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Haroon S, Davenport A. The effect of changes in intra-compartmental bioimpedance measurements with early intra-dialytic hypotension during haemodialysis. Int J Artif Organs 2024:3913988241269444. [PMID: 39166424 DOI: 10.1177/03913988241269444] [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: 08/22/2024]
Abstract
INTRODUCTION Intra-dialytic hypotension (IDH) remains the commonest problem associated with routine haemodialysis treatments. Fluid shifts from intracellular(ICW) and extracellular(ECW) compartments to refill plasma volume during haemodialysis with ultrafiltration. METHODS We studied the effect of relative changes in ICW and ECW indifferent body segments using multifrequency segmental bioimpedance during haemodialysis and IDH episodes. RESULTS Of 42 haemodialysis patients,16 patients (38.1%) developed IDH within the first hour of dialysis. Patients with and without early IDH were well-matched for demographics and starting bioimpedance measurements. However, after 60 min, the relative change in in ECW/ICW ratio between the non-fistula arm and leg was significantly different for the early IDH group median -1.07 (-3.33 to 0.8) versus 0.61 (-0.78 to 1.8), p < 0.05, whereas there no differences in ultrafiltration rate, relative blood volume monitoring or on-line clearance. CONCLUSION Monitoring serial changes in fluid status in different body compartments with bioimpedance may potentially prevent IDH in the future.
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Affiliation(s)
- Sabrina Haroon
- Division of Nephrology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Andrew Davenport
- University College London, Department of Renal Medicine, Royal Free Hospital, London, UK
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Zhou X, Lin X, Yu J, Yang Y, Muzammel H, Amissi S, Schini-Kerth VB, Lei X, Jose PA, Yang J, Shi D. Effects of DASH diet with or without time-restricted eating in the management of stage 1 primary hypertension: a randomized controlled trial. Nutr J 2024; 23:65. [PMID: 38886740 PMCID: PMC11181626 DOI: 10.1186/s12937-024-00967-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 06/06/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Time-restricted eating (TRE), a popular form of intermittent fasting, has shown benefits for improving metabolic diseases and cardiometabolic health. However, the effect of TRE in the regulation of blood pressure in primary hypertension remains unclear. METHODS A 6-week randomized controlled trial was conducted, in which a total of 74 stage 1 primary hypertensive patients without high-risk were randomly assigned to Dietary Approaches to Stop Hypertension (DASH) group (n = 37) or DASH + TRE group (n = 37). Participants in the DASH + TRE group were instructed to consume their food within an 8-h window. Scientific research platform in We Chat application was used to track participants. The primary outcome was blood pressure. The secondary outcomes included body composition, cardiometabolic risk factors, inflammation-related parameters, urinary Na+ excretion, other clinical variables and safety outcomes. RESULTS The reduction of systolic blood pressure and diastolic blood pressure were 5.595 ± 4.072 and 5.351 ± 5.643 mm Hg in the DASH group and 8.459 ± 4.260 and 9.459 ± 4.375 mm Hg in the DASH + TRE group. DASH + TRE group improved blood pressure diurnal rhythm. Subjects in DASH + TRE group had decreased extracellular water and increased urinary Na+ excretion. Furthermore, the decrease in blood pressure was associated with a reduction of extracellular water or increase in urinary Na+ excretion. In addition, safety outcomes such as nighttime hunger were also reported. CONCLUSION Our study demonstrated that 8-h TRE + DASH diet caused a greater decrease in blood pressure in stage 1 primary hypertensive patients than DASH diet. This study may provide novel insights into the benefits of lifestyle modification in the treatment of primary hypertension. TRIAL REGISTRATION https://www.chictr.org.cn/ (ChiCTR2300069393, registered on March 15, 2023).
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Affiliation(s)
- Xiaoxin Zhou
- Research Center for Metabolic and Cardiovascular Diseases, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Clinical Nutrition, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Translational CardioVascular Medicine, Faculty of Pharmacy, UR 3074, University of Strasbourg, Strasbourg, France
| | - Xiaoqian Lin
- Research Center for Metabolic and Cardiovascular Diseases, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Clinical Nutrition, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Yu
- Department of Nutrition and Food Hygiene, School of Public Health, Chongqing Medical University, Chongqing, China
- Research Centre for Environment and Human Health, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Yi Yang
- Department of Logistics Management Division, Chongqing Medical University, Chongqing, China
| | - Hira Muzammel
- Translational CardioVascular Medicine, Faculty of Pharmacy, UR 3074, University of Strasbourg, Strasbourg, France
| | - Said Amissi
- Translational CardioVascular Medicine, Faculty of Pharmacy, UR 3074, University of Strasbourg, Strasbourg, France
| | - Valérie B Schini-Kerth
- Translational CardioVascular Medicine, Faculty of Pharmacy, UR 3074, University of Strasbourg, Strasbourg, France
| | - Xun Lei
- Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Pedro A Jose
- Department of Medicine and Department of Physiology and Pharmacology, Division of Renal Diseases and Hypertension, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jian Yang
- Research Center for Metabolic and Cardiovascular Diseases, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Department of Clinical Nutrition, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Dan Shi
- Department of Nutrition and Food Hygiene, School of Public Health, Chongqing Medical University, Chongqing, China.
- Research Centre for Environment and Human Health, School of Public Health, Chongqing Medical University, Chongqing, China.
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Davenport A. Why is Intradialytic Hypotension the Commonest Complication of Outpatient Dialysis Treatments? Kidney Int Rep 2023; 8:405-418. [PMID: 36938081 PMCID: PMC10014354 DOI: 10.1016/j.ekir.2022.10.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
Intradialytic hypotension (IDH) is the most frequent complication of hemodialysis (HD) treatments with a frequency of 10% to 12% for patients with chronic kidney disease attending for outpatient treatments and is associated with both temporary ischemic stress to vital organs, including the heart and brain, and increased patient mortality. Although there have been many different definitions of IDH over the years, an absolute nadir systolic blood pressure (SBP) has the strongest association with patient outcomes. The unifying pathophysiology is one of reduced effective blood volume, resulting in lower plasma tonicity, and if this cannot be adequately compensated for by activation of neurohumeral systems, then arteriolar tone and blood pressure fall. The risk factors for developing IDH are numerous, ranging from patient-related factors, including age and comorbidity with reduced cardiac reserve, to patient compliance with dietary and lifestyle advice, to reactions with the extracorporeal circuit and medications, choice of dialysate composition and temperature, setting of postdialysis target weight, ultrafiltration rate, and profiling. Advances in dialysis machine technology by providing real time estimates of the effective circulating volume and adjusting dialysate composition to maintain vascular tonicity are being developed, but currently require more sophisticated biofeedback loops to be clinically effective in preventing IDH. While awaiting advances in artificial intelligence, the clinician continues to rely on patient education to limit interdialytic weight gains, frequent assessment of the postdialysis target weight, adjusting dialysate composition and temperature, introducing convective therapies to increase thermal losses, and altering dialysis session duration and frequency to reduce ultrafiltration rate requirements.
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Affiliation(s)
- Andrew Davenport
- Department of Renal Medicine, Royal Free Hospital, Faculty of Medical Sciences, University College London, London, UK
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Li W, Li X, Huang T, Chen Y, Zhang H, Dai H, Wen Y. Normative reference data for body composition in healthy indigenous populations on the Qinghai-Tibet Plateau. Front Public Health 2022; 10:986720. [PMID: 36276374 PMCID: PMC9584638 DOI: 10.3389/fpubh.2022.986720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Body composition represents an important aspect of physical fitness and has received increasing attention in recent years. The present study was designed and conducted to provide reference values for age-, sex-, and altitude-specific body composition for healthy indigenous Tibetan adults living on the Qinghai-Tibet Plateau, which has not yet been studied. A cross-sectional survey was conducted among 2,356 healthy Tibetan adults (1,433 females and 923 males) living on the Qinghai-Tibet Plateau for generations. The body composition of the participants was measured by bioelectrical impedance analysis (BIA). The measurements included weight, basal metabolic rate (BMR), fat-free mass (FFM), skeletal muscle mass (SMM), protein mass (PM), bone mass (BM), fat mass (FM), percentage of body fat (PBF), subcutaneous fat mass (SFM), visceral fat mass (VFM), total body water (TBW), intracellular water (ICW), and extracellular water (ECW). Overall, males had greater FFM, SMM, PM, BM, and water mass, whereas females were high in fat mass. Participants from plains generally had higher body composition values, and PM, BM, FM and body water values decreased with increasing altitude, with the lowest values found in >4,000 m Shigatse. FFM, SMM, PM, and BM tended to decrease with increasing age, whereas fat mass and ECW tended to increase with increasing age. This study provides the first normative reference data of body composition for healthy indigenous individuals on the Qinghai-Tibet Plateau. These datasets are important for future research related to body composition. A considerable decrease in body composition values in > 4,000 m-altitude areas suggested that body composition cutoff values should be established by altitude. Age-, sex-, and altitude-specific alterations in body composition values also inform the prevention and amendment of abnormal body composition changes and resultant health complications.
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Affiliation(s)
- Wenhui Li
- Experimental Teaching Center of Basic Medicine, Jinzhou Medical University, Jinzhou, China
| | - Xin Li
- Institute of Biological Anthropology, Jinzhou Medical University, Jinzhou, China
| | - Ting Huang
- Institute of Biological Anthropology, Jinzhou Medical University, Jinzhou, China
| | - Ying Chen
- School of Public Health, Jinzhou Medical University, Jinzhou, China
| | - Hailong Zhang
- Experimental Teaching Center of Basic Medicine, Jinzhou Medical University, Jinzhou, China
| | - Hongliang Dai
- School of Nursing, Jinzhou Medical University, Jinzhou, China,*Correspondence: Hongliang Dai
| | - Youfeng Wen
- Institute of Biological Anthropology, Jinzhou Medical University, Jinzhou, China,Youfeng Wen
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