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Bozman DF, Bazin D, Lavainne F, Hamroun A, Couchoud C, Hannedouche T. Loop diuretics improve conditions of dialysis inception in advanced CKD: an observational cohort study. J Nephrol 2023; 36:2047-2056. [PMID: 37768547 DOI: 10.1007/s40620-023-01752-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/31/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Diuretics can reduce fluid overload but their effects on conditions of dialysis start remain elusive. We aimed to determine whether loop diuretics exposure in the year before inception can delay the need for dialysis, affect the conditions of dialysis start, and cause early mortality three months after initiation in pre-dialysis patients. METHODS All adult patients starting dialysis from 2009 to 2015 in the REIN registry were included. Three subgroups were defined according to diuretics exposure: "continuous", "stopped", or "no diuretics" over the year before inception and compared for pre-dialysis hospitalization rates, and 3-month mortality after dialysis. RESULTS Among 59,302 patients, we found fewer emergency initiations of dialysis in the continuous diuretics group than in the stopped diuretics and no diuretics groups: 9492 (27.5%) vs 1905 (32.3%) and 5226 (35.0%), respectively; p < 0.0001. In the continuous diuretics group, there were fewer starts on central venous catheters than in the stopped diuretics and no diuretics groups: 16,677 (49.4%) vs. 3246 (56.0%) vs. 8,639 (58.4%); p < 0.0001. Patients with continuous diuretic exposure had a lower hospitalization rate than the stopped diuretics group in the year prior to dialysis, except for heart failure. The unadjusted 3-month hazard ratio of mortality after dialysis inception was significantly higher in the "no diuretics" or "stopped diuretics" groups compared with "continuous diuretics", but the excess of risk was blunted after adjustment for emergency start and pre-dialysis visits to a nephrologist. CONCLUSION Continuous loop diuretics exposure in the year before dialysis was associated with better conditions of dialysis inception, and possibly lower mortality rates in the three months after inception.
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Affiliation(s)
- Dogan-Firat Bozman
- Department of Nephrology, Hôpitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, 67 000, Strasbourg, France
| | - Dorothée Bazin
- Department of Nephrology, Hôpitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, 67 000, Strasbourg, France
| | - Frédéric Lavainne
- Pôle Santé Atlantique-Association ECHO, Avenue Claude Bernard, 44800, Saint-Herblain, France
| | - Aghiles Hamroun
- Department of Nephrology, CHRU Lille, Rue Polonovski, 59800, Lille, France
| | - Cécile Couchoud
- Agence de Biomédecine, Registre REIN, 1 Avenue du Stade de France, 93212, Saint Denis La Plaine Cedex, France
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Radić J, Kolak E, Vučković M, Gelemanović A, Đogaš H, Bučan Nenadić D, Radić M. Assessment of Hydration, Nutritional Status and Arterial Stiffness in Hypertensive Chronic Kidney Disease Patients. Nutrients 2023; 15:2045. [PMID: 37432203 DOI: 10.3390/nu15092045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 07/12/2023] Open
Abstract
The aim of this cross-sectional study was to determine the body fluid volume in patients diagnosed with both chronic kidney disease (CKD) and arterial hypertension (AH), and to investigate the relationship between fluid overload (FO), nutritional status and arterial stiffness in this specific patient population. A total of 169 participants with CKD and AH were enrolled in the study, and data on general parameters, comorbidities, medication use, and laboratory parameters were collected. Body composition was assessed with a Tanita MC 780 device, and data on the central and peripheral systolic and diastolic blood pressure, as well as pulse wave velocity (PWV) and the augmentation index (AIx) were collected with an IEM Mobil-O-Graph 24 h ambulatory blood pressure monitor, which was based on oscillometry. The Mediterranean Diet Serving Score (MDSS) questionnaire was used to determine the adherence to the Mediterranean diet (MeDi). Our results showed that the significant positive predictors of hydration status were the use of diuretics and oral hypoglycemic agents, whereas the negative predictors were female sex, higher body mass index level and use of two or more antihypertensives in the form of a single-pill combination. We also found differences in blood pressure and arterial stiffness parameters in relation to volume status, along with differences based on the presence of diabetes mellitus (DM). In conclusion, these results call for a higher awareness of volume status in the care of CKD patients with AH, especially in those with diabetes mellitus.
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Affiliation(s)
- Josipa Radić
- Internal Medicine Department, Nephrology and Haemodialysis Division, University Hospital Centre Split, 21000 Split, Croatia
- Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia
| | - Ela Kolak
- Nutrition and Dietetics Department, University Hospital Centre Split, 21000 Split, Croatia
| | - Marijana Vučković
- Internal Medicine Department, Nephrology and Haemodialysis Division, University Hospital Centre Split, 21000 Split, Croatia
| | - Andrea Gelemanović
- Mediterranean Institute for Life Sciences (MedILS), 21000 Split, Croatia
| | - Hana Đogaš
- Internal Medicine Department, Nephrology and Haemodialysis Division, University Hospital Centre Split, 21000 Split, Croatia
| | - Dora Bučan Nenadić
- Nutrition and Dietetics Department, University Hospital Centre Split, 21000 Split, Croatia
| | - Mislav Radić
- Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia
- Internal Medicine Department, Rheumatology, Allergology and Clinical Immunology Division, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital Centre Split, 21000 Split, Croatia
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Kameda Y, Suzuki Y, Sugai M, Ishinabe K, Fukuoka N. Comment on: Long-term hemodialysis improved and stabilized diabetic macular edema: two case reports. Int J Ophthalmol 2022; 15:1891-1892. [PMID: 36404974 PMCID: PMC9631177 DOI: 10.18240/ijo.2022.11.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/14/2022] [Indexed: 12/18/2022] Open
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Low S, Pek S, Liu YL, Moh A, Ang K, Tang WE, Lim Z, Subramaniam T, Sum CF, Lim CL, Ali Y, Lim SC. Higher extracellular water to total body water ratio was associated with chronic kidney disease progression in type 2 diabetes. J Diabetes Complications 2021; 35:107930. [PMID: 33902998 DOI: 10.1016/j.jdiacomp.2021.107930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/29/2021] [Accepted: 04/11/2021] [Indexed: 01/14/2023]
Abstract
AIM We studied the association between extracellular volume status and chronic kidney disease (CKD) progression; and the role of extracellular volume excess as a potential mediator in the relationship between matrix metalloproteinases (MMP)-2 and CKD progression in Type 2 diabetes mellitus (T2DM). METHODS We conducted a prospective cohort study of 1079 T2DM patients. Bioelectrical impedance analysis (BIA) was performed to assess body fluid status. RESULTS After up to 8.6 years of follow-up, 471 (43.7%) patients experienced CKD progression. In the fully adjusted model, extracellular water (ECW)/ total body water (TBW)ratios 0.39-0.40 and > 0.40 were associated with 45% and 78% higher risk of CKD progression respectively. Patients with an increase in ECW/TBW ratio had 40% higher risk of CKD progression compared to those with no change or reduction of ECW/TBW ratio. Higher ECW/TBW ratio accounted for 17.4% of the relationship between MMP-2 and CKD progression in T2DM (p = 0.026). CONCLUSIONS Extracellular volume excess was independently associated with CKD progression in T2DM. Higher ECW/TBW ratio mediated the positive association between MMP-2 and CKD progression. Further studies are needed to elucidate the role of extracellular volume excess in deterioration of renal function.
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Affiliation(s)
- Serena Low
- Diabetes Centre, Admiralty Medical Centre, Singapore, Block 676, Level 4, Kampung Admiralty, Woodlands Drive 71, 730676, Singapore; Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, 90 Yishun Central, 768828, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore
| | - Sharon Pek
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, 90 Yishun Central, 768828, Singapore
| | - Yan Lun Liu
- Department of General Medicine, Khoo Teck Puat Hospital, Singapore, 90 Yishun Central, Singapore
| | - Angela Moh
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, 90 Yishun Central, 768828, Singapore
| | - Keven Ang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, 90 Yishun Central, 768828, Singapore
| | - Wern Ee Tang
- National Healthcare Group Polyclinics, Singapore, 3 Fusionopolis Link, Nexus@one-north, South Tower, 138543, Singapore
| | - Ziliang Lim
- National Healthcare Group Polyclinics, Singapore, 3 Fusionopolis Link, Nexus@one-north, South Tower, 138543, Singapore
| | - Tavintharan Subramaniam
- Diabetes Centre, Admiralty Medical Centre, Singapore, Block 676, Level 4, Kampung Admiralty, Woodlands Drive 71, 730676, Singapore
| | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre, Singapore, Block 676, Level 4, Kampung Admiralty, Woodlands Drive 71, 730676, Singapore
| | - Chin Leong Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore
| | - Yusuf Ali
- Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore
| | - Su Chi Lim
- Diabetes Centre, Admiralty Medical Centre, Singapore, Block 676, Level 4, Kampung Admiralty, Woodlands Drive 71, 730676, Singapore; Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, 90 Yishun Central, 768828, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore.
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Liu AYL, Pek S, Low S, Moh A, Ang K, Tang WE, Lim Z, Subramaniam T, Sum CF, Lim SC. Association of overhydration and serum pigment epithelium-derived factor with CKD progression in diabetic kidney disease: A prospective cohort study. Diabetes Res Clin Pract 2021; 174:108754. [PMID: 33741351 DOI: 10.1016/j.diabres.2021.108754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 12/01/2022]
Abstract
AIM Little is known about whether overhydration (OH), measured using bioimpedance assay (BIA), is associated with CKD progression in patients with type 2 diabetes mellitus (T2DM). We hypothesised that OH was a predictor, and pigment epithelium-derived factor (PEDF) was a modifiable risk factor of CKD progression. METHODS We conducted a prospective cohort study of 1,065 patients with clinically euvolemic T2DM who attended the diabetes centre in a tertiary hospital or primary care clinic. CKD progression was defined as a combination of the worsening of the KDIGO defined CKD category by eGFR and a ≥25% decline in eGFR compared to baseline. RESULTS Patients with T2DM in the highest tertile of OH and relative OH (OH/ extracellular water > 7%) were positively associated with CKD progression (hazard ratio [HR] 1.45 [95% confidence interval (CI) 1.14-1.85; p = 0.003 and HR 1.29 [95%CI 1.05-1.59; p = 0.017]). There were positive associations between PEDF and CKD progression (β = 1.10; p = 0.001) and between OH and CKD progression (β = 0.21; p = 0.036). OH remained positively associated with CKD progression mediated by PEDF. CONCLUSIONS OH is an independent risk factor for CKD progression in patients with T2DM. Our study supports the novel definition of PEDF as a positive mediator between OH and CKD progression.
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Affiliation(s)
- Allen Yan Lun Liu
- Department of General Medicine, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore
| | - Sharon Pek
- Clinical Research Unit, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
| | - Serena Low
- Clinical Research Unit, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
| | - Angela Moh
- Clinical Research Unit, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
| | - Keven Ang
- Clinical Research Unit, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
| | - Wern Ee Tang
- National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north, South Tower, Singapore 138543, Singapore
| | - Ziliang Lim
- National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north, South Tower, Singapore 138543, Singapore
| | - Tavintharan Subramaniam
- Diabetes Centre, Admiralty Medical Centre, Block 676, Level 4, Kampung Admiralty, Woodlands Drive 71, Singapore 730676, Singapore
| | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre, Block 676, Level 4, Kampung Admiralty, Woodlands Drive 71, Singapore 730676, Singapore
| | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore; Diabetes Centre, Admiralty Medical Centre, Block 676, Level 4, Kampung Admiralty, Woodlands Drive 71, Singapore 730676, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.
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Muli S, Meisinger C, Heier M, Thorand B, Peters A, Amann U. Prevalence, awareness, treatment, and control of hypertension in older people: results from the population-based KORA-age 1 study. BMC Public Health 2020; 20:1049. [PMID: 32616004 PMCID: PMC7331188 DOI: 10.1186/s12889-020-09165-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/24/2020] [Indexed: 01/10/2023] Open
Abstract
Background Hypertension remains a significant modifiable risk factor for cardiovascular diseases and a major determinant of morbidity and mortality. We aimed to describe sex-stratified age-standardized estimates of prevalence, awareness, treatment and control of hypertension, and their associated factors in older adults. Methods The KORA-Age1 is a population-based cross-sectional survey carried out in 2008/2009 on individuals aged 65–94 years in Augsburg region, Germany. Blood pressure measurements were available for 1052 out of 1079 persons who participated in the physical examination. Factors associated with prevalence, awareness and control of hypertension were investigated by multivariable logistic regression. Results The overall prevalence of hypertension (≥140/90 mmHg) was 73.8% [95% confidence interval (CI), 69.3–77.9], representing 74.8% (95% CI, 68.4–80.2) in men and 73.5% (95% CI, 66.8–79.3) in women. Among those with hypertension, 80.2% (95% CI, 75.3–84.4) were aware of their hypertensive condition and 74.4% (95% CI, 69.2–79.1) were on treatment for hypertension. Among those aware of their hypertension status, 92.8% (95% CI, 88.8–95.6) were on treatment and 53.7% (95% CI, 47.0–60.1) had their blood pressure controlled. Hypertension was more frequent in individuals who were older, obese, or had diabetes. Higher education attainment or presence of comorbidities was associated with higher level of hypertension awareness. Individuals taking three antihypertensive drug classes were more likely to have controlled hypertension compared with those taking one antihypertensive drug class, odds ratio (OR), 1.85 (95% CI, 1.14–2.99). Conclusion Our findings identified high prevalence of hypertension and relevant health gaps on awareness, treatment and suboptimal control of hypertension in older adults in Germany. Screening for hypertension should especially target older adults with low educational attainment and ‘healthy’ elderly with less contact to physicians.
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Affiliation(s)
- Samuel Muli
- Institute for Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Independent Research Group Clinical Epidemiology, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
| | - Christa Meisinger
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Independent Research Group Clinical Epidemiology, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T, Augsburg, Germany
| | - Margit Heier
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology, Neuherberg, Germany.,University Hospital of Augsburg, KORA Study Centre, Augsburg, Germany
| | - Barbara Thorand
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology, Neuherberg, Germany
| | - Annette Peters
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology, Neuherberg, Germany
| | - Ute Amann
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Independent Research Group Clinical Epidemiology, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T, Augsburg, Germany
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Moralidis E, Papanastasiou E, Didangelos T, Hilidis I, Siountas A, Arsos G. Determination of the glomerular filtration rate in patients with type 2 diabetes: An assessment of the agreement between 51Cr-EDTA plasma clearance and 99mTc-DTPA plasma clearance, 99mTc-DTPA renography and plasma creatinine prediction equation. Diabetes Res Clin Pract 2020; 161:108079. [PMID: 32057963 DOI: 10.1016/j.diabres.2020.108079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
AIMS To investigate the agreement of glomerular filtration rate (GFR) determination between 51Cr-ethylenediaminetetraacetic acid (51Cr-EDTA) plasma clearance (GFREDTA) and 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) plasma clearance (GFRDTPA), the Gates 99mTc-DTPA renographic method (GFRGates) and the serum creatinine Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI, GFRSCr) in patients with type 2 diabetes mellitus (T2DM). METHODS Ninety-nine T2DM patients underwent GFR determinations simultaneously with 51Cr-EDTA and 99mTc-DTPA (using the slope-intercept technique and the Brochner-Mortensen correction) and also with GFRGates and GFRSCr. RESULTS In the comparison between GFREDTA versus GFRDTPA, GFRGates and GFRSCr, the Bland-Altman statistic provided 0.0 ± 13.2, 17.4* ± 28.8 and -5.9* ± 30.1 (*p < 0.001 for the difference from 0). Lin's concordance correlation coefficient showed substantial (0.976), poor (0.737) and poor (0.872) agreement, respectively. The proportion of the index results within the 30% and 10% of GFREDTA measurements were 95% and 74% for GFRDTPA, 53% and 19% for GFRGates, and 83% and 26% for GFRSCr, respectively. CONCLUSION In T2DM patients, a clinically acceptable agreement is demonstrated between 51Cr-EDTA and 99mTc-DTPA plasma clearance for GFR measurements, suggesting conditional interchangeability between those compounds. Both the CKD-EPI prediction equation and the Gates' renographic method cannot assess GFR reliably, the latter appearing less unfailing than the former.
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Affiliation(s)
- Efstratios Moralidis
- Department of Nuclear Medicine, Papageorgiou Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Ring Road, Nea Efkarpia, 56429 Thessaloniki, Greece.
| | - Emmanouil Papanastasiou
- Laboratory of Medical Physics, AHEPA University Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 1 Stilponos Kyriakidi Str, 54636 Thessaloniki, Greece.
| | - Triantafyllos Didangelos
- 1st Propedeutic Department of Internal Medicine, AHEPA University Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 1 Stilponos Kyriakidi Str, 54636 Thessaloniki, Greece.
| | - Ilias Hilidis
- Department of Nuclear Medicine, AHEPA University Hospital, Thessaloniki, 1 Stilponos Kyriakidi Str, 54636 Thessaloniki, Greece
| | - Anastasios Siountas
- Laboratory of Medical Physics, AHEPA University Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 1 Stilponos Kyriakidi Str, 54636 Thessaloniki, Greece.
| | - Georgios Arsos
- Department of Nuclear Medicine, Papageorgiou Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Ring Road, Nea Efkarpia, 56429 Thessaloniki, Greece.
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Ruperto M, Sánchez-Muniz FJ, Barril G. Extracellular mass to body cell mass ratio as a potential index of wasting and fluid overload in hemodialysis patients. A case-control study. Clin Nutr 2019; 39:1117-1123. [PMID: 31060893 DOI: 10.1016/j.clnu.2019.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/02/2019] [Accepted: 04/16/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND & AIMS Extracellular mass-to-body cell mass ratio (ECM/BCM ratio) which differentiates the proportion between intraextracellular compartments, could be a nutrition index of being wasted overloaded in hemodialysis (HD) patients. This study aimed to describe a cut-off point of the ECM/BCM ratio and, to find out the relationship between the nutritional-hydration status and this ratio in HD patients. METHODS A case-control study was carried out in 64 HD patients individually age-gender-matched to controls. Demographic, clinical and laboratory parameters were recorded. Bioelectrical impedance analysis was used to estimate ECM/BCM ratio as an indicator of the nutritional hydration status. Receiver operator characteristic (ROC) curve analysis was applied to determine the optimal cut-off point for identification of ECM/BCM ratio. An univariate and multivariate conditional logistic regression for the ECM/BCM ratio ≥1.20 was performed. RESULTS Median of ECM/BCM ratio was 1.50 (IQR:0.66) in HD patients, whereas 0.87 (IQR: 0.35) was found in controls (p < 0.001). HD-patients had lower body weight, serum albumin (s-albumin) and higher serum C-reactive protein (s-CRP) than controls. By ROC curve analysis, a cut-off point of 1.20 for the ECM/BCM ratio best discriminates to be wasted-overhydrated (sensitivity: 81.2%; specificity: 87.5%). Conditional logistic regression showed that for each 10%, ECM/BCM ratio increase the probability of developing fluid overload was increased 63% (OR: 1.63; 95% CI, 1.15-2.29), whereas an inverse association with s-albumin (OR: 0.15; 95% CI, 0.03-0.61) and other nutritional indicators were found. CONCLUSIONS The ECM/BCM ratio appears as a sensitive index that discriminates nutritional and/or hydration status in HD patients compared with age-gender-matched-controls. ECM/BCM ratios ≥1.20 are indicators of wasting and fluid overload in HD patients.
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Affiliation(s)
- Mar Ruperto
- Human Nutrition Department, Faculty of Health Sciences, University Alfonso X el Sabio, 28697, Villanueva de la Cañada, Madrid, Spain.
| | - Francisco J Sánchez-Muniz
- Nutrition and Bromatology Department (Nutrition), Faculty of Pharmacy, Universidad Complutense de Madrid, Spain
| | - Guillermina Barril
- Nephrology Department, Hospital Universitario La Princesa, Madrid, Spain
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Agustiyowati THR, Sitorus R, Waluyo A, Besral B. The Effectiveness of Roy’s Adaptation Model for Patients with Chronic Kidney Disease Undergoing Pre-Dialysis in Indonesia. JURNAL NERS 2019. [DOI: 10.20473/jn.v13i2.7836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Patients with chronic kidney disease (CKD) undergoing pre-dialysis requires a good self-management to control low protein intake and maintain kidney function. Adaptation to the existing stimulus through coping and adjustment mechanisms is important to maintaining good kidney function. However, few studies applied nursing theory based to guide intervention in helping the adaptation of patient CKD with their condition. The purpose of this study is to evaluate the effectiveness of Roy’s adaptation model towards physiological and psychological adaptation response among patients with CKD undergoing pre-dialysis.Methods: This study was conducted using a quasi-experiment to patients with CKD pre-dialysis, age over 18 years old. We modified Roy’s adaptation model for patients with CKD undergoing pre-dialysis.Results: A total of 70 subjects agreed to join the study, 38 subjects in intervention and 32 subjects in the control group. The mean of eGFR ranged from 26.3 to 26.6 mL/min/1.73 m2. We found that Roy’s adaptation model has significantly improved drinking behavior, reduce protein intake, blood creatinine, and psychosocial adaptation response after the intervention.Conclusion: These study findings suggested that Roy’s adaptation model is effective to help patients with CKD undergoing pre-dialysis improve their behavior and maintain kidneyfunction . Model dissemination, advocacy to related units, and application in nursing care in patients with chronic kidney disease pre-dialysis are necessary.
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Hwang SD, Lee JH, Lee SW, Kim JK, Kim MJ, Song JH. Risk of overhydration and low lean tissue index as measured using a body composition monitor in patients on hemodialysis: a systemic review and meta-analysis. Ren Fail 2018; 40:51-59. [PMID: 29347876 PMCID: PMC6014525 DOI: 10.1080/0886022x.2017.1419963] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Overhydration and sarcopenia, related to an individual's nutritional status, have been associated with increased cardiovascular mortality and poor prognosis in patients on hemodialysis. The purpose of this study was to investigate the prediction of overhydration and sarcopenia on mortality in patients on hemodialysis using a body composition monitor. We conducted a systematic review and meta-analysis using a random-effects model. We searched the Cochrane Central Register, OVID MEDLINE, EMBASE and PubMed databases for all studies published prior to December 9, 2016 and reviewed the reference lists of relevant reviews, registered trials and relevant conference proceedings. The overhydration group (fluid excess, >15% vs. the normohydration group) and the low lean tissue index group ( <10%) were compared with a reference group. Six trials, consisting of 29,469 patients, were included in the pooled analysis. The pooled hazard ratio for overall survival of the overhydration group, compared with the reference normohydration group was 1.798 (95% confidence interval [CI]: 1.53-2.804, p = .001). The hazard ratio for mortality in the low lean tissue index group was 1.533 (95% CI, 1.411-1.644; p = .001) in the random-effects model. The results from the most recent study showed the greatest heterogeneity in the sensitivity analysis. Low lean tissue index and overhydration, measured using a body composition monitor, were associated with a high mortality rate in patients on hemodialysis.
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Affiliation(s)
- Seun Deuk Hwang
- a Division of Nephrology and Hypertension, Department of Internal Medicine , Inha University College of Medicine , Incheon , Korea
| | - Jin Ho Lee
- b Divison of Nephrology, Department of Internal Medicine , Bong Seng Memorial Hospital , Busan , Korea
| | - Seoung Woo Lee
- a Division of Nephrology and Hypertension, Department of Internal Medicine , Inha University College of Medicine , Incheon , Korea
| | - Joong Kyung Kim
- b Divison of Nephrology, Department of Internal Medicine , Bong Seng Memorial Hospital , Busan , Korea
| | - Moon-Jae Kim
- a Division of Nephrology and Hypertension, Department of Internal Medicine , Inha University College of Medicine , Incheon , Korea
| | - Joon Ho Song
- a Division of Nephrology and Hypertension, Department of Internal Medicine , Inha University College of Medicine , Incheon , Korea
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Hao G, Lu W, Huang J, Ding W, Wang P, Wang L, Ding F, Hu M, Hou L. Predialysis fluid overload linked with quality of sleep in patients undergoing hemodialysis. Sleep Med 2018; 51:140-147. [PMID: 30165338 DOI: 10.1016/j.sleep.2018.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/04/2018] [Accepted: 07/23/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Hemodialysis (HD) patients are exposed to dysregulated fluid balance which can lead to overhydration. Poor sleep quality and excessive daytime sleepiness are particularly common in these patients, however the relationship between fluid status and sleep quality and daytime sleepiness has not yet been studied. Therefore, the aim of this study is to evaluate the correlations between fluid status and sleep quality and daytime sleepiness in HD patients. METHOD This cross-sectional study included 115 HD patients and 30 healthy control subjects from the HD center of Shanghai Ninth People's Hospital. Fluid compartments [total body water (TBW)], extracellular water (ECW)] and overhydration index (OH) were analyzed by multifrequency bio-impedance (BCM). Overhydration was defined as OH/ECW≥7%. HD patients were divided into an overhydration group and non overhydration group according to OH/ECW. Sleep quality was assessed by the Chinese version of the Pittsburgh Sleep Quality Index (PSQI), and excessive daytime sleepiness was evaluated by the Epworth Sleepiness Scale (ESS). RESULTS The prevalence rate of fluid overload in HD patients was 65.2%. Poor sleep quality (PSQI≥5) and excessive daytime sleepiness (ESS≥11) were significantly higher in HD patients compared with the healthy controls [6 (3, 10) vs.2.11 ± 1.59, p = 0.000; 3 (0, 6) vs.1.68 ± 1.07, p = 0.045]. Furthermore, the PSQI scores were higher in HD patients with overhydration (7.8 ± 4.5 vs. 4.8 ± 3.2, p = 0.000). The component scores 1, 2, 3 and 5 of the PSQI showed significant differences between the overhydration and non overhydration groups. The ESS scores did not show differences between the two groups (3.9 ± 4.1 vs. 3.3 ± 3.5, p = 0.508). OH was correlated with Systolic BP and Diastolic BP, and additionally was an independent predictor of poor sleep quality. CONCLUSION Fluid overload is significantly linked with poor quality of sleep in HD patients, however there is no association with excessive daytime sleepiness. Our study provides new insight into possible treatment strategies. Future studies should examine the effects of optimizing fluid status on quality of sleep.
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Affiliation(s)
- Guihua Hao
- Division of Surgical Intensive Care Unit, Shanghai Ninth People's Hospital, School of Medicine, Shanghai jiaotong University, China
| | - Wei Lu
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai jiaotong University, China
| | - Jie Huang
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai jiaotong University, China
| | - Wei Ding
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai jiaotong University, China
| | - Pengfei Wang
- Division of Surgical Intensive Care Unit, Shanghai Ninth People's Hospital, School of Medicine, Shanghai jiaotong University, China
| | - Lili Wang
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai jiaotong University, China
| | - Feng Ding
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai jiaotong University, China
| | - Min Hu
- Division of Surgical Intensive Care Unit, Shanghai Ninth People's Hospital, School of Medicine, Shanghai jiaotong University, China.
| | - Lili Hou
- Department of Nursing, Shanghai Ninth People's Hospital, School of Medicine, Shanghai jiaotong University, Shanghai 200011, China.
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Fernandes MIDCD, Bispo MDM, Leite ÉMD, Lopes MVDO, da Silva VM, Lira ALBDC. Diagnostic accuracy of the defining characteristics of the excessive fluid volume diagnosis in hemodialysis patients. Rev Lat Am Enfermagem 2018; 23:1057-64. [PMID: 26625996 PMCID: PMC4664005 DOI: 10.1590/0104-1169.0380.2649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 05/30/2015] [Indexed: 12/26/2022] Open
Abstract
Objective: to evaluate the accuracy of the defining characteristics of the excess fluid
volume nursing diagnosis of NANDA International, in patients undergoing
hemodialysis. Method: this was a study of diagnostic accuracy, with a cross-sectional design, performed
in two stages. The first, involving 100 patients from a dialysis clinic and a
university hospital in northeastern Brazil, investigated the presence and absence
of the defining characteristics of excess fluid volume. In the second step, these
characteristics were evaluated by diagnostic nurses, who judged the presence or
absence of the diagnosis. To analyze the measures of accuracy, sensitivity,
specificity, and positive and negative predictive values were calculated. Approval
was given by the Research Ethics Committee under authorization No. 148.428. Results: the most sensitive indicator was edema and most specific were pulmonary
congestion, adventitious breath sounds and restlessness. Conclusion: the more accurate defining characteristics, considered valid for the diagnostic
inference of excess fluid volume in patients undergoing hemodialysis were edema,
pulmonary congestion, adventitious breath sounds and restlessness. Thus, in the
presence of these, the nurse may safely assume the presence of the diagnosis
studied.
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Affiliation(s)
| | | | - Érida Maria Diniz Leite
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
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Vega A, Abad S, Macías N, Aragoncillo I, García-Prieto A, Linares T, Torres E, Hernández A, Luño J. Any grade of relative overhydration is associated with long-term mortality in patients with Stages 4 and 5 non-dialysis chronic kidney disease. Clin Kidney J 2018; 11:372-376. [PMID: 29942502 PMCID: PMC6007594 DOI: 10.1093/ckj/sfy018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/06/2018] [Indexed: 12/27/2022] Open
Abstract
Background Overhydration (OH) is associated with mortality in chronic kidney disease (CKD). A relative overhydration adjusted for extracellular water (OH/ECW) measured by bioimpedance >15% has shown an increased mortality risk in haemodialysis but few studies have been developed in advanced CKD. Our objective was to evaluate the effect of OH on mortality in patients with Stage 4 or 5 non-dialysis CKD. Methods We performed a prospective study of 356 patients enrolled in 2011 and followed up until 2016. At baseline we collected general characteristics, serum inflammatory and nutrition markers, cardiovascular events (CVEs) and body composition using bioimpedance spectroscopy. During a median follow-up of 50 (24–66) months we collected mortality data. Results The mean creatinine was 3.5 ± 1.3 mg/dL, median proteinuria was 0.5 [interquartile range (IQR) 0.2–1.5] g/24 h, median OH was 0.6 (IQR −0.4–1.5) L and mean relative OH (OH/ECW) was 2.3 ± 0.8%. We found that 32% of patients died. The univariate Cox analysis showed an association between mortality and age, diabetes, previous CVEs, Charlson comorbidity index, low albumin and pre-albumin, high C-reactive protein (CRP), low lean tissue and high OH/ECW. Multivariate Cox analysis confirmed an association between mortality and age {exp(B) 1.1 [95% confidence interval (CI) 1.0–1.3]; P = 0.001}, Charlson comorbidity index [exp(B) 1.1 (95% CI 1.0–1.2); P = 0.01], CRP [exp(B) 1.1 (95% CI 1.0–1.2); P = 0.04], OH/ECW [exp(B) 3.18 (95% CI 2.09–4.97); P = 0.031] and low lean tissue [exp(B) 0.82 (95% CI 0.69–0.98); P = 0.002]. Kaplan–Meier analysis confirmed higher mortality in patients with OH/ECW >0% (log rank 11.1; P = 0.001). Conclusion Any grade of relative OH measured by OH/ECW >0% is associated with long-term mortality in patients with Stage 4 or 5 non-dialysis CKD.
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Affiliation(s)
- Almudena Vega
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Soraya Abad
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nicolás Macías
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Inés Aragoncillo
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana García-Prieto
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Tania Linares
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Esther Torres
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Andrés Hernández
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Luño
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Esmeray K, Dizdar OS, Erdem S, Gunal Aİ. Effect of Strict Volume Control on Renal Progression and Mortality in Non-Dialysis-Dependent Chronic Kidney Disease Patients: A Prospective Interventional Study. Med Princ Pract 2018; 27:420-427. [PMID: 30149377 PMCID: PMC6243950 DOI: 10.1159/000493268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 08/27/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE The aim of this study was to examine the effect of volume status on the progressions of renal disease in normovolemic and hypervolemic patients with advanced non-dialysis-dependent chronic kidney disease (CKD) who were apparently normovolemic in conventional physical exam-ination. MATERIALS AND METHODS This was a prospective interventional study performed in a group of stage 3-5 CKD patients followed up for 1 year. Three measurements were made for volume and renal status for every patient. The fluid status was assessed by a bioimpedance spectroscopy method. A blood pressure (BP) value > 130/80 mm Hg prompted the initiation or dose increment of diuretic treatment in normovolemic patients. RESULT Forty-eight patients (48%) were hypervolemic. At the end of the 1-year follow-up, hypervolemic patients were found to have a significantly lower estimated glomerular filtration rate and higher systolic BP compared to baseline. Hypervolemia was associated with an increased incidence of death. CONCLUSION We have shown that maintenance of normovolemia with diuretic therapy in normovolemic patients was able to slow down and even improve the progression of renal disease. Volume overload leads to an increased risk for dialysis initiation and a decrease in renal function in advanced CKD. Volume overload exhibits a stronger association with mortality in CKD patients.
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Affiliation(s)
- Kubra Esmeray
- Division of Nephrology, Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
- *Dr. Kubra Esmeray, Kayseri Training and Research Hospital, Atatürk Avenue Hastane No. 78, Kocasinan, TR-38010 Kayseri (Turkey), E-Mail
| | - Oguzhan Sıtkı Dizdar
- Division of Nephrology, Department of Internal Medicine and Clinical Nutrition, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Selahattin Erdem
- Division of Nephrology, Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ali İhsan Gunal
- Division of Nephrology, Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
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Khan YH, Sarriff A, Adnan AS, Khan AH, Mallhi TH. Chronic Kidney Disease, Fluid Overload and Diuretics: A Complicated Triangle. PLoS One 2016; 11:e0159335. [PMID: 27442587 PMCID: PMC4956320 DOI: 10.1371/journal.pone.0159335] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/30/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Despite promising role of diuretics to manage fluid overload among chronic kidney disease (CKD) patients, their use is associated with adverse renal outcomes. Current study aimed to determine the extent of renal deterioration with diuretic therapy. METHODS A total 312 non-dialysis dependent CKD (NDD-CKD) patients were prospectively followed-up for one year. Fluid overload was assessed via bioimpedance spectroscopy. Estimated GFR (eGFR) was calculated from serum creatinine values by using Chronic Kidney Disease- Epidemiology Collaboration (CKD-EPI) equation. RESULTS Out of 312 patients, 64 (20.5%) were hypovolemic while euvolemia and hypervolemia were observed in 113 (36.1%) and 135 (43.4%) patients. Overall 144 patients were using diuretics among which 98 (72.6%) were hypervolemic, 35 (30.9%) euvolemic and 11 (17.2%) were hypovolemic. The mean decline in estimated GFR of entire cohort was -2.5 ± 1.4 ml/min/1.73m2 at the end of follow up. The use of diuretics was significantly associated with decline in eGFR. A total of 36 (11.5%) patients initiated renal replacement therapy (RRT) and need of RRT was more profound among diuretic users. CONCLUSIONS The use of diuretics was associated with adverse renal outcomes indicated by decline in eGFR and increasing risk of RRT initiation in our cohort of NDD-CKD patients. Therefore, it is cautiously suggested to carefully prescribe diuretics by keeping in view benefit versus harm for each patient.
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Affiliation(s)
- Yusra Habib Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, 11800, Malaysia
- Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerain, 16150, Kelantan, Malaysia
| | - Azmi Sarriff
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, 11800, Malaysia
| | - Azreen Syazril Adnan
- Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerain, 16150, Kelantan, Malaysia
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, 11800, Malaysia
| | - Tauqeer Hussain Mallhi
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, 11800, Malaysia
- Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerain, 16150, Kelantan, Malaysia
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16
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Diuretics prescribing in chronic kidney disease patients: physician assessment versus bioimpedence spectroscopy. Clin Exp Nephrol 2016; 21:488-496. [DOI: 10.1007/s10157-016-1303-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
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Abreo AP, Dalrymple LS, Chertow GM, Kaysen GA, Herzog CA, Johansen KL. Predialysis volume overload and patient-reported sleep duration and quality in patients receiving hemodialysis. Hemodial Int 2016; 21:133-141. [PMID: 27346666 DOI: 10.1111/hdi.12446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previous studies of patients with end-stage renal disease have examined the role of fluid shifts on apnea-hypopnea episodes, but the association between volume overload and patient-reported sleep quality or duration has not been well-established. METHODS We studied the association between predialysis bioimpedance spectroscopy-derived volume estimates and self-reported sleep quality and duration in 638 patients in the United States Renal Data System ACTIVE/ADIPOSE study receiving hemodialysis from 2009 to 2011. We used questionnaires to assess self-reported sleep duration and quality. We used relative hydration status (fluid overload/extracellular water; FO/ECW) as the primary predictor and examined associations with hours of sleep duration using linear regression. We used multivariable ordinal logistic regression to determine the association between categories of relative hydration status (normal hydration [FO/ECW < 6.8%], mild overhydration [FO/ECW 6.8%-15%], and hyperhydration [FO/ECW > 15%]) and four levels of difficulty with falling asleep, waking, and returning to sleep. FINDINGS Higher relative hydration status was associated with fewer hours of sleep (-0.31 hours per 10%, 95% confidence interval (CI) -0.49 to -0.13). Compared to the normal hydration group, there was a statistically significant association between higher relative hydration status category and more frequent nighttime waking (OR: mild overhydration 1.92 [95% CI 1.23-2.99], hyperhydration 1.87 [95% CI 1.16-2.99]), a trend toward more difficulty returning to sleep (OR: mild overhydration 1.46 [95% CI 0.94-2.27], hyperhydration 1.52 [95% CI 0.95-2.43]), and no association between relative hydration category and difficulty falling asleep. DISCUSSION Hydration status was associated with self-reported sleep duration in patients on dialysis. Future studies should prospectively examine the effects of optimizing fluid status on sleep duration and quality.
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Affiliation(s)
- Adrian P Abreo
- Division of Nephrology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, Louisiana, USA
| | - Lorien S Dalrymple
- Division of Nephrology, University of California Davis, Davis, California, USA
| | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - George A Kaysen
- Division of Nephrology, University of California Davis, Davis, California, USA.,Department of Biochemistry and Molecular Medicine, University of California Davis, Davis, California, USA
| | - Charles A Herzog
- Division of Cardiology, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota, USA
| | - Kirsten L Johansen
- Division of Nephrology, University of California, San Francisco, San Francisco, California, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, USA.,Nephrology Section, San Francisco VA Medical Center, San Francisco, California, USA
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Sheen YJ, Sheu WHH. Risks of rapid decline renal function in patients with type 2 diabetes. World J Diabetes 2014; 5:835-46. [PMID: 25512785 PMCID: PMC4265869 DOI: 10.4239/wjd.v5.i6.835] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/26/2014] [Accepted: 09/17/2014] [Indexed: 02/05/2023] Open
Abstract
Progressive rising population of diabetes and related nephropathy, namely, diabetic kidney disease and associated end stage renal disease has become a major global public health issue. Results of observational studies indicate that most diabetic kidney disease progresses over decades; however, certain diabetes patients display a rapid decline in renal function, which may lead to renal failure within months. Although the definition of rapid renal function decline remained speculative, in general, it is defined by the decrease of estimated glomerular filtration rate (eGFR) in absolute rate of loss or percent change. Based on the Kidney Disease: Improving Global Outcomes 2012 clinical practice guidelines, a rapid decline in renal function is defined as a sustained decline in eGFR of > 5 mL/min per 1.73 m(2) per year. It has been reported that potential factors contributing to a rapid decline in renal function include ethnic/genetic and demographic causes, smoking habits, increased glycated hemoglobin levels, obesity, albuminuria, anemia, low serum magnesium levels, high serum phosphate levels, vitamin D deficiency, elevated systolic blood pressure, pulse pressure, brachial-ankle pulse wave velocity values, retinopathy, and cardiac autonomic neuropathy. This article reviews current literatures in this area and provides insight on the early detection of diabetic subjects who are at risk of a rapid decline in renal function in order to develop a more aggressive approach to renal and cardiovascular protection.
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Tsai YC, Chiu YW, Kuo HT, Chen SC, Hwang SJ, Chen TH, Kuo MC, Chen HC. Fluid overload, pulse wave velocity, and ratio of brachial pre-ejection period to ejection time in diabetic and non-diabetic chronic kidney disease. PLoS One 2014; 9:e111000. [PMID: 25386836 PMCID: PMC4227653 DOI: 10.1371/journal.pone.0111000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 09/22/2014] [Indexed: 11/19/2022] Open
Abstract
Fluid overload is one of the characteristics in chronic kidney disease (CKD). Changes in extracellular fluid volume are associated with progression of diabetic nephropathy. Not only diabetes but also fluid overload is associated with cardiovascular risk factors The aim of the study was to assess the interaction between fluid overload, diabetes, and cardiovascular risk factors, including arterial stiffness and left ventricular function in 480 patients with stages 4–5 CKD. Fluid status was determined by bioimpedance spectroscopy method, Body Composition Monitor. Brachial-ankle pulse wave velocity (baPWV), as a good parameter of arterial stiffness, and brachial pre-ejection period (bPEP)/brachial ejection time (bET), correlated with impaired left ventricular function were measured by ankle-brachial index (ABI)-form device. Of all patients, 207 (43.9%) were diabetic and 240 (50%) had fluid overload. For non-diabetic CKD, fluid overload was associated with being female (β = –2.87, P = 0.003), heart disease (β = 2.69, P = 0.04), high baPWV (β = 0.27, P = 0.04), low hemoglobin (β = –1.10, P<0.001), and low serum albumin (β = –5.21, P<0.001) in multivariate analysis. For diabetic CKD, fluid overload was associated with diuretics use (β = 3.69, P = 0.003), high mean arterial pressure (β = 0.14, P = 0.01), low bPEP/ET (β = –0.19, P = 0.03), low hemoglobin (β = –1.55, P = 0.001), and low serum albumin (β = –9.46, P<0.001). In conclusion, baPWV is associated with fluid overload in non-diabetic CKD and bPEP/bET is associated with fluid overload in diabetic CKD. Early and accurate assessment of these associated cardiovascular risk factors may improve the effects of entire care in late CKD.
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Affiliation(s)
- Yi-Chun Tsai
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Tien Kuo
- Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Population Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Tzu-Hui Chen
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Mei-Chuan Kuo
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail:
| | - Hung-Chun Chen
- Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan
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Ernstbrunner M, Kostner L, Kimberger O, Wabel P, Säemann M, Markstaller K, Fleischmann E, Kabon B, Hecking M. Bioimpedance spectroscopy for assessment of volume status in patients before and after general anaesthesia. PLoS One 2014; 9:e111139. [PMID: 25360698 PMCID: PMC4215896 DOI: 10.1371/journal.pone.0111139] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/27/2014] [Indexed: 12/27/2022] Open
Abstract
Background Technically assisted assessment of volume status before surgery may be useful to direct intraoperative fluid administration. We therefore tested a recently developed whole-body bioimpedance spectroscopy device to determine pre- to postoperative fluid distribution. Methods Using a three-compartment physiologic tissue model, the body composition monitor (BCM, Fresenius Medical Care, Germany) measures total body fluid volume, extracellular volume, intracellular volume and fluid overload as surplus or deficit of ‘normal’ extracellular volume. BCM-measurements were performed before and after standardized general anaesthesia for gynaecological procedures (laparotomies, laparoscopies and vaginal surgeries). BCM results were blinded to the attending anaesthesiologist and data analysed using the 2-sided, paired Student’s t-test and multiple linear regression. Results In 71 females aged 45±15 years with body weight 67±13 kg and duration of anaesthesia 154±68 min, pre- to postoperative fluid overload increased from −0.7±1.1 L to 0.1±1.0 L, corresponding to −5.1±7.5% and 0.8±6.7% of normal extracellular volume, respectively (both p<0.001), after patients had received 1.9±0.9 L intravenous crystalloid fluid. Perioperative urinary excretion was 0.4±0.3 L. The increase in extracellular volume was paralleled by an increase in total body fluid volume, while intracellular volume increased only slightly and without reaching statistical significance (p = 0.15). Net perioperative fluid balance (administered fluid volume minus urinary excretion) was significantly associated with change in extracellular volume (r2 = 0.65), but was not associated with change in intracellular volume (r2 = 0.01). Conclusions Routine intraoperative fluid administration results in a significant, and clinically meaningful increase in the extracellular compartment. BCM-measurements yielded plausible results and may become useful to guide intraoperative fluid therapy in future studies.
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Affiliation(s)
- Matthäus Ernstbrunner
- Medical University of Vienna, Department of Anaesthesiology and Critical Care Medicine, Vienna, Austria
| | - Lisa Kostner
- Medical University of Vienna, Department of Anaesthesiology and Critical Care Medicine, Vienna, Austria
| | - Oliver Kimberger
- Medical University of Vienna, Department of Anaesthesiology and Critical Care Medicine, Vienna, Austria
| | - Peter Wabel
- Fresenius Medical Care, Bad Homburg, Germany
| | - Marcus Säemann
- Medical University of Vienna, Department of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Vienna, Austria
| | - Klaus Markstaller
- Medical University of Vienna, Department of Anaesthesiology and Critical Care Medicine, Vienna, Austria
| | - Edith Fleischmann
- Medical University of Vienna, Department of Anaesthesiology and Critical Care Medicine, Vienna, Austria
| | - Barbara Kabon
- Medical University of Vienna, Department of Anaesthesiology and Critical Care Medicine, Vienna, Austria
| | - Manfred Hecking
- Medical University of Vienna, Department of Anaesthesiology and Critical Care Medicine, Vienna, Austria
- Medical University of Vienna, Department of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Vienna, Austria
- * E-mail:
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