), the function of the hind limb was assessed using behavioral scores based on gait, grasp, paw position, and pinch sensitivity. The sciatic nerve was removed for light microscopy studies and graded for ischemic fiber degeneration (IFD) and edema. Plasma malondialdehyde (MDA) level was measured as an indicator of lipid peroxidation at the end of reperfusion intervals. RESULT Behavioral scores were improved in the pioglitazone groups just on the 4th and 7th days of reperfusion (p < 0.05). Comparison of the pioglitazone with the control groups showed significant differences in edema at 4 and 7 days. Although IFD decreased in the pioglitazone group at 7 days of reperfusion, it was not statistically significant. In addition, the MDA level was significantly lower in pioglitazone-treated groups. CONCLUSION Our results show the protective effect of pioglitazone on sciatic nerve I/R injury.
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Affiliation(s)
- Reza Rahimian
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Langenbach GEJ, van Wessel T, Brugman P, Korfage JAM, van Eijden TMGJ. Is fiber-type composition related to daily jaw muscle activity during postnatal development? Cells Tissues Organs 2007; 187:307-15. [PMID: 18089936 DOI: 10.1159/000112791] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2007] [Indexed: 11/19/2022] Open
Abstract
AIM Muscles containing large numbers of slow-contracting fibers are generally more active than muscles largely composed of fast fibers. This relationship between muscle activity and phenotype suggests that (1) changes in fiber-type composition during postnatal development are accompanied by changes in daily activity and (2) individual variations in fiber-type composition are related to similar variations in daily muscle activity. METHODS The masseter and digastric muscles of 23 New Zealand White rabbits (young, juvenile and adult) were examined for their phenotype (myosin heavy chain content) and their daily activity (total daily number of activity bursts). RESULTS During development, the masseter showed a strong increase in the number of fast-type fibers compared to the number of slow-type fibers. During development, also the number of powerful bursts in the masseter increased. The digastric showed no significant changes in fiber types or burst numbers. Within each muscle, across individual animals, no significant correlations (R < 0.70) were found between any of the fiber types and daily burst numbers in any of the age groups. CONCLUSIONS The results suggest that activity-related influences are of relatively minor importance during development and that other factors are dominant in determining fiber-type composition.
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Affiliation(s)
- G E J Langenbach
- Department of Functional Anatomy, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.
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