4308Lung ultrasound guided dry-weight probing reduces left and right atrial dimensions and left ventricular filling pressures in hemodialysis patients with hypertension

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Loutradis ◽  
C E Papadopoulos ◽  
V Sachpekidis ◽  
E Pagourelias ◽  
R Ekart ◽  
...  
Keyword(s):  
Weight Reduction ◽  
Dry Weight ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Active Group ◽  
Control Group ◽  
Ultrasound Guided ◽  
Left And Right ◽  
B Lines

Abstract Introduction and purpose Left ventricular hypertrophy and dysfunction is tightly associated with adverse outcome in hemodialysis. Hypertension and increased preload due to hypervolemia are major factors for these cardiac anomalies in hemodialysis. This study examined the effect of lung-ultrasound-guided dry-weight reduction on echocardiographic indices of left and right cardiac size, systolic and diastolic function in hypertensive hemodialysis patients. Methods This pilot, single-blind trial randomised 71 clinically euvolemic hypertensive hemodialysis patients in an active group (n=35), following a strategy for dry-weight reduction guided by the total number of US-B lines (US-B lines score) prior to a mid-week dialysis session, and a control group (n=36), following standard-of-care treatment. Among others, patients underwent two-dimensional and tissue-Doppler echocardiographic (TDI) at baseline and after 8-weeks. Results Overall, 19 (54.3%) patients in the active and 5 (13.9%) in the control group had UF intensification (p<0.001) during follow-up (US-B lines 5.3±12.5 vs +2.2±7.6, p<0.001, dry-weight: −0.71±1.39 vs +0.51±0.98 kg, p<0.001). Inferior vena cava diameter was reduced to a greater extend in the active compared to control group (−0.43±4.00 vs 0.71±4.82, p=0.033) at study-end. Reductions in LA and RA sizing parameters were greater in the active group (LA Surface: −1.09±4.61 vs 0.93±3.06 cm2, p=0.034; RA surface: −1.56±6.17 vs 0.47±2.31, p=0.024; LAVi: −2.43±13.14 vs 2.95±9.42 ml/m2, p=0.052). Reductions in LV end-diastolic diameter and volume were marginally greater in the active group. LV filling pressures significantly decreased in the active compared to the control group (E/e' LV: −0.38±3.14 vs 1.36±3.54, p=0.034; DT: 35.43±85.25 vs −18.44±50.69, p=0.002). Systolic function indices were unchanged in both groups. In multivariate analysis, US-B lines reduction was a powerful predictor (OR: 4.542, 95% CI: 1.266–16.292, p=0.020) of E/e' LV ratio decrease, among various factors examined. Conclusions A lung-ultrasound-guided strategy for dry-weight reduction can effectively reduce cardiac chambers dimensions and LV filling pressures without changing systolic performance during an 8-week follow-up in hypertensive hemodialysis patients.

MO102LUNG ULTRASOUND-GUIDED DRY-WEIGHT REDUCTION DECREASES AMBULATORY BLOOD PRESSURE LEVELS IN HYPERTENSIVE HEMODIALYSIS PATIENTS: LONG-TERM ANALYSIS OF A LUST SUB-STUDY*

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Charalampos Loutradis ◽  
Pantelis Sarafidis ◽  
Robert Ekart ◽  
Ioannis Tsouchnikas ◽  
Christodoulos Papadopoulos ◽  
...  
Keyword(s):  
Weight Reduction ◽  
Lung Ultrasound ◽  
Dry Weight ◽  
Hemodialysis Patients ◽  
Active Group ◽  
Control Group ◽  
Ultrasound Guided ◽  
B Lines

Abstract Background and Aims Hypertension is highly prevalent and independently associated with adverse outcomes in patients undergoing hemodialysis. The main mechanism leading to BP elevation in these individuals is their inability to maintain water homeostasis. This study examines the long-term effects of dry-weight reduction with a standardized lung-ultrasound-guided strategy on ambulatory BP in hypertensive hemodialysis patients. Method This is the report of the 12-month trial phase of a randomized controlled trial in 71 clinically euvolemic, hemodialysis patients with hypertension. Patients were randomized (1:1 ratio) in the active group (23 male and 12 female), following dry-weight reduction guided by the total number of US-B lines prior to a mid-week dialysis session and the control group (24 male and 12 female), following standard-of-care treatment. A 48-hour ABPM was performed in all study participants at baseline and after 12 months. Results During follow-up more patients in the active compared to control group had dry weight reduction (71.4% vs 22.2%; p&lt;0.001). US-B lines -4.83±13.73 vs 5.53±16.01; p=0.005) and dry-weight (-1.68±2.38 vs 0.54±2.32; p&lt;0.001) decreased in the active and slightly increased in the control group. At 12 months, 48-hour SBP (136.19±14.78 vs 130.31±13.57; p=0.034) and DBP (80.72±9.83 vs 76.82±8.97; p=0.008) were lower compared to baseline in the active but similar in the control group. Changes in 48-hour SBP (-7.78±13.29 vs -0.10±14.75; p=0.021) were significantly greater in the active compared to the control group. Comparisons for intradialytic, 44-hour, Day-1, Day-2 and day- and night-time BP were to the same direction. The proportion of patients experiencing at least one episode of intradialytic hypotension was numerically lower in the active group (71.4% vs 88.9%, p=0.065). Conclusion A lung-ultrasound-guided strategy for dry-weight reduction can effectively and safely decrease ambulatory BP levels during a 12-month follow-up period This method is a simple treatment approach to improve hypertension management in hemodialysis patients.

P2640The effect of dry-weight reduction guided by lung ultrasound on ambulatory aortic blood pressure and arterial stiffness parameters in hemodialysis patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Loutradis ◽  
C E Papadopoulos ◽  
V Sachpekidis ◽  
E Pagourelias ◽  
R Ekart ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Weight Reduction ◽  
Lung Ultrasound ◽  
Dry Weight ◽  
Hemodialysis Patients ◽  
Active Group ◽  
Control Group ◽  
Aortic Blood ◽  
Aortic Blood Pressure ◽  
B Lines

Abstract Introduction and purpose Arterial stiffness and aortic blood pressure (BP) augmentation are significantly increased in hemodialysis patients. Recent studies suggest that the prognostic significance of ambulatory recordings of arterial stiffness is high in hemodialysis. This study examines for the first time the effect of dry weight reduction with a standardized lung-ultrasound-guided strategy on ambulatory aortic BP and arterial stiffness parameters in hypertensive hemodialysis patients. Methods A total 71 hemodialysis patients with hypertension (mean home BP ≥135/85 mmHg), that were clinically euvolemic, were included in this single-blind randomized clinical trial. Patients were randomized in a 1:1 ratio in the active group (n=35), following a strategy for dry-weight reduction guided by the total number of US-B lines (US-B lines score) prior to a mid-week dialysis session and the control group (n=), following standard-of-care treatment. All patients underwent 48-hour ABPM with the Mobil-O-Graph monitor (IEM, Stolberg, Germany) and PWV measurement in office with SphygmoCor (ArtCor, Sydney, Australia) at baseline and after 8-weeks. Results Overall, the US-B lines change during follow-up were −5.3±12.5 in active versus +2.2±7.6 in control group (p<0.001), which corresponded to dry-weight changes of −0.71±1.39 versus +0.51±0.98 kg (p<0.001). The change in 48-hour cSBP was significantly greater in the active group (−6.30±8.90 vs −0.50±12.46, p=0.027); the relevant cDBP fall was marginally greater (−3.85±6.61 vs −0.63±8.36, p=0.077) in the active group. 48-hour cPP (41.51±9.63 vs 39.06±9.61 mmHg, p=0.004) and 48-hour PWV (9.30±2.00 vs 9.08±2.04 m/sec, p=0.032) were significantly reduced from baseline to study-end in the active group but remained unchanged in controls. In contrast, 48-hour AIx and AIx(75) did not change between baseline and study-end in both groups; changes in AIx(75) were similar in the two groups (−0.97±3.51 vs −0.36±4.25, p=0.517). PWV measured in office was decreased from baseline to study-end in the active (10.07±2.66 vs 9.79±2.81, p=0.038) but not in the control group. Conclusions A lung-ultrasound-guided strategy for dry-weight reduction reduces ambulatory aortic BP and ambulatory or office PWV, but not ambulatory AIx(75). These results suggest that dry-weight reduction can primarily reduce aortic BP levels and large arteries stiffness but not wave reflections from the periphery.

scholarly journals Lung Ultrasound-Guided Dry-Weight Reduction in Hemodialysis Patients Does Not Affect Short-Term Blood Pressure Variability

2019 ◽  
Vol 32 (8) ◽  
pp. 786-795 ◽  
Author(s):  
Charalampos Loutradis ◽  
Pantelis A Sarafidis ◽  
Marieta Theodorakopoulou ◽  
Robert Ekart ◽  
Maria Eleni Alexandrou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Weight Reduction ◽  
Lung Ultrasound ◽  
Dry Weight ◽  
Hemodialysis Patients ◽  
Control Group ◽  
Weight Changes ◽  
Ultrasound Guided ◽  
Short Term ◽  
The Impact

AbstractBackgroundIncreased short-term blood pressure (BP) variability (BPV) in hemodialysis is associated with increased cardiovascular and all-cause mortality. Studies on the impact of BP-lowering interventions on BPV are scarce. This study examined the effect of dry-weight reduction with a lung ultrasound-guided strategy on short-term BPV in hemodialysis patients with hypertension.MethodsThis is a prespecified analysis of a randomized clinical trial in 71 hemodialysis patients with hypertension, assigned in a 1:1 ratio in the active group, following a strategy for dry-weight reduction guided by pre-hemodialysis lung ultrasound and the control group following standard-of-care treatment. All patients underwent 48-hour ambulatory BP monitoring at baseline and after 8 weeks. BPV was calculated with validated formulas for the 48-hour interval and the 2 daytime and nighttime periods.ResultsDry-weight changes were –0.71 ± 1.39 in active vs. +0.51 ± 0.98 kg in the control group (P < 0.001), generating a between-group difference of 5.9/3.5 mm Hg (P < 0.05) in 48-hour BP at study end. All brachial BPV indices [SD, weighted SD, coefficient of variation, and average real variability (ARV)] did not change significantly from baseline to study end in the active [systolic blood pressure (SBP)-ARV: 12.58 ± 3.37 vs. 11.91 ± 3.13, P = 0.117; diastolic blood pressure (DBP)-ARV: 9.14 ± 1.47 vs. 8.80 ± 1.96, P = 0.190] or control (SBP-ARV: 11.33 ± 2.76 vs. 11.07 ± 2.51, P = 0.544; DBP-ARV: 8.38 ± 1.50 vs. 8.15 ± 1.49, P = 0.295) group (between-group comparison P = 0.211/0.117). Aortic BPV indices followed a similar pattern. Likewise, no significant changes in BPV indices for the daytime and nighttime periods were noted in both groups during follow-up.ConclusionsThis study is the first to evaluate the effects of a nonpharmacological intervention on short-term BPV in hemodialysis, showing no effect of dry-weight reduction on BPV, despite BP decrease.

MO729LUNG ULTRASOUND GUIDED DRY-WEIGHT REDUCTION DECREASES CARDIAC CHAMBERS DIMENSIONS AND IMPROVES VENTRICULAR DIASTOLIC FUNCTION IN HEMODIALYSIS PATIENTS: LONG-TERM ANALYSIS OF A LUST SUB-STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Charalampos Loutradis ◽  
Christodoulos Papadopoulos ◽  
Vassilios Sachpekidis ◽  
Robert Ekart ◽  
Barbara Krunic ◽  
...  
Keyword(s):  
Usual Care ◽  
Weight Reduction ◽  
Usual Care Group ◽  
Dry Weight ◽  
Hemodialysis Patients ◽  
Volume Index ◽  
Care Group ◽  
Control Group ◽  
Ultrasound Guided

Abstract Background and Aims Left ventricular hypertrophy (LVH) and dysfunction are highly prevalent in hemodialysis patients and independently associated with adverse outcomes. Few interventions were shown to effectively reduce LVH in hemodialysis. This study examines the long-term effects of dry-weight reduction with a standardized lung-ultrasound-guided strategy on echocardiographic indices of left and right cardiac chambers in hemodialysis patients. Method This is the report of the 12-month trial phase of a randomized controlled trial in 71 clinically euvolemic, hemodialysis patients with hypertension. Patients were randomized (1:1 ratio) in the active group (23 male and 12 female), following dry-weight reduction guided by the total number of US-B lines prior to a mid-week dialysis session and the control group (24 male and 12 female), following standard-of-care treatment. Among several assessments, participants underwent two-dimensional and tissue-Doppler echocardiographic (TDI) at baseline and study-end. Results During follow-up dry-weight reduction took place in more patients in the active compared with the control group (71.4% vs 22.2%; p&lt;0.001). Left atrial (LA) surface (-1.37±4.50 vs 1.28±5.00 cm2; P=0.006) and LA volume index (-3.22±11.82 vs 4.76±12.83 ml/m2; P=0.009) decreased in the active and increased in the usual-care group. Left ventricle (LV) diastolic (-0.94±11.45 vs 6.58±13.92 ml/m2; P=0.015) and systolic (-0.89±7.11 vs 3.38±7.89 ml/m2; P=0.018) volume index decreased only in the active group. LV mass index slightly decreased in the active (134.21±44.75 vs 133.57±45.51; P=0.844) and was marginally increased in the control group (134.21±40.96 vs 143.77±50.04 g/m2; P=0.089). Right ventricular (RV) systolic pressure was stable in the active (23.74±13.76 vs 24.35±12.99; P= 0.795) and significantly increased in the usual-care group (26.24±12.95 vs 31.20±16.13 mmHg; P=0.028). Reductions in LV A wave were greater in the active compared to the usual-care group (-4.98±15.11 vs 2.23±21.71 m/s; P=0.009). Changes in LV systolic and RV diastolic function indices were not different between the two groups. Conclusion Over 12 months, a lung-ultrasound-guided strategy for dry-weight reduction can effectively decrease cardiac chamber dimensions, prevent LVMi increase and improve LV diastolic and RV systolic function.

scholarly journals SaO019LUNG ULTRASOUND GUIDED DRY-WEIGHT PROBING REDUCES CARDIAC CHAMBERS DIMENSIONS AND LEFT VENTRICULAR FILLING PRESSURES IN HEMODIALYSIS PATIENTS WITH HYPERTENSION

2019 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Charalampos Loutradis ◽  
Pantelis Sarafidis ◽  
Christodoulos Papadopoulos ◽  
Vasileios Sachpekidis ◽  
Robert Ekart ◽  
...  
Keyword(s):  
Dry Weight ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Left Ventricular Filling ◽  
Ultrasound Guided ◽  
Ventricular Filling

scholarly journals Motor learning-based activities may improve functional ability in adults with severe cerebral palsy: A controlled pilot study

2021 ◽  
pp. 1-11
Author(s):  
Helle Hüche Larsen ◽  
Rasmus Feld Frisk ◽  
Maria Willerslev-Olsen ◽  
Jens Bo Nielsen
Keyword(s):  
Cerebral Palsy ◽  
Motor Learning ◽  
Motor Function ◽  
Functional Ability ◽  
Active Group ◽  
Control Group ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Learning Principles

BACKGROUND: Cerebral palsy (CP) is a neurodevelopmental disturbance characterized by impaired control of movement. Function often decreases and 15% of adults are classified as severely affected (Gross Motor Function Classification Scale III-V). Little is known about interventions that aim to improve functional abilities in this population. OBJECTIVE: To evaluate a 12-week intervention based on motor learning principles on functional ability in adults with severe CP. METHODS: 16 adults (36±10 years, GMFCS III-V) were enrolled and divided into an intervention group (Active group) and a standard care group (Control group). Primary outcome measure was Gross Motor Function Measure (GMFM-88). Secondary measures were neurological status. The Active group were measured at baseline, after the intervention and at one-month follow-up. The Control group were measured at baseline and after one month. RESULTS: Analysis showed statistically significant improvement in GMFM-88 for the Active group from baseline to post assessment compared with the Control group (group difference: 5 points, SE 14.5, p = 0.008, CI: 1.2 to 8.7). Improvements were maintained at follow-up. Results from the neurological screening showed no clear tendencies. CONCLUSIONS: The study provides support that activities based on motor learning principles may improve gross motor function in adults with severe CP.

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