scholarly journals Hydration Status Is Associated with Aortic Stiffness, but Not with Peripheral Arterial Stiffness, in Chronically Hemodialysed Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Daniel Bia ◽  
Cintia Galli ◽  
Rodolfo Valtuille ◽  
Yanina Zócalo ◽  
Sandra A. Wray ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Body Fluid ◽  
Fluid Management ◽  
Blood Pressure Level ◽  
Whole Body ◽  
Volume Status ◽  
Hydration Status ◽  
Fluid Status ◽  
Peripheral Arterial

Background. Adequate fluid management could be essential to minimize high arterial stiffness observed in chronically hemodialyzed patients (CHP).Aim. To determine the association between body fluid status and central and peripheral arterial stiffness levels.Methods. Arterial stiffness was assessed in 65 CHP by measuring the pulse wave velocity (PWV) in a central arterial pathway (carotid-femoral) and in a peripheral pathway (carotid-brachial). A blood pressure-independent regional arterial stiffness index was calculated using PWV. Volume status was assessed by whole-body multiple-frequency bioimpedance. Patients were first observed as an entire group and then divided into three different fluid status-related groups: normal, overhydration, and dehydration groups.Results. Only carotid-femoral stiffness was positively associated (P<0.05) with the hydration status evaluated through extracellular/intracellular fluid, extracellular/Total Body Fluid, and absolute and relative overhydration.Conclusion. Volume status and overload are associated with central, but not peripheral, arterial stiffness levels with independence of the blood pressure level, in CHP.

P1185LUNG COMETS AND EVALUATION OF HYDRATION STATUS IN PERITONEAL DIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Robert Ekart ◽  
Lucijan Lucic Srajer ◽  
Katharina Marko ◽  
Nina Hojs ◽  
Sebastjan Bevc ◽  
...  
Keyword(s):  
Body Composition ◽  
Peritoneal Dialysis ◽  
The Body ◽  
Whole Body ◽  
Fluid Distribution ◽  
Hydration Status ◽  
Non Invasive ◽  
Fluid Status ◽  
Multifrequency Bioimpedance ◽  
Dialysis Vintage

Abstract Background and Aims Assessment of optimal hydration status in patients with end-stage renal disease (ESRD) on peritoneal dialysis (PD) is a challenge. Multiple diagnostic options to determine hydration status in PD patients are available. Multifrequency bioimpedance spectroscopy (MBIS) is a cheap, simple and non-invasive method of estimating body composition, including estimates of total body water (TBW), extracellular water (ECW), intracellular water (ICW) and the ratio between both spaces (ECW/ICW). Lung ultrasonography (LUS) and lung B-lines (lung comets) can be used for the evaluation of extravascular lung water. Ultrasound evaluation of inferior vena cava (UIVC) provides rapid, non-invasive assessment of a patient's hemodynamic and volume status. N-terminal pro-brain natriuretic peptide (NT-proBNP) is related to fluid status and fluid distribution. The aim of our study was to assess fluid status in PD patients comparing four different methods: MBIS, LUS, UIVC and NT-proBNP. Method We performed a single-centre cohort study in 19 PD patients. The body composition was measured using the portable whole-body MBIS device, Body Composition Monitor-BCM(®) (Fresenius Medical Care, Bad Homburg, Germany), LUS with portable US device (VScan, General Electrics Corporate), UIVC index with SonoSite US device. NT-proBNP was measured in a one-step sandwich chemiluminescent immunoassay (Dimension Vista® System 1500, Siemens Healthcare Diagnostics Inc., Newark, NJ, USA). Results The mean age of patients was 54 ± 10 years, mean dialysis vintage 53 (10-194) months, 63% were men. Thirteen (68.4%) patients had fluid overload (FO) &gt; 1.1 L. Data of patients are presented in table 1. We found a statistically significant correlation between the number of lung comets and ECW/ICW ratio (r = 0.496, P = 0.031) and NT-proBNP (r = 0.759, P &lt; 0.0001). In contrast, there was no significant correlation between the number of lung comets and UIVC (r = 0.221, P &lt; 0.364). Conclusion According to our results, LUS with lung comets, MBIS with ECW/ICW ratio and NT-proBNP are useful and complementary methods for evaluation of fluid status in PD patients.

Fluid and Volume Monitoring

2008 ◽  
Vol 31 (2) ◽  
pp. 111-126 ◽  
Author(s):  
M.R. Pinsky ◽  
P. Brophy ◽  
J. Padilla ◽  
E. Paganini ◽  
N. Pannu
Keyword(s):  
Blood Pressure ◽  
Fluid Management ◽  
Kidney Injury ◽  
Consensus Conference ◽  
Volume Status ◽  
Future Research ◽  
Positive Pressure ◽  
Supporting Evidence ◽  
Mean Flow ◽  
Volume Responsiveness

Background Fluid resuscitation is not only used to prevent acute kidney injury (AKI) but fluid management is also a cornerstone of treatment for patients with established AKI and renal failure. Ultrafiltration removes volume initially from the intravascular compartment inducing a relative degree of hypovolemia. Normal reflex mechanisms attempt to sustain blood pressure constant despite marked changes in blood volume and cardiac output. Thus, compensated shock with a normal blood pressure is a major cause of AKI or exacerbations of AKI during ultrafiltration. Methods We undertook a systematic review of the literature using MEDLINE, Google Scholar and PubMed searches. We determined a list of key questions and convened a 2-day consensus conference to develop summary statements via a series of alternating breakout and plenary sessions. In these sessions, we identified supporting evidence and generated clinical practice recommendations and/or directions for future research. Results We defined three aspects of fluid monitoring: i) normal and pathophysiological cardiovascular mechanisms; ii) measures of volume responsiveness and impending cardiovascular collapse during volume removal, and; iii) measured indices of each using non-invasive and minimally invasive continuous and intermittent monitoring techniques. The evidence documents that AKI can occur in the setting of normotensive hypovolemia and that under-resuscitation represents a major cause of both AKI and mortality ion critically ill patients. Traditional measures of intravascular volume and ventricular filling do not predict volume responsiveness whereas dynamic functional hemodynamic markers, such as pulse pressure or stroke volume variation during positive pressure breathing or mean flow changes with passive leg raising are highly predictive of volume responsiveness. Numerous commercially-available devices exist that can acquire these signals. Conclusions Prospective clinical trials using functional hemodynamic markers in the diagnosis and management of AKI and volume status during ultrafiltration need to be performed. More traditional measure of preload be abandoned as marked of volume responsiveness though still useful to assess overall volume status.

MO662EFFECT OF ARTERIOVENOUS VASCULAR ACCESS ON BIOIMPEDANCE MEASUREMENTS IN HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Lin-Chun Wang ◽  
Fansan Zhu ◽  
Ohnmar Thwin ◽  
Priscila Preciado Rojas ◽  
Laura Rosales Merlo ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Objective Assessment ◽  
Fluid Management ◽  
The Body ◽  
Whole Body ◽  
Large Contribution ◽  
Fluid Status ◽  
Single Side ◽  
The Difference ◽  
The Impact

Abstract Background and Aims Fluid management remains a major problem in hemodialysis (HD) patients, partly because of the lack of objective assessment methods. Many methods have been proposed to estimate the fluid status in HD patients and bioimpedance has established as one of the most popular clinical tools. Resistance to alternate current was found to be lower in the arteriovenous (AV) access-bearing side compared with the non-access side in post-HD bioimpedance measurements. We hypothesized this difference between access and non-access sides can be seen in both pre- and post-HD measurements of arms and whole body. The aim of the study was to investigate whether this variation between access and non-access sides could affect single-side whole body measurements. Method Pre- and post-HD bioimpedance measurements with two 8-point devices (InBody 770 and Seca mBCA 514) were performed in 11 HD patients with functioning AV access in the arm (8 male, pre-HD 75.4 ± 13.6 kg, post-HD 72.8 ± 13.5 kg). Values of resistance at 5 kHz (R5) in the arm and whole body (R5 of arm + trunk + leg on the same side) were extracted. Whole-body extracellular water (ECW) was calculated using whole-body R5 by the Xitron equation* to evaluate how measuring only one side of the body can affect the fluid volume calculation. Results The R5 of the arm on the access side was lower compared with the non-access side both pre- and post-HD (P &lt; 0.01), measured by InBody. The same was seen with the Seca but did not reach statistical significance (Table 1). The estimated whole-body ECW was higher on the access side for InBody (P &lt; 0.01). With Seca, the same trend was seen but remained non-significant. While the difference in ECW between both arms reported by InBody was small, the impact on calculated whole-body ECW was much larger with a difference between sides of 0.50 ± 0.82 L pre HD and 0.55 ± 0.81 L post HD. Conclusion InBody appears to pick up the difference in fluid status between the access and non-access side with greater precision than Seca. The large contribution of the arm to whole-body resistance amplifies the impact of the presence of an AV access on whole-body ECW estimations based on single-side wrist-to-ankle bioimpedance measurements. Eight-point bioimpedance devices (like the tested InBody and Seca) measure both sides of the body, so, choice of measurement side does not enter the picture.

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