Differences in the extracellular body water/total body water (ebw/tbw) in hemodialysis and chronic kidney disease patients. Relationship with nutritional parameters

Abstract Background and Aims Knowing the hydration status of CKD patients is one of the basic objectives in CKD patients considering the Ratio of EBW(TBW) as indicator of them. Aim Determine the cut-off point of the EBW/TBW ratio using Bioimpedance in patients with global CKD and divided into advanced CKD and hemodialysis (HD) as a hydration marker in relation to MIS scale (malnutrition inflammation score), cut-off point 5. Method We value 199 CKD patients by setting the EBW/TBW cut-off points using Inbody S10 multifrequency bioimpedance with global ROC curve and for advanced CKD (ACKD) and HD analyzing differences according to age ranges (<65,65,1-75 and >75 years) and differences in nutritional parameters (visceral proteins, MIS scale and body composition). Results We have evaluated 199 patients with ACKD, 143 male and 56 female, 74 in CKD xage72.27 ?11.98years and 125 in HD, xage 70.76 ?12.73 years. Overall EBW / TBW ratio: AUC 0.657, p0.006, cut-off point 0.3965 60% sensitivity, 64% specificity. Advanced CKD: AUC 0.648, p0.071, cutoff point 0.397, 64% sensitivity, 61% specificity. HD: AUC 0.706, p0.012, cutoff point 0.391, 71% sensitivity, 63% specificity. The results in relation to age strata and MIS with 5 as the cut-off point in the table. No greater hydration in men than in women overall. The nutrition-inflammation parameters according to the cut-off point are different: Advanced CKD: age 0.001, albumin 0.024, prealbumin 0.013, trasferrin 0.078, CRP 0.432. HD: albumin 0.014, prealbumin 0.001, transferrin 0.939, lymphocytes 0.030, CRP 0.342, age 0.000. Conclusion 1. We have found slightly higher cut-off points between ACKD and hemodialysis in the assessed sample. 2. The EBW / TBW ratio appears higher in patients > 65 years in both ACKD and HD, in contrast to what is observed in the healthy population. 3. A greater malnutrition appairs in a greater hyperhydration in HD and ACKD.

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The effects of oral sodium bicarbonate on extracellular water in patients with chronic kidney disease

10.36811/cjn.2019.110002 ◽

2019 ◽

pp. 04-13

Author(s):

Colin Jones ◽

Louise Wells ◽

Graham Woodrow ◽

David Ashford

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Sodium Bicarbonate ◽

Total Body Water ◽

Extracellular Fluid ◽

Body Water ◽

Fluid Volume ◽

Extracellular Fluid Volume ◽

Total Body ◽

Oral Sodium

Background: Metabolic acidosis in chronic kidney disease (CKD) is often treated with oral sodium bicarbonate. There is limited evidence around the effects of sodium bicarbonate on extracellular fluid and blood pressure in CKD. Methods: In a double blind randomised comparison patients with stage 3-5 CKD were randomised to either oral sodium bicarbonate 1.5 g three times a day (n=18) or placebo (n=21) for 4 weeks. Assessments performed at 0 and 4 weeks included: body weight, office blood pressure and assessment for peripheral/pulmonary oedema; serum creatinine, electrolytes and venous bicarbonate; 24-hour urine for sodium excretion; extracellular fluid volume and total body water determined by sodium bromide and deuterium oxide dilution respectively; extracellular fluid volume and total body water by bioimpedance. Differences between the active and placebo groups at week 4 were analysed by ANCOVA. Results: At week 4, serum bicarbonate was higher (25.6±2.4 vs 23.3±3.1 mmol/l) and blood urea lower (14.2±5.6 vs 17.0±5.8 mmol/l) in the active treatment group. Urine sodium concentration was also higher (82.7±25.3 vs 59.0±21.9 mmol/l). Extracellular fluid volume (20.0±4.3 vs 18.0±2.9) and total body water (42.3±9.6 vs 39.0±6.8) measured by bioimpedance and total body water by deuterium dilution (41.7±8.3 vs 39.4±6.2) were significantly greater in the treatment arm at week 4. Differences in systolic and diastolic blood pressure did not reach statistical significance. Conclusions: Oral sodium bicarbonate has a biological effect and increases body water content, without evidence of a clinical consequence. This may reflect the fact that some of the ingested sodium is excreted in the urine.

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Association between Daily Urinary Sodium Excretion, Ratio of Extracellular Water-to-Total Body Water Ratio, and Kidney Outcome in Patients with Chronic Kidney Disease

Nutrients ◽

10.3390/nu13020650 ◽

2021 ◽

Vol 13 (2) ◽

pp. 650

Author(s):

Kaori Kohatsu ◽

Sayaka Shimizu ◽

Yugo Shibagaki ◽

Tsutomu Sakurada

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Sodium Excretion ◽

Total Body Water ◽

Salt Intake ◽

Urinary Sodium Excretion ◽

Volume Status ◽

Extracellular Water ◽

Renal Outcomes ◽

Total Body

Whether dietary salt intake affects chronic kidney disease (CKD) progression remains unclear. We conducted a retrospective cohort study to analyze the effects of both daily salt intake (DSI) and volume status on renal outcomes in 197 CKD patients. DSI was estimated by 24-h urinary sodium excretion and volume status was assessed by the ratio of extracellular water (ECW) to total body water (TBW) measured by bioelectrical impedance analysis (BIA). We divided patients into two groups according to DSI (6 g/day) or median ECW/TBW (0.475) and compared renal outcomes of each group. Furthermore, we classified and analyzed four groups according to both DSI and ECW/TBW. The higher DSI group showed a 1.69-fold (95% confidence interval (CI) 1.12–2.57, p = 0.01) excess risk of outcome occurrence compared to the lower group. Among the four groups, compared with Group 1 (low DSI and low ECW/TBW), Group 3 (high DSI and low ECW/TBW) showed a 1.84-fold (95% CI 1.03–3.30, p = 0.04) excess risk of outcome occurrence; however, Group 2 (low DSI and high ECW/TBW) showed no significant difference. High salt intake appears to be associated with poor renal outcome independent of blood pressure (BP), proteinuria, and volume status.

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