scholarly journals Inferior vena cava diameter and collapsibility index as a marker of fluid status in regular hemodialysis patients

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Mohamed Abd El Hamid Hafiz ◽  
Emad Allam Mohamed ◽  
Mohamed Abo El Naga Mohamed ◽  
Mohamed Ahmed El Sayed Ahmed
Keyword(s):  
Inferior Vena ◽  
Fluid Overload ◽  
Vena Cava ◽  
Dry Weight ◽  
Hemodialysis Patients ◽  
Clinical Parameters ◽  
Fluid Status ◽  
Group A ◽  
Group B ◽  
Regular Hemodialysis

Abstract Background Patients with renal failure suffer from fluid overload which is a risk factor for mortality and morbidity. Therefore, fluid status assessment in patients on regular hemodialysis is very important. Dry weight assessment by clinical parameters is not always reliable. We evaluate the role of inferior vena cava ultrasound in estimating fluid overload in regular hemodialysis patients. Results A total of 45 persons, 30 end-stage renal disease patients on regular hemodialysis in group A (18 men and 12 women) and 15 healthy persons in group B (10 men and 5 women), were included in the study. The patients in group A ages ranged from 29 to 70 years with a mean of 48.38 ± 12.70 years and in group B ages ranged from 25 to 55 years with a mean of 34.93 ± 8.26. By clinical methods, the mean dry weight was 68.37 kg (68.37 ± 10.42). After HD mean, IVCe decreased from 2.01 ± 0.29 to 1.79 ± 0.22 cm (P < 0.001) similarly, mean IVCi decreased from 0.99 ± 0.48 to 0.64 ± 0.39 cm (P < 0.001). Changes in IVCD were significantly correlated with alterations in body weight following dialysis (P < 0.001). The IVC-CI increased significantly after dialysis (P < 0.001). IVCD and its IVC-CI reflected alterations in fluid status (P < 0.001). Considering the clinical parameters of fluid status, following HD mean, heart rate increased from 81.80 ± 5.15 beats per minute to 89.87 ± 6.42, (P < 0.001), systolic blood pressure decreased from 130 ± 18.43 mmHg to 113.33 ± 15.27 (P < 0.001), and diastolic blood pressure decreased from 80.17 ± 10.12 mmHg to 71.50 ± 9.29 (P < 0.001). Conclusion It was found a significant correlation between IVCD and IVC-CI with ultrafiltration of hemodialysis. Thus, IVC ultrasound can be used in dry weight assessment in ESRD patients on regular HD by measurement of IVCD and IVC-CI before and after hemodialysis.

scholarly journals Use of Handheld Ultrasound to Estimate Fluid Status of Hemodialysis Patients

2018 ◽  
Vol 1 (2) ◽  
pp. 65-69
Author(s):  
Sanjaya Kumar Shrestha ◽  
Anupam Ghimire ◽  
Safiur Rahman Ansari ◽  
Ashok Adhikari
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Vena Cava ◽  
Dry Weight ◽  
Hemodialysis Patients ◽  
Clinical Parameters ◽  
Fluid Status ◽  
Before And After ◽  
Handheld Ultrasound ◽  
End Stage

Introduction: Accurate assessment of fluid status in hemodialysis patients presents a significant challenge. Nephrologists have long relied on dry weight estimation based solely on clinical parameters to decide the ultrafiltration volume for patients with end-stage kidney disease on dialysis. However, this method is far from accurate and many patients recurrently suffer from signs and symptoms of fluid overload or circulatory collapse from overaggressive ultrafiltration. Invasive methods such as measurement of central venous pressure cannot be used routinely. We evaluated the usefulness of inferior vena cava (IVC) diameter measured by handheld ultrasound in the estimation of fluid status in patients before and after hemodialysis. Materials and Methods: Clinical assessment included patients’ symptoms, weight, blood pressure, heart rate, and presence of edema before and after dialysis session. Dry weight was assessed based on the above parameters. Each patient underwent measurement of inferior vena cava before and after hemodialysis. The anteroposterior IVC diameter (IVCD) was measured 1.5 cm below the diaphragm in the hepatic segment in supine position during normal inspiration and expiration.Results:  Thirty hemodialysis patients (mean age 51.6±18.03 years) were evaluated in outpatient dialysis unit. Following hemodialysis mean IVCe (IVC diameter in expiration) decreased from 1.40±0.38 to 0.91±0.30 cm (p<0.001). Similarly, mean IVCi (IVC diameter in inspiration) decreased from 0.67±0.34 to 0.35±0.19 cm (p<0.001). Changes in IVCD were significantly correlated with alterations in body weight following dialysis (p<0.0001). The IVC collapsibility index (IVC-CI, per cent of change in IVC diameter in expiration vs. inspiration) increased significantly from 0.53±0.18 to 0.68±0.18 after dialysis (p=0.002). IVC diameter and IVC-CI clearly reflected alterations in fluid status. Regarding the clinical parameters of fluid status, following hemodialysis, mean heart rate increased from 81.17±5.21 beats per minute to 86.50±7.99, (p=0.003), systolic blood pressure increased from 148.67±26.36 mmHg to 155.00±28.50, (p=0.05), and diastolic blood pressure increased from 78.62±12.74 mmHg to 84.83±14.55, (p<0.001).Conclusions:  Our findings support the applicability of IVCD measurement and IVC-CI in the estimation of fluid status in end stage kidney disease patients on hemodialysis. The clinical parameters of fluid status including heart rate, systolic blood pressure, and diastolic blood pressure suggest that significant numbers of patients underwent excess ultrafiltration based on their traditional dry weight calculation. Thus, using IVC parameters before and during hemodialysis might give a better estimation of fluid status of the patient and guide the amount of ultrafiltration to be done. 

P1807COMPARISON BETWEEN INFERIOR VENA CAVA DIAMETER, BIOIMPEDANCE SPECTROSCOPY AND CLINICAL CRITERION FOR DRY WEIGHT ESTIMATION IN HEMODIALYZED CHILDREN

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Varvara Askiti ◽  
Georgia Malakasioti ◽  
George Servos ◽  
Georgia Grigoriadou ◽  
Andromachi Mitsioni
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
New Technologies ◽  
Fluid Overload ◽  
Vena Cava ◽  
Dry Weight ◽  
Chronic Hemodialysis ◽  
Hydration Status ◽  
Clinical Criteria

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&lt;0,05) and to IVCDi (r=0,4, r=0,5, p&lt;0,05) and IVCDe (r=0,4, r=0,6, p&lt;0,05). A negative association between IVCCI and relOH-BIS was observed (r= -0,4, p&lt;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 &lt;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.

Bioimpedance and inferior vena cava diameter for assessment of dialysis dry weight

2000 ◽  
Vol 14 (10-11) ◽  
pp. 903-907 ◽  
Author(s):  
Tobias Dietel ◽  
Guido Filler ◽  
Ryszard Grenda ◽  
Norman Wolfish
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Dry Weight ◽  
Inferior Vena Cava Diameter

scholarly journals Androgen versus erythropoietin for the treatment of anemia in hemodialyzed patients: a prospective study.

1996 ◽  
Vol 7 (1) ◽  
pp. 140-144
Author(s):  
J L Teruel ◽  
R Marcen ◽  
J Navarro-Antolin ◽  
A Aguilera ◽  
G Fernandez-Juarez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Recombinant Human Erythropoietin ◽  
Dry Weight ◽  
Pressure Control ◽  
Therapeutic Approaches ◽  
Human Erythropoietin ◽  
Group A ◽  
Male Patients ◽  
Group B ◽  
A Prospective Study

According to this facility's protocol for the treatment of anemia in hemodialyzed patients, androgens were administered to male patients aged over 50 yr and recombinant human erythropoietin was administered to male patients below 50 yr of age and to female patients. In the study presented here, both therapeutic approaches have been prospectively analyzed. Patients were divided into two groups. Group A was composed of 18 patients, aged 62 +/- 12 yr, treated with nandrolone decanoate (200 mg/wk im) for 6 months; Group B was composed of 22 patients (6 men, 16 women) aged 47 +/- 15 yr, treated with subcutaneous recombinant human erythropoietin (initial dose, 6000 IU/wk) for 6 months. The increases of hemoglobin were similar in both groups; Group A, from 7.3 +/- 0.8 to 10.8 +/- 1.7 g/dL (P < 0.001), and Group B, from 7 +/- 0.6 to 10.4 +/- 1 g/dL (P < 0.001). In Group A, increases of triglycerides (159 +/- 71 versus 267 +/- 153 mg/dL, P < 0.001), serum albumin (3.9 +/- 0.3 versus 4.2 +/- 0.3 g/dL, P < 0.05), and dry weight (62.1 +/- 9.8 versus 64.9 +/- 10.1 kg, P < 0.001) were observed, which remained unmodified in Group B. Blood pressure control worsened in one patient (6%) from Group A, and in ten patients (45%) from Group B (P < 0.05). In conclusion, androgens produced an improvement in anemia in selected patients, similar to that achieved by use of recombinant human erythropoietin but at a lower cost. Androgens also have an appreciable anabolic effect and did not increase the blood pressure.

ALBUMIN VERSUS FRESH FROZEN PLASMA IN MANAGING DIURETIC RESISTANT EDEMA IN CHILDREN WITH IDIOPATHIC NEPHROTIC SYNDROME

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Vishwajeet Singh ◽  
P K Berwal ◽  
T C Saini ◽  
Narender Mishra
Keyword(s):  
Nephrotic Syndrome ◽  
Pediatric Patients ◽  
Idiopathic Nephrotic Syndrome ◽  
Dry Weight ◽  
Fresh Frozen Plasma ◽  
Fresh Frozen ◽  
Double Number ◽  
Group A ◽  
Group B ◽  
Frozen Plasma

Background: This study was carried out to compare the efficacy and outcome of albumin with fresh frozen plasma (FFP) in the treatment of diuretic resistant edema in nephrotic syndrome Methods: Sixty patients with idiopathic NS were enrolled in this prospective analytic study. Patients with moderate to severe edema with serum albumin <1.5 gm/dl were given albumin and FFP dividing into two groups. Group-A, received intravenous albumin- 1 gm/kg/day and Group-B intravenous FFP 15ml/kg/day. Total number of albumin and FFP infusion were determined by edema reduction. Results: Diagnosis of NS and biochemical parameters were same in both groups. Dry weight was achieved in Group-A in 6.62± 3.15 days and in Group-B 6.65 ± 3.18 days. In GroupA the number of albumin infusion required was 1.42±0.62 and Group-B FFP infusion required was 3.11± 1.05 (p=0.0001). No significant complications were observed in both the groups. Conclusion: FFP cost half than albumin and same duration required to reduce edema but with double number of infusion and it is safe in pediatric patients with NS presenting with moderate to severe edema. Keywords: NS, Oedema, FFP, Albumin

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