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Zeni C, Meinerz G, Kist R, Gottschall CBA, Jorge BB, Goldani JC, Keitel E. Bioimpedanciometry in nutritional and hydration assessments in a single dialysis center. J Bras Nefrol 2023; 45:277-286. [PMID: 36469485 PMCID: PMC10697165 DOI: 10.1590/2175-8239-jbn-2022-0037en] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 10/07/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Bioimpedance analysis (BIA) has been demonstrated to add accuracy to nutritional and volume status assessments in dialysis (HD) patients. AIM to describe a sample of dialysis patients from a single center on their demographics and BIA of volume distribution and nutritional status, and mortality during 12-month follow-up. METHODS prospective observational cohort study to evaluate vintage HD patients with single-frequency BIA. RESULTS we evaluated 82 patients, 29% over 65 years old. Elderly patients had higher ECW/TBW (0.51 vs. 0.44, p < 0.0001), and narrower phase angle (PhA) (4.9 vs. 6.4º, p < 0.0001). Fifteen patients (18.2%) died during follow-up, eight (53%) were elderly. Death was associated with age (62.6 vs. 50.2 years, p = 0.012), post-HD PhA (4.8 vs. 6.2º, p = 0.0001), and post-HD ECW/TBW (0.50 vs. 0.45, p = 0.015). The ROC curve analysis to predict mortality found ECW/TBW ≥ 0.47 and PhA ≤ 5.5º to have the best sensitivity and specificity. One-year patient survival was lower with post-HD ECW/TBW ≥ 0.47 (69.5% vs. 90.6%, p = 0.019), age ≥ 65 years (64.2%, vs. 86.2%, p = 0.029), and PhA ≤ 5.5º (68.2 vs. 91.0%, p = 0.002). Cox regression analysis demonstrated that PhA [HR 5.04 (95%CI 1.60-15.86), p = 0.006] remained associated with death after adjusting for age and ECW/TBW. CONCLUSION BIA is useful in assessing volume distribution and nutrition in HD patients, and combined with clinical judgement, may help determine dry weight, especially in elderly patients. Narrower PhA and higher ECW/TBW after HD were associated with poorer one-year survival.
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Affiliation(s)
- Claudia Zeni
- Santa Casa de Misericórdia de Porto Alegre, Departamento de
Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, RS, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Programa
de Pós-Graduação em Patologia, Porto Alegre, RS, Brazil
| | - Gisele Meinerz
- Santa Casa de Misericórdia de Porto Alegre, Departamento de
Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, RS, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Programa
de Pós-Graduação em Patologia, Porto Alegre, RS, Brazil
| | - Roger Kist
- Santa Casa de Misericórdia de Porto Alegre, Departamento de
Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, RS, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Programa
de Pós-Graduação em Ciências da Saúde, Porto Alegre, RS, Brazil
| | | | - Brunno Brochado Jorge
- Universidade Federal de Ciências da Saúde de Porto Alegre, Programa
de Iniciação Científica, Porto Alegre, RS, Brazil
| | - João Carlos Goldani
- Santa Casa de Misericórdia de Porto Alegre, Departamento de
Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, RS, Brazil
| | - Elizete Keitel
- Santa Casa de Misericórdia de Porto Alegre, Departamento de
Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, RS, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Programa
de Pós-Graduação em Patologia, Porto Alegre, RS, Brazil
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Benefits of BNP/NT-proBNP serum level evaluation for dry weight adjustment in pediatric hemodialysis patients. Pediatr Nephrol 2023; 38:811-818. [PMID: 35758998 DOI: 10.1007/s00467-022-05658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Dry weight (DW) adjustment in children on hemodialysis (HD) can be challenging. It relies on clinical evaluation and additional supports. Our aim was to study the benefits of cardiac biomarker assessment, in addition to the more commonly used technique, bioimpedance spectroscopy (BIS), and clinical signs for DW prescription in pediatric HD patients. METHOD Observational study including 41 children on HD in three pediatric HD centers in the Paris region. During one session, BIS was performed before the session and serum levels of BNP and NT-proBNP were analyzed before and after the session. RESULTS Median pre-dialysis level of BNP was 87 ng/L [24-192] and NT-proBNP 968 ng/L [442-4828]. Cardiac biomarker levels showed positive correlation with the BIS hydration status evaluation (p = 0.004). The most appropriate cutoff for pre-dialysis BNP to detect significant overhydration (OH) was 165 ng/L (sensitivity 0.67, specificity 0.84). Based on the BIS evaluation, only 32% of patients with high blood pressure (BP) had OH, whereas in the normal BP group, 33% had significant OH. CONCLUSIONS DW prescription for children on HD should not only rely on clinical evaluation, particularly BP, but should also include additional helpful parameters. BIS is well-validated in children, but it has limitations in non-cooperative patients, and its cost can limit its use in some settings. Cardiac biomarkers, especially BNP, were well-correlated to hydration status evaluated by BIS, and thus could add valuable information for individual patient management and DW assessment. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Zeni C, Meinerz G, Kist R, Gottschall CBA, Jorge BB, Goldani JC, Keitel E. Bioimpedanciometria em avaliações nutricionais e de hidratação em um único centro de diálise. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2022-0037pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RESUMO Antecedentes: Análise de bioimpedância (BIA) demonstrou adicionar acurácia às avaliações de estado nutricional e de volume em pacientes em diálise (HD). Objetivo: descrever amostra de pacientes em diálise de um único centro quanto aos aspectos demográficos e BIA na distribuição de volume e no estado nutricional, e a mortalidade em 12 meses de acompanhamento. Métodos: estudo de coorte observacional prospectivo para avaliar pacientes prevalentes em HD com BIA de frequência única. Resultados: avaliamos 82 pacientes, 29% acima de 65 anos. Pacientes idosos apresentaram maior AEC/ACT (0,51 vs. 0,44; p < 0,0001), e ângulo de fase mais estreito (PhA) (4,9 vs. 6,4º; p < 0,0001). Quinze pacientes (18,2%) foram a óbito durante acompanhamento, oito (53%) eram idosos. Óbito foi associado à idade (62,6 vs. 50,2 anos, p = 0,012), PhA pós-HD (4,8 vs. 6,2º; p = 0,0001), e AEC/ACT pós-HD (0,50 vs. 0,45, p = 0,015). A análise da curva ROC para prever mortalidade constatou que AEC/ACT ≥ 0,47 e PhA ≤ 5,5º apresentam melhor sensibilidade e especificidade. Sobrevida do paciente em um ano foi menor com AEC/ACT pós-HD ≥ 0,47 (69,5% vs. 90,6%; p = 0,019), idade ≥ 65 anos (64,2% vs. 86,2%; p = 0,029), e PhA ≤ 5,5º (68,2 vs. 91,0%; p = 0,002). A análise de regressão de Cox demonstrou que PhA [HR 5,04 (IC 95% 1,60–15,86); p = 0,006] permaneceu associado ao óbito após ajuste para idade e AEC/ACT. Conclusão: BIA é útil ao avaliar distribuição de volume e nutrição em pacientes em HD, e juntamente com julgamento clínico, pode ajudar a determinar o peso seco, principalmente em pacientes idosos. PhA mais estreito e maior AEC/ACT pós-HD foram associados a pior sobrevida em um ano.
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Affiliation(s)
- Claudia Zeni
- Santa Casa de Misericórdia de Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Gisele Meinerz
- Santa Casa de Misericórdia de Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Roger Kist
- Santa Casa de Misericórdia de Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | | | | | | | - Elizete Keitel
- Santa Casa de Misericórdia de Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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Pérez-Morales R, Donate-Correa J, Martín-Núñez E, Pérez-Delgado N, Ferri C, López-Montes A, Jiménez-Sosa A, Navarro-González JF. Extracellular water/total body water ratio as predictor of mortality in hemodialysis patients. Ren Fail 2021; 43:821-829. [PMID: 33966595 PMCID: PMC8118427 DOI: 10.1080/0886022x.2021.1922442] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Overhydration is a predictor of mortality in hemodialysis (HD) patients. Bioimpedance spectroscopy (BIS) is used to determine the body composition. Extracellular Water/Total Body Water (ECW/TBW) ratio has been proposed to predict mortality. Methods Multicenter, prospective, observational, proof-of-concept study to estimate the impact of ECW/TBW in global and cardiovascular mortality and the relationship with cardiovascular biomarkers. The study included 60 patients (mean age, 71.8 ± 11.4 years; mean time on HD, 52.3 ± 30.8 months) with a median follow-up of 30.5 months (IQ range, 17.2–34 months). Results Post-dialysis ECW/TBW was directly associated with NT-proBNP and cTnT. During the study 28 patients died, most of them (43%) due to cardiovascular events. Compared to the survivors, these subjects had a higher post-dialysis ECW/TBW ratio (p = 0.006), while for cardiovascular mortality the only significant difference was a higher pre-dialysis ECW/TBW. The ability of post-dialysis ECW/TBW ratio to predict all-cause mortality had an area under the ROC curve (AUC) of 0.71 (CI 95%, 0.57–0.81; p = 0.002), with a cutoff point of 0.5023. For cardiovascular mortality the AUC was 0.66 (CI 95%, 0.52–0.77; p = 0.045), with a cutoff point of 0.4713. Conclusions The post-dialysis ECW/TBW ratio measured by BIS can be a predictor of all-cause and cardiovascular mortality.
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Affiliation(s)
- Rosa Pérez-Morales
- Nephrology Department, Hospital Universitario Nuestra Señora de Candelaria (HUNSC), Santa Cruz de Tenerife, Spain
| | | | | | | | - Carla Ferri
- Research Unit, HUNSC, Santa Cruz de Tenerife, Spain
| | - Aurora López-Montes
- Nephrology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Juan Francisco Navarro-González
- Nephrology Department, Hospital Universitario Nuestra Señora de Candelaria (HUNSC), Santa Cruz de Tenerife, Spain.,Research Unit, HUNSC, Santa Cruz de Tenerife, Spain
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Suarez J, Niyyar VD. Lung Ultrasound: A "Biomarker" for Fluid Overload? Adv Chronic Kidney Dis 2021; 28:200-207. [PMID: 34906304 DOI: 10.1053/j.ackd.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/18/2021] [Accepted: 03/09/2021] [Indexed: 11/11/2022]
Abstract
Fluid overload is associated with poor outcomes in patients with acute kidney injury as well as end-stage kidney disease. Lung ultrasound (LUS) has been used in many different settings and specialties including the emergency department, intensive care unit, trauma, cardiology, and nephrology. Although LUS has been a valuable tool in assessing pulmonary congestion, LUS findings may not always be pathognomonic for pulmonary congestion. Furthermore, the feasibility of doing an extensive LUS examination as has been done in research studies may be hard to implement within the clinical setting. This review will go over the use of LUS to evaluate for fluid overload, compare LUS with other markers of fluid overload, review limitations of LUS, and suggest potential future directions in the use of LUS in nephrology.
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Luce M, Bres E, Yi D, Pastural M, Granjon S, Szelag JC, Laville M, Arkouche W, Bouchara A, Fouque D, Soulage CO, Koppe L. Natriuretic Peptides as Predictors of Protein-Energy Wasting in Hemodialysis Population. J Ren Nutr 2021; 32:234-242. [PMID: 33888408 DOI: 10.1053/j.jrn.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/18/2020] [Accepted: 03/07/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Imbalance between anabolism and catabolism is linked to cachexia and protein-energy wasting (PEW), especially in frail populations such as patients with chronic kidney disease. PEW is responsible of poor outcomes with increased morbidity and mortality. Several causes are involved in PEW such as insulin resistance, acidosis, or hyperparathyroidism. Natriuretic peptides (NPs) have recently been described as activators of resting energy expenditure through the induction of browning of white adipose tissue in rodents with chronic kidney disease. The present study was therefore implemented to investigate whether NPs could be associated with PEW criteria and predict clinical outcomes. METHODS We quantified serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) in a prospective cohort of 231 patients undergoing maintenance hemodialysis and atrial natriuretic peptide in a subgroup of 35 patients. Body composition parameters were measured with bioimpedance spectroscopy. RESULTS NT-proBNP was inversely associated with serum albumin, prealbumin, and body mass index and, conversely, positively associated with age and C-reactive protein. NT-proBNP as well as atrial natriuretic peptide were significantly higher in patients with PEW criteria. NT-proBNP was negatively associated with body fat mass. In multiple linear regression, NT-proBNP remained associated with body mass index. Kaplan-Meier analysis revealed a significant correlation between serum NT-proBNP concentrations and all-cause mortality and cardiovascular events. This association remained significant after multivariable Cox regression models adjusted for demographic factors and cardiovascular risk factors. CONCLUSION Accumulation of NPs seems to be associated with poor nutritional status and reduced survival among hemodialysis patients. Further studies are needed to confirm this association using resting energy expenditure measurement and adipose tissue biopsy.
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Affiliation(s)
- Mathilde Luce
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite, France; University of Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Emilie Bres
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite, France; University of Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Dan Yi
- University of Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Myriam Pastural
- Association pour l'Utilisation du Rein Artificiel dans la région Lyonnaise (AURAL), Lyon, France
| | - Samuel Granjon
- Laboratoire d'Analyse Médicale Cerballiance Rhône alpes, Lyon, France
| | - Jean Christophe Szelag
- Association pour l'Utilisation du Rein Artificiel dans la région Lyonnaise (AURAL), Lyon, France
| | - Maurice Laville
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Walid Arkouche
- Association pour l'Utilisation du Rein Artificiel dans la région Lyonnaise (AURAL), Lyon, France
| | - Anais Bouchara
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Denis Fouque
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite, France; University of Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Christophe O Soulage
- University of Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Laetitia Koppe
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite, France; University of Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France.
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Do Natriuretic Peptide Measurements Provide Insights into Management of End-Stage Renal Disease Patients Undergoing Dialysis? Curr Heart Fail Rep 2020; 17:449-456. [PMID: 32939671 DOI: 10.1007/s11897-020-00488-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Impaired renal function may affect natriuretic peptide levels through a variety of factors and mechanisms, such as high prevalence of concomitant vascular and myocardial diseases, reduced clearance, increased risk of volume overload, and different types and solute removal techniques in the setting of dialysis. Nevertheless, accumulating evidence suggests that natriuretic peptide testing may provide insights into management of patients with chronic kidney disease (CKD) and end-stage kidney disease (ESRD) on dialysis, as they have been shown to be independently associated with morbidity and mortality. RECENT FINDINGS Rising natriuretic peptide levels over time may identify CKD patients more likely to approach ESRD and requiring dialysis initiation. Moreover, serial natriuretic peptide measurements may also be helpful in guiding fluid management in ESRD patients on dialysis. However, since patients with CKD usually have significantly higher and more variable baseline levels of natriuretic peptides than those without CKD, traditional cut-off values may not be applicable, and individualized trajectories should be applied and interpreted in the clinical context. Routine clinical use natriuretic peptide testing in the CKD and ESRD settings still needs to be refined and individualized, yet their diagnostic and prognostic values can provide valuable insights into clinical trajectories and potential treatment responses.
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Yang WL, Fahim M, Johnson DW. Pathophysiology and significance of natriuretic peptides in patients with end-stage kidney disease. Clin Biochem 2020; 83:1-11. [PMID: 32511964 DOI: 10.1016/j.clinbiochem.2020.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 12/30/2022]
Abstract
Natriuretic peptides (NP), especially B type (BNP) and its N-terminal pro-B type natriuretic peptide (NT-proBNP), have long been regarded as biomarkers of volume overload and tools to exclude heart failure in the general population. However, their role in end-stage kidney disease (ESKD) is less certain given that BNP and NT-proBNP are excreted by the kidney and so serum concentrations of NPs are nearly universally elevated compared to controls. Nevertheless, the accumulated evidence suggests thatserum concentrations of NPs in patients with ESKD show moderate or strong positive relationships with underlying heart disease, abnormal cardiac structure or function and mortality. Limited evidence also supports the role of BNP including NT-proBNP, ANP in some studies, rather than CNP or DNP in risk stratification among ESKD patients as well as the utility of BNP samplings pre- and post- hemodialysis. However, studies of the cut-off values of NPs have yielded inconsistent results, such that further large-scale studies are needed to clarify these issues. This review summarizes the pathophysiology and significance of NPs in ESKD patients, especially their potential role as risk stratification biomarkers in clinical management.
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Affiliation(s)
- Wen-Ling Yang
- Department of Nephrology, Peking University Third Hospital, Beijing, China; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Kidney Disease Research, The University of Queensland, Queensland, Australia
| | - Magid Fahim
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Kidney Disease Research, The University of Queensland, Queensland, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Kidney Disease Research, The University of Queensland, Queensland, Australia; Translational Research Institute, Brisbane, Australia.
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N-terminal Pro-B-Type Natriuretic Peptide and Malnutrition in Patients on Hemodialysis. Int J Nephrol 2020; 2020:9528014. [PMID: 32206350 PMCID: PMC7077038 DOI: 10.1155/2020/9528014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 02/11/2020] [Indexed: 11/17/2022] Open
Abstract
Natriuretic peptides, brain natriuretic peptide (BNP), and N-terminal probrain natriuretic peptide (NT-proBNP) are mainly known as diagnostic markers for heart failure with high diagnostic and prognostic values in the general population. In patients who are undergoing hemodialysis (HD), changes in NT-proBNP can be related to noncardiac problems such as fluid overload, inflammation, or malnutrition and can also be influenced by the dialysis characteristics. The current review aimed to summarize findings from studies on the association between NT-proBNP and malnutrition in HD patients. Articles published after 2009 and over a ten-year period were considered for inclusion. We first briefly discuss the traditional functions of NT-proBNP, and after, we describe the functions of this prohormone by focusing on its relation with protein energy wasting (PEW) in HD patients. Mechanisms that could explain these relationships were also discussed. Overall, 7 studies in which the investigation of the relations between NT-proBNP and nutritional status in HD patients were among the main objects were taken into account. NT-proBNP levels correlated with several factors described in the 4 categories of markers indicative of PEW (body mass and composition, muscle mass, biochemical criteria, and dietary intakes) and/or were associated with PEW. Interactions between several parameters could be involved in the association between NT-proBNP and malnutrition with a strong role of weight status. NT-proBNP is elevated in HD patients and is associated with malnutrition. Nevertheless, the prognostic value of NT-proBNP on nutritional status should be evaluated.
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Mohamed A, Davenport A. Sodium loss, extracellular volume overload and hypertension in peritoneal dialysis patients treated by automated peritoneal dialysis cyclers. Int J Artif Organs 2019; 43:17-24. [PMID: 31402728 DOI: 10.1177/0391398819864368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Achieving sodium balance is important for peritoneal dialysis patients, as sodium excess may lead to hypertension and extracellular water expansion. We wished to determine whether greater sodium removal had adverse consequences. METHODS We calculated 24-h urinary and peritoneal sodium losses in peritoneal dialysis patients treated by automated cyclers, when attending for peritoneal membrane and bioimpedance assessments. RESULTS We reviewed 439 peritoneal dialysis patients, 56.7% male, average age 54.6 years, median sodium loss 110 (68-155) mmol/day. Sodium loss was strongly associated with urine volume, r = 0.37, protein nitrogen appearance rate, r = 0.29, and body cell mass, r = 0.21, all p < 0.001. We found no association with blood pressure or anti-hypertensive medication prescription, or extracellular water. On multivariable logistic regression analysis, sodium loss was associated with greater urine output, odds ratio 1.001, 95% confidence interval 1.00-1.001, p < 0.001, and protein nitrogen appearance (odds ratio 1.023, confidence interval 1.006-1.04), p = 0.008. Adjusting for body weight, sodium loss was associated with urine output (odds ratio 1.001, confidence interval 1.001-1.002, p < 0.001), and negatively with body fat index (odds ratio 0.96, confidence interval 0.93-0.99, p = 0.008) and co-morbidity grade (odds ratio 0.58, confidence interval 0.36-0.39, p = 0.023). CONCLUSION Heavier peritoneal dialysis patients with greater estimated dietary protein intake (protein nitrogen appearance), those with greater residual renal function and peritoneal clearances, along with lower co-morbidity, had greater daily sodium losses. Adjusting for body weight, then sodium losses were greater with higher daily urine output, and lower in patients with proportionately more body fat and co-morbidity. Sodium losses would appear to primarily determined by body size and not associated with hypertension or extracellular water expansion.
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Affiliation(s)
- Ahmed Mohamed
- UCL Department of Nephrology, Royal Free Hospital, University College London, London, UK
| | - Andrew Davenport
- UCL Department of Nephrology, Royal Free Hospital, University College London, London, UK
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Arias-Guillén M, Masso E, Gomez M, Rodas L, Broseta J, Vera M, Rios J, Fontseré N, Maduell F. Are Currently Used Bioimpedance Methods in Hemodialysis Comparable for Calculating Dialysis Dose? Ther Apher Dial 2019; 24:154-162. [PMID: 31325207 DOI: 10.1111/1744-9987.13424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 11/27/2022]
Abstract
Bioelectrical impedance analysis has increasingly been incorporated into hemodialysis units (HD) as a useful, noninvasive technique for evaluating overall fluid status. The aims of this study were to verify whether the information obtained from two different bioelectrical impedance analysis methods (spectroscopy bioimpedance [BCM] and single-frequency bioelectric impedance vector analysis [SF-BIVA]) was comparable for analyzing fluid status, and to determine their impact when used to calculate dialysis dose. This observational cross-sectional study included 78 HD patients who underwent one measurement with BCM and one with SF-BIVA in the same dialysis session. For calculating the dialysis dose, total body water or urea distribution volume (V) was calculated by the Watson formula and compared with the V obtained from the two devices. The difference in V between the two devices was 5.4 L (P < 0.001). Given the existent correlation between VBCM and VSF-BIVA , we were able to apply a formula (corrected V = VSF-BIVA = 1.04 × VBCM + 4.85, r = 0.93), allowing comparison of the two bioimpedance methods. The mean dialysis dose for BCM device (KtID /VBCM ) was 2.49 ± 0.85, much higher than KtID /VSF-BIVA (2.06 ± 0.72) mainly due to the V obtained with the different devices, with KtID /VWatson being 2.03 ± 0.67. The results on volume distribution showed an acceptable correlation but the devices were not comparable due to intermethod differences observed. Dialysis centers using SF-BIVA will obtain much lower dialysis dose, but by applying our formula, the Kt/V would resemble that obtained by the BCM device.
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Affiliation(s)
- Marta Arias-Guillén
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain
| | - Elisabet Masso
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain
| | - Miquel Gomez
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain
| | - Lida Rodas
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain.,Spanish Kidney Research Network, ISCIII-RETIC (REDinREN), Madrid, Spain
| | - Jose Broseta
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain.,Spanish Kidney Research Network, ISCIII-RETIC (REDinREN), Madrid, Spain
| | - Manel Vera
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain
| | - Jose Rios
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clínic, Barcelona, Spain
| | - Néstor Fontseré
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain
| | - Francisco Maduell
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain.,Spanish Kidney Research Network, ISCIII-RETIC (REDinREN), Madrid, Spain
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12
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Lee SW, Ngoh CLY, Chua HR, Haroon S, Wong WK, Lee EJ, Lau TW, Sethi S, Teo BW. Evaluation of different bioimpedance methods for assessing body composition in Asian non-dialysis chronic kidney disease patients. Kidney Res Clin Pract 2019; 38:71-80. [PMID: 30897894 PMCID: PMC6481966 DOI: 10.23876/j.krcp.18.0069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/14/2018] [Accepted: 12/01/2018] [Indexed: 02/03/2023] Open
Abstract
Background Chronic kidney disease (CKD) is associated with fluid retention, which increases total body water (TBW) and leads to changes in intracellular water (ICW) and extracellular water (ECW). This complicates accurate assessments of body composition. Analysis of bioelectrical impedance may improve the accuracy of evaluation in CKD patients and multiple machines and technologies are available. We compared body composition by bioimpedance spectroscopy (BIS) against multi-frequency bioimpedance analysis (BIA) in a multi-ethnic Asian population of stable, non-dialysis CKD patients. Methods We recruited 98 stable CKD patients comprising 54.1% men and 70.4% Chinese, 9.2% Malay, 13.3% Indian, and 8.2% other ethnicities. Stability was defined as no variation in serum creatinine > 20% over three months. Patients underwent BIS analyses using a Fresenius body composition monitor, while BIA analyses employed a Bodystat Quadscan 4000. Results Mean TBW values by BIS and BIA were 33.6 ± 7.2 L and 38.3 ± 7.4 L; mean ECW values were 15.8 ± 3.2 L and 16.9 ± 2.7 L; and mean ICW values were 17.9 ± 4.3 L and 21.0 ± 4.9 L, respectively. Mean differences for TBW were 4.6 ± 1.9 L (P < 0.001), for ECW they were 1.2 ± 0.5 L (P < 0.001), and for ICW they were 3.2 ±1.8 L (P < 0.001). BIA and BIS measurements were highly correlated: TBW r = 0.970, ECW r = 0.994, and ICW r = 0.926. Compared with BIA, BIS assessments of fluid overload appeared to be more associated with biochemical and clinical indicators. Conclusion Although both BIA and BIS can be used for body water assessment, clinicians should be aware of biases that exist between bioimpedance techniques. The values of body water assessments in our study were higher in BIA than in BIS. Ethnicity, sex, body mass index, and estimated glomerular filtration rate were associated with these biases.
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Affiliation(s)
- Sean Wy Lee
- Division of Nephrology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Clara Lee Ying Ngoh
- Division of Nephrology, Department of Medicine, National University Health System, Singapore
| | - Horng Ruey Chua
- Division of Nephrology, Department of Medicine, National University Health System, Singapore
| | - Sabrina Haroon
- Division of Nephrology, Department of Medicine, National University Health System, Singapore
| | - Weng Kin Wong
- Division of Nephrology, Department of Medicine, National University Health System, Singapore
| | - Evan Jc Lee
- Division of Nephrology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Nephrology, Department of Medicine, National University Health System, Singapore
| | - Titus Wl Lau
- Division of Nephrology, Department of Medicine, National University Health System, Singapore
| | - Sunil Sethi
- Department of Pathology, National University Health System, Singapore
| | - Boon Wee Teo
- Division of Nephrology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Nephrology, Department of Medicine, National University Health System, Singapore
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13
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Stenberg J, Melin J, Lindberg M, Furuland H. Brain natriuretic peptide reflects individual variation in hydration status in hemodialysis patients. Hemodial Int 2019; 23:402-413. [PMID: 30848066 PMCID: PMC6850372 DOI: 10.1111/hdi.12751] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 12/15/2022]
Abstract
Introduction: Fluid management in hemodialysis patients is a controversial topic. Brain natriuretic peptide (BNP) is secreted from the heart in response to volume overload, and may be a marker of overhydration in hemodialysis patients. Our aim was to investigate the correlation between BNP and overhydration in a cohort of hemodialysis patients, and to find out whether BNP and overhydration correlate in repeated measurements within individuals with elevated BNP. Methods: The study was prospective, observational, and had a cross‐sectional part and a longitudinal follow‐up. The distribution of BNP was investigated in a cohort of 64 hemodialysis patients. Blood samples and bioimpedance spectroscopy measurements were performed before midweek dialysis. Subsequently, 11 study participants with elevated BNP concentrations (>500 pg/mL) were assessed in another nine dialysis sessions each. These individuals also had their cardiac function and heart rate variability (HRV) examined. Findings: BNP was above 500 pg/mL in 38% of the participants, and correlated positively with overhydration (rs = 0.381), inflammation and malnutrition, but not with systolic blood pressure. In comparison to participants with BNP below 500 pg/mL, participants with elevated BNP were older, had lower muscle strength, lower bodyweight and lower levels of hemoglobin and albumin. Echocardiography revealed cardiac anomalies in all 11 participants in the longitudinal follow‐up, and HRV, as measured by SDNN, was pathologically low. In repeated measurements, the between‐individuals variation of BNP in relation to overhydration was greater (SD = 0.581) than the within‐person variation (SD = 0.285). Discussion: BNP correlates positively to overhydration, malnutrition, and inflammation. In a subgroup of patients with elevated BNP, who are mainly elderly and frail, BNP reflects individual variation in hydration status, and hence seems to be a modifiable marker of overhydration. These data suggest that BNP is best applied for measuring changes in hydration status within an individual over time.
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Affiliation(s)
- Jenny Stenberg
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jan Melin
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Magnus Lindberg
- Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Hans Furuland
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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14
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Abstract
Dysregulation of intravascular fluid leads to chronic volume overload in children with end-stage kidney disease (ESKD). Sequelae include left ventricular hypertrophy and remodeling and impaired cardiac function. As a result, cardiovascular complications are the commonest cause of mortality in the pediatric dialysis population. The clinical need to optimize intravascular volume in children with ESKD is clear; however, its assessment and management is the most challenging aspect of the pediatric dialysis prescription. Minimizing chronic fluid overload is a key priority; however, excessive ultrafiltration is toxic to the myocardium and can precipitate intradialytic symptoms. This review outlines emerging objective techniques to enhance the assessment of fluid overload in children on dialysis and outlines evidence for current management strategies to address this clinical problem.
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15
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Eng CSY, Bhowruth D, Mayes M, Stronach L, Blaauw M, Barber A, Rees L, Shroff RC. Assessing the hydration status of children with chronic kidney disease and on dialysis: a comparison of techniques. Nephrol Dial Transplant 2018; 33:847-855. [DOI: 10.1093/ndt/gfx287] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Affiliation(s)
- Caroline S Y Eng
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Paediatric Nephrology Unit, Tuanku Ja’afar Hospital, Seremban, Malaysia
| | - Devina Bhowruth
- Vascular Physiology Unit, University College London Institute of Child Health, London, UK
| | - Mark Mayes
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lynsey Stronach
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michelle Blaauw
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Amy Barber
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lesley Rees
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rukshana C Shroff
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Vascular Physiology Unit, University College London Institute of Child Health, London, UK
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16
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Ohashi Y, Joki N, Yamazaki K, Kawamura T, Tai R, Oguchi H, Yuasa R, Sakai K. Changes in the fluid volume balance between intra- and extracellular water in a sample of Japanese adults aged 15–88 yr old: a cross-sectional study. Am J Physiol Renal Physiol 2018; 314:F614-F622. [DOI: 10.1152/ajprenal.00477.2017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The fluid volume balance between intracellular water (ICW) and extracellular water (ECW) gradually changes with age and various medical conditions. Comprehension of these physiological changes would aid in clinical decision-making related to body fluid assessments. A total of 1,992 individuals (753 men and 1,239 women) aged ≥15 yr included in this study had their body composition measurements performed at training gyms in 2014. We developed a regression formula to assess the association of age with the ratio of ECW to ICW in these subjects. The mean ages of male and female subjects were 51.2 ± 15.2 and 57.4 ± 15.2 yr, and their mean body mass indexes were 23.4 ± 3.3 and 21.1 ± 2.8 kg/m2, respectively. The total fluid volumes of male and female subjects were 39.6 ± 4.9 and 27.7 ± 3.0 liters, whereas the percent body fat mass per kilogram of body weight were 19 and 26%, respectively. The ECW-to-ICW ratio increased with age because of the steeper decrease in the ICW content than in the ECW content, especially after the age of 70 yr. The regression formulas used for calculating the age-adjusted ECW/ICW ratio were as follows: 0.5857 + 7.4334 × 10−6 × (age)2 in men and 0.6062 + 5.5775 × 10−6 × (age)2 in women. In conclusion, the fluid imbalance between ICW and ECW contents is driven by decreased cell volume associated with aging and muscle attenuation. Therefore, our proposed formula may serve as a useful assessment tool for the calculation of body fluid composition.
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Affiliation(s)
- Yasushi Ohashi
- Department of Nephrology, Sakura Medical Center, Toho University, Chiba, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Keisuke Yamazaki
- Department of Nephrology, Sakura Medical Center, Toho University, Chiba, Japan
| | - Takeshi Kawamura
- Department of Nephrology, Sakura Medical Center, Toho University, Chiba, Japan
| | - Reibin Tai
- School of Medicine, Department of Nephrology, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Hideyo Oguchi
- School of Medicine, Department of Nephrology, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Rena Yuasa
- School of Medicine, Department of Nephrology, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Ken Sakai
- School of Medicine, Department of Nephrology, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
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17
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Covic A, Siriopol D, Voroneanu L. Use of Lung Ultrasound for the Assessment of Volume Status in CKD. Am J Kidney Dis 2018; 71:412-422. [DOI: 10.1053/j.ajkd.2017.10.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 10/12/2017] [Indexed: 12/20/2022]
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18
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Hayes W, Allinovi M. Beyond playing games: nephrologist vs machine in pediatric dialysis prescribing. Pediatr Nephrol 2018; 33:1625-1627. [PMID: 30003314 PMCID: PMC6132900 DOI: 10.1007/s00467-018-4021-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022]
Abstract
In a recent article in Pediatric Nephrology, Olivier Niel and colleagues applied an artificial intelligence algorithm to a clinical problem that continues to challenge experienced pediatric nephrologists: optimizing the target weight of children on dialysis. They compared blood pressure, antihypertensive medication and intradialytic symptoms in children whose target weight was prescribed firstly by a nephrologist, then subsequently using a machine learning algorithm. Improvements in all outcome measures are reported. Their innovative approach to tackling this important clinical problem appears promising. In this editorial, we discuss the strengths and weaknesses of their study and consider to what extent machine learning strategies are suited to optimizing pediatric dialysis outcomes.
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Affiliation(s)
- Wesley Hayes
- Great Ormond Street Hospital, London, UK. .,University College London Institute of Child Health, London, UK.
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19
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Strapazzon G, Pun M, Cappello TD, Procter E, Lochner P, Brugger H, Piccoli A. Total Body Water Dynamics Estimated with Bioelectrical Impedance Vector Analysis and B-Type Natriuretic Peptide After Exposure to Hypobaric Hypoxia: A Field Study. High Alt Med Biol 2017; 18:384-391. [PMID: 29035594 PMCID: PMC5743030 DOI: 10.1089/ham.2017.0056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/07/2017] [Indexed: 01/15/2023] Open
Abstract
Strapazzon, Giacomo, Matiram Pun, Tomas Dal Cappello, Emily Procter, Piergiorgio Lochner, Hermann Brugger, and Antonio Piccoli. Total body water dynamics estimated with bioelectrical impedance vector analysis and B-type natriuretic peptide after exposure to hypobaric hypoxia: A field study. High Alt Med Biol. 18:384-391, 2017.-The relationship between total body water (TBW) dynamics and N-terminal pro-B-type natriuretic peptide (NT-proBNP), a stable metabolite of B-type natriuretic peptide, during acute high altitude exposure is not known. To investigate this, we transported 19 healthy lowland subjects to 3830 m with a helicopter after baseline measurements (262 m). The physiological measurements and clinical assessments were taken at 9, 24, 48, and 72 hours and on the eighth day of altitude exposure. A bioelectrical impedance vector analysis (BIVA) from height corrected Resistance-Reactance (R-Xc graph) was used to estimate TBW status. NT-proBNP was measured from venous blood samples. The changes in impedance vector were lengthened at 9 (p = 0.011), 48 (p = 0.033), and 72 hours (p = 0.015) indicating dehydration compared to baseline. However, there was no dehydration at 24 hours (p > 0.05) from the baseline and the subjects trended to get euhydrated from 9 to 24 hours (p = 0.097). The maximum percent changes in vector length from the baseline were within 10%-15%. There was a significant increase of natural logarithm (ln)(NT-proBNP) after ascent with a peak at 24 hours, although similarly to BIVA values, ln(NT-proBNP) returned to baseline after 8 days of altitude exposure. The changes in impedance vector length were not correlated with the changes in ln(NT-proBNP) (r = -0.101, p = 0.656). In conclusion, the dehydration at high altitude as reflected by 10%-15% vector lengthening falls within "appropriate dehydration" in healthy lowland subjects. NT-proBNP does not simply reflect the TBW status during acute high altitude exposure and needs further investigation.
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Affiliation(s)
| | - Matiram Pun
- EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy
| | | | - Emily Procter
- EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy
| | - Antonio Piccoli
- Department of Medicine DIMED, University Hospital of Padova, Padova, Italy
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20
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Mandic A, Cavar I, Skoro I, Tomic I, Ljubic K, Coric S, Mikulic I, Azinovic I, Pravdic D. Body Composition and Inflammation in Hemodialysis Patients. Ther Apher Dial 2017; 21:556-564. [DOI: 10.1111/1744-9987.12575] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/02/2017] [Accepted: 05/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ante Mandic
- Department of Internal Medicine; Mostar University Hospital; Mostar Bosnia and Herzegovina
| | - Ivan Cavar
- Department of Physiology; Mostar University Faculty of Medicine; Mostar Bosnia and Herzegovina
| | - Ivana Skoro
- Department of Internal Medicine; Mostar University Hospital; Mostar Bosnia and Herzegovina
| | - Ivan Tomic
- Department of Internal Medicine; Mostar University Hospital; Mostar Bosnia and Herzegovina
| | - Kristina Ljubic
- Department of Laboratory Diagnostics; Mostar University Hospital; Mostar Bosnia and Herzegovina
| | - Slavica Coric
- Department of Internal Medicine; Mostar University Hospital; Mostar Bosnia and Herzegovina
| | - Ivanka Mikulic
- Department of Laboratory Diagnostics; Mostar University Hospital; Mostar Bosnia and Herzegovina
| | - Igor Azinovic
- Laboratory Diagnostics; Mostar University Faculty of Medicine; Mostar Bosnia and Herzegovina
| | - Danijel Pravdic
- Department of Internal Medicine; Mostar University Hospital; Mostar Bosnia and Herzegovina
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21
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Siriopol I, Siriopol D, Voroneanu L, Covic A. Predictive abilities of baseline measurements of fluid overload, assessed by bioimpedance spectroscopy and serum N-terminal pro-B-type natriuretic peptide, for mortality in hemodialysis patients. Arch Med Sci 2017; 13:1121-1129. [PMID: 28883854 PMCID: PMC5575229 DOI: 10.5114/aoms.2017.68993] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/04/2017] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Fluid overload is one of the most important, yet modifiable, risk factors associated with worse outcomes in hemodialysis (HD) patients. However, its precise assessment in clinical practice is still under investigation. MATERIAL AND METHODS This is an observational prospective study which included 285 stable patients with end-stage renal disease on standard thrice-weekly HD therapy. Overhydration was assessed by the combination of relative fluid overload (RFO), using bioimpedance spectroscopy, and N-terminal pro-B-type natriuretic peptide (NT-proBNP). The outcome of interest was all-cause mortality. RESULTS The median values for NT-proBNP and RFO were 4595 pg/ml and 6.9%, respectively. We divided the study population into four groups according to these median levels: group 1 - low NT-proBNP and low RFO; group 2 - high NT-proBNP and low RFO; group 3 - low NT-proBNP and high RFO; group 4 - high NT-proBNP and high RFO. During the follow-up (mean: 41.1, median: 48.7 months), 89 (31.2%) patients died. In the univariable Cox survival analysis only patients in group 4, and not those from group 2 or 3, had significantly higher HRs as compared to those in group 1 (HR = 1.5, 95% CI: 0.8-2.8, HR = 1.6, 95% CI: 0.8-2.9 and HR = 2.4, 95% CI: 1.3-4.2, for group 2, 3 and 4, respectively). Furthermore, these results were maintained in the multivariable Cox analysis. CONCLUSIONS Including both bioimpedance and NT-proBNP monitoring in a more comprehensive fluid status assessment could improve the diagnosis of fluid overload with a final improvement in patients' outcome.
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Affiliation(s)
- Ianis Siriopol
- Intensive Care Unit Department, Regional Institute of Oncology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Dimitrie Siriopol
- Nephrology Department, Dialysis and Renal Transplant Center, “Dr. C.I. Parhon” University Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Luminita Voroneanu
- Nephrology Department, Dialysis and Renal Transplant Center, “Dr. C.I. Parhon” University Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Adrian Covic
- Nephrology Department, Dialysis and Renal Transplant Center, “Dr. C.I. Parhon” University Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
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22
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Rasche FM, Stoebe S, Ebert T, Feige S, Hagendorff A, Rasche WG, Barinka F, Busch V, Sack U, Schneider JG, Schiekofer S. Modern peptide biomarkers and echocardiography in cardiac healthy haemodialysis patients. BMC Nephrol 2017; 18:175. [PMID: 28558715 PMCID: PMC5450351 DOI: 10.1186/s12882-017-0589-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/16/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In this prospective study, we aimed to assess the haemodynamic changes before and after haemodialysis (HD) in cardiac healthy subjects on chronic HD by imaging methods and endocrine markers of fluid balance. METHODS Mid-regional pro-atrial natriuretic peptide (MR-proANP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), vasopressin (AVP) and copeptin (CT-proAVP), metanephrines and normetanephrines, renin and aldosterone, standard transthoracic echocardiography and diameter of vena cava inferior (VCID) were performed in 20 patients with end stage renal disease (CKD5D) before and after HD and were stratified in residual excretion (RE, less or more 0.5 l) and ultrafiltration rate (UF, less or more 2 l). RESULTS Copeptin was significantly higher in patients before HD. Copeptin was inversely correlated with haemodialysis treatment adequacy (KT/v), RE and UF, but was not significantly influenced by age, gender and body mass index (BMI). MR-proANP was significantly reduced by haemodialysis by 27% and was inversely correlated with KT/v, but there was a significant influence by UF, RE, age, gender and BMI. NT-proBNP was significantly higher in patients before HD and was not influenced by RE and UF. Renin, aldosterone, metanephrines and normetanephrines did not demonstrate significant differences. Echocardiographic parameters and VCID were significantly correlated with RE, UF and copeptin. CONCLUSION Modern biomarkers will provide cardiovascular risk assessment, but elimination (UF), RE and other factors may influence the serum concentrations, e.g. in patients with renal impairment. The interpretation will be limited by altered reference ranges, and will be restricted to individual courses combined with clinical and echocardiographic data.
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Affiliation(s)
- Franz Maximilian Rasche
- Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, Section of Nephrology, University Leipzig, Leipzig, Germany
| | - Stephan Stoebe
- Department of Internal Medicine, Neurology, Dermatology, Clinic for Cardiology and Angiology, University Leipzig, Leipzig, Germany
| | - Thomas Ebert
- Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, Section of Nephrology, University Leipzig, Leipzig, Germany
| | - Silvana Feige
- Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, Section of Nephrology, University Leipzig, Leipzig, Germany
| | - Andreas Hagendorff
- Department of Internal Medicine, Neurology, Dermatology, Clinic for Cardiology and Angiology, University Leipzig, Leipzig, Germany
| | - Wilma Gertrud Rasche
- Department of Head Medicine and Oral Health, Department of Ophthalmology, University Leipzig, Leipzig, Germany
| | - Filip Barinka
- Center for Geriatric Medicine at Bezirksklinikum Regensburg, Universitätsstr. 84, 93053 Regensburg, Germany
| | - Volker Busch
- Center for Geriatric Medicine at Bezirksklinikum Regensburg, Universitätsstr. 84, 93053 Regensburg, Germany
| | - Ulrich Sack
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Jochen G. Schneider
- Translational & Experimental Medicine, Luxembourg Centre de Systems Biomedicine, Luxembourg City, Luxembourg
- Department of Internal Medicine II, Saarland University, Homburg Saar, Germany
| | - Stephan Schiekofer
- Center for Geriatric Medicine at Bezirksklinikum Regensburg, Universitätsstr. 84, 93053 Regensburg, Germany
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23
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Ikeda M, Honda H, Takahashi K, Shishido K, Shibata T. N-Terminal Pro-B-Type Natriuretic Peptide as a Biomarker for Loss of Muscle Mass in Prevalent Hemodialysis Patients. PLoS One 2016; 11:e0166804. [PMID: 27870908 PMCID: PMC5117720 DOI: 10.1371/journal.pone.0166804] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/03/2016] [Indexed: 12/24/2022] Open
Abstract
Protein-energy wasting (PEW) is common in hemodialysis (HD) patients. A recent study demonstrated that a high level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) may be associated with PEW in those patients. This prospective study aimed to assess the association of NT-proBNP with body composition and muscle loss. A cohort of prevalent HD patients (n = 238) was examined. Blood samples were obtained at baseline to measure high-sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), adiponectin and NT-proBNP. Nutritional status and changes in muscle mass were assessed by subjective global assessment, percentage creatinine generation rate (%CGR), creatinine index (CI) and lean body mass (LBM) estimated by dual-energy X-ray absorptiometry (DXA). The %CGR and CI were calculated five times for one year, and DXA was performed at baseline and one year later. Cardiac function was estimated by ultrasonography at baseline. NT-proBNP was significantly higher in HD patients with PEW. High NT-proBNP was associated with cardiac dysfunction, increased levels of hsCRP and IL-6, and serially decreased levels of the indexes for muscle mass. Multiple regression analysis adjusted with confounders showed that NT-proBNP was an independent predictor for decrease in LBM and serial lower levels of %CGR and CI. In conclusion, the present study demonstrated a novel association between NT-proBNP and muscle loss. NT-proBNP may be an independent biomarker for malnutrition in HD patients, especially in patients with muscles loss, regardless of chronic inflammation, cardiac dysfunction, or overhydration.
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Affiliation(s)
- Misa Ikeda
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hirokazu Honda
- Division of Nephrology, Department of Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan
- * E-mail:
| | - Keiko Takahashi
- Division of Dialysis, Kitami Higashiyama Clinic, Tokyo, Japan
| | - Kanji Shishido
- Department of Medicine, Kawasaki Clinic, Kawasaki, Japan
| | - Takanori Shibata
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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24
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Tangvoraphonkchai K, Davenport A. Do Bioimpedance Measurements of Over-Hydration Accurately Reflect Post-Haemodialysis Weight Changes? Nephron Clin Pract 2016; 133:247-52. [DOI: 10.1159/000447702] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/16/2016] [Indexed: 11/19/2022] Open
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Pre-dialysis and post-dialysis hydration status and N-terminal pro-brain natriuretic peptide and survival in haemodialysis patients. Int J Artif Organs 2016; 39:282-7. [PMID: 27515857 DOI: 10.5301/ijao.5000514] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE Many dialysis centres have no formal program for assessing and adjusting post-haemodialysis (HD) target weight. Apart from clinical assessment, there are bioimpedance devices and natriuretic peptides that could potentially aid clinical management. We wished to determine whether pre- or post-HD bioimpedance assessment of extracellular water (ECW) or N terminal probrain natriuretic peptide (NT-proBNP) affected patient outcomes. METHODS Multi-frequency bioimpedance assessments (MFBIA) were made before and after the midweek dialysis session, along with a post-dialysis NT-proBNP measurement. RESULTS Data from 362 patients, median age of 63 (50-76) years, 59.7% male, 41.2% Caucasoid, with a median dialysis vintage of 31.4 (13.5-61.7) months were available for review. During a median follow-up of 49.6 (21.9-50.2) months there were 110 (30.4%) deaths. Patients who died had significantly increased ECW, as % over-hydrated both pre-HD 6.6 (5.8-7.6)% vs. survivors 5.1 (4-6.6)%, and post-HD 5.1 (4-6.6)% vs. 0.5 (-1-2.2.0, p<0.001, respectively. They also had higher NT-proBNP 325 (122-791) vs. 102 (48-342) pmol/l, p = 0.002. Using an adjusted Cox model, pre-HD ECW overhydration remained an independent factor associated with mortality (overhydration %: hazard ratio 1.15, 95% limits 1.03-1.28, p = 0.013), with a receiver operator curve (ROC) value of 0.7. CONCLUSIONS ECW excess is associated with increased mortality for HD patients, with ECW excess pre-dialysis being the strongest association, although these patients also had increased ECW post dialysis. Future trials are required to determine whether achieving euvolaemia as determined by bioimpedance improves patient survival.
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