Abstract
Background and Aims
The determination of dry weight (DW) in children on chronic hemodialysis (HD) remains problematic. No method has been shown superior for DW assessment in the few pediatric studies exploring the utility of inferior vena cava expiratory and inspiratory diameter diameter (IVCDe, IVCDi) and BIS against clinical criteria. We aimed to compare the performance of IVCD, BIS and clinical judgement in DW prediction in hemodialyzed children.
Method
IVCD and BIS were measured serially pre and post the midweek HD session. IVCDi, IVCDe and IVC contractility index (IVCCI) associations with: (1) BIS estimated (BIS-relOH) and (2) clinically assessed hydration status (OHc) based on deviation from DW were explored. The interpretation of IVC measurements was based on previously published pediatric reference values. The level of agreement between the three tools in fluid overload recognition was studied.
Results
Fifty-two sets of measurements were undertaken in 13 patients (median age 11 years). OHc and BIS-relOH were positively associated to each other (r=0,5, p<0,05) and to IVCDi (r=0,4, r=0,5, p<0,05) and IVCDe (r=0,4, r=0,6, p<0,05). A negative association between IVCCI and relOH-BIS was observed (r= -0,4, p<0,05). There was a poor agreement between the three methods in identification of fluid overload; out of 28 clinically overloaded patients, BIS identified only 7 whereas IVCD none (Cohen’s k <0).
Conclusion
IVCD measurements alone are not reliable for accurate fluid status prediction in hemodialyzed children as they seem to underestimate fluid overload compared to BIS and clinical criteria. Further studies are warranted to explore the applicability of new technologies for DW assessment of dialysis patients.
FP523CHARACTERISTICS OF B-LINES AND ASSOCIATIONS BETWEEN FLUID REMOVAL AND NUMBER OF B-LINES, PEAK EARLY MITRAL INFLOW WAVE VELOCITY, AND INFERIOR VENA CAVA DIMENSIONS IN HEMODIALYSIS PATIENTS
