Annual change in the extracellular fluid/intracellular fluid ratio and mortality in patients undergoing maintenance hemodialysis

We aimed to investigate whether annual change in the extracellular fluid to intracellular fluid (ΔECF/ICF) ratio can accurately predict mortality in hemodialysis patients. Totally, 247 hemodialysis patients were divided into two groups according to the median baseline ECF/ICF ratio of 0.563 and ΔECF/ICF ≥ 0% or < 0% during the first year, respectively. Thereafter, they were divided into four groups according to each cutoff point and were followed up for mortality assessment. The ECF/ICF ratio increased from 0.566 ± 0.177 to 0.595 ± 0.202 in the first year (P = 0.0016). During the 3.4-year median follow-up, 93 patients died (42 cardiovascular-specific causes). The baseline ECF/ICF ≥ 0.563 and ΔECF/ICF ≥ 0% were independently associated with all-cause mortality (adjusted hazard ratio [aHR] 4.55, 95% confidence interval [CI] 2.60–7.98 and aHR 8.11, 95% CI 3.47–18.96, respectively). The aHR for ECF/ICF ≥ 0.563 and ΔECF/ICF ≥ 0% vs. ECF/ICF < 0.563 and ΔECF/ICF < 0% was 73.49 (95% CI 9.45–571.69). For model discrimination, adding the ΔECF/ICF (0.859) alone and both the baseline ECF/ICF and ΔECF/ICF (0.903) to the established risk model (0.746) significantly improved the C-index. Similar results were obtained for cardiovascular mortality. In conclusion, the ΔECF/ICF ratio could not only predict all-cause and cardiovascular mortality but also improve predictability of mortality in hemodialysis patients.

Aether, Fields & Energy Dynamics in Living Bodies - Part II

In this article, we examine dynamics of the three primary aether modalities in the water-body: first, the magnetic, which takes origin in the cardiovascular system; secondly, the radiant, related to ambient light-fall upon the body from the outside or that generated internally, and flows as organized currents in interstitial water; and the dielectric, which predominates in the intracellular fluid spaces, mediated by ion currents, and is involved in the generation and maintenance of cell structure and molecular energy metabolism.

Abstract 16937: Gender Differences in Baseline Body Composition Profiles and Improvements With Visceral Fat-Focused Weight Loss Program

Cardiovascular disease (CVD) in women remains a leading cause of death. A recent study in the Journal of the American Medical Association highlighted the significant risk that central (or visceral) obesity confers in normal-weight postmenopausal women versus normal-weight women without central obesity- a 31% increase in premature death, including death from CVD and obesity-related cancer. Strategies targeting central obesity (visceral adipose tissue or visceral fat, VF) are a promising means to reduce the risk of, and events associated with CVD. A comprehensive telehealth program (20Lighter, 20L) combining patented customizable VLCD meal plans, nutritional supplementation, and expert daily oversight significantly reduces VF. Here we present data assessing body composition (BC) improvements between female (n= 931) and male (n= 1269) participants. We found the baseline BC profiles differed, with 3 of the 4 measures varying significantly between female and male participants (shown as female versus male, mean ± SEM): BMI (33.7 ±0.722 vs 35.4 ±0.511, p=0.0548), Body Fat (45.7% ±0.754 vs 38.8% ±0.613, p<0.0001), VF (15.2 ±0.664 vs 22.7 ±0.563, p<0.0001), and Intracellular Fluid (38.6% ±0.539 vs 45.2% ±0.303, p<0.0001) (Figure1A). Interestingly, while baseline measures differed, both women and men achieved the same magnitude of relative percentage improvements in BC measures: BMI (12.9% ±0.192 vs 13.3% ±0.228, p=0.1798), Body Fat (19.5% ±0.560 vs 19.7% ±0.634, p=0.8131), VF (24.7% ±0.643 vs 25.9% ±0.633, p=0.1837), and Intracellular Fluid (6.9% ±0.366 vs 7.9% ±0.486, p=0.0970) (Figure1B). Our data suggest that while women and men have different baseline BC profiles, they achieve equally statistically significant and clinically meaningful changes in outcomes in an expert-supervised, structured comprehensive program that are associated with risk reduction for CVD and CVD-associated events including premature death, heart attack, and stroke.

Importance of Snehapan and Swedan :A review article

Shodhan chikitsa is done for elimination of excess as well as vitiated doshas. For this chikitsa oleation therapy is used as Purvakarma. Snehapan which is taken in small dose along with diet is said to be brimhan Snehapan. It gives strength to the body & can be continued for many days. Regularly we are using this type of Snehapan with diets by ways of milk, ghee, oil etc. After Snehapan , whatever sneha is digested by Jatharagni, that sneha along with ahararasa will be carried out by Saman vayu upto the liver, where panchamahabhutagni will act on it. So the toxins present in the cells i.e. in intracellular fluid should come into the koshtha means ECF and then from ECF to circulation. From circulation to GIT and from GIT , these vitiated doshas are to be eliminated either by Vaman or Virechan karma. Although it is proved that Shodhanchikitsa eliminates toxins from the body, but which toxins are elevated within blood from purvakarma

P1401THE REMOVAL EFFICIENCY OF PHOSPHATE FROM INTRACELLULAR FLUID DURING HEMODIALYSIS

Background and Aims In hemodialysis (HD) patients without residual renal function, almost all of phosphate (P) absorbed through intestine is eliminated with HD. To avoid hyperphosphatemia, which is major risk for mortality in HD patients, reduced P absorption and /or improved P removal efficiency should be required. The P elimination during HD from intracellular fluid (ICF) remarkably differs from that from extracellular fluid (ECF). Because the total P removal is too complicate to analyze, few studies about P removal efficiency have been performed. In this study, we tried to separately estimate the amount of P removal from ICF and ECF. Method Fifty-eight patients undergoing 4-hour HD with BMI 22±3 were enrolled this study. ECF and ICF volumes were considered respectively as 20% and 40% of body weight (BW). The amount of urea nitrogen (UN) removal (Run) was calculated using the values of serum UN concentration (UN0, UN4) and total body fluid (60% of BW) at pre and post HD as 0.6(UN0 x pre BW – UN4 x post BW). The amount of intradialytic total P removal (Rp) was calculated using the formula previously reported. At starting phase of HD, P is considered to be removed only from ECF, and from ECF and ICF at later stage. In initial hours, when P is removed only from ECF, serum P concentration change exponentially (P = KptP0) as serum UN concentration (UN = KuntUN0). (Where, Kun and Kp are exponential coefficient of UN and P respectively, t is time (min), P0 is serum P concentration before HD). If P outflow from ICF is disregarded, the exponential change in P persists, and serum P concentration at the end of 4-hour HD is Kp240P0. Consequently, the amount of P removal from ECF (Rp(ex)) was calculated as 0.2(P0 x preBW - Kp240P0 x postBW). The exponential coefficient in P change was reported to be 0.997788 times of that in UN. The amount of P removal from ICF (Rp(in)) was calculated as difference between Rp and Rp(ex). Each removal efficiency was calculate as Run/UN0, Rp(ex)/P0 or Rp(in)/P0. Intradialytic removal of P from ECF and ICF were compared with that of UN. Regression analysis was performed on 24 factors which might affect the efficiency. The relationship between drug administration and the removal efficiency was investigated as for 22 drugs. Results UN removal and P removal from ECF were closely related. Run and Rp(ex) had positive correlation (0.564, p&lt;0.001). And Run/UN0 also correlated positively to Rp(ex)/P0 (R=0.970, p&lt;0.001). Rp(ex)/P0 and P0 had a positive correlation (R=0.334, p&lt;0.01) as well as Run/UN0 and UN0 (R=0.382, p&lt;0.01). P removal from ICF showed different pattern. In comparison between P removal from ECF and ICF, removal amount showed positive correlation (R=0.634, p&lt;0.001), but removal efficiency showed no correlation(R=0.006, ns). Notably, Rp(in)/P0 and P0 had negative correlation (R=0.315, p&lt;0.02). Rp(in) accounted for 44.6±6.2% of Rp. On regression analysis concerning the 24 factors, only P0 and its confounding factors showed correlation with Rp(ex), Rp(in), Rp(ex)/P0 or Rp(in)/P0. Rp(ex)/P0 or Rp(in)/P0 were not affected with administration of 22 investigated drugs. To exclude the influence of P0 on Rp(in)/P0, adjusted Rp(in)/P0 (removal efficiency of P from ICF not affected by P0) was calculated. Investigation on iron containing P binders and ion exchange resins revealed each drug groups ameliorated adjusted Rp(in)/P0. Conclusion This is the first report to analyze separately P removal from ECF and ICF during HD. Increased UN removal efficiency results in increased the removal efficiency of P from ECF, but did not improved that from ICF. Rp(in) accounts for about half of Rp. For improving total P removal efficiency, removal efficiency of P from ICF should be increased. Some drugs were suggested to increase removal efficiency of P from ICF.

Combined Predictive Value of Extracellular Fluid/Intracellular Fluid Ratio and the Geriatric Nutritional Risk Index for Mortality in Patients Undergoing Hemodialysis

The ratio of extracellular fluid (ECF) to intracellular fluid (ICF) may be associated with mortality in patients undergoing hemodialysis, possibly associated with protein-energy wasting. We therefore investigated the relationship of the ECF/ICF ratio and the geriatric nutritional risk index (GNRI) with the all-cause and cardiovascular-specific mortality in 234 patients undergoing hemodialysis. Bioimpedance analysis of the ECF and ICF was performed and the ECF/ICF ratio was independently associated with GNRI (β = −0.247, p < 0.0001). During a median follow-up of 2.8 years, 72 patients died, of which 29 were cardiovascular. All-cause mortality was independently associated with a lower GNRI (adjusted hazard ratio [aHR] 3.48, 95% confidence interval [CI] 2.01–6.25) and a higher ECF/ICF ratio (aHR 11.38, 95%CI 5.29–27.89). Next, we divided patients into four groups: group 1 (G1), higher GNRI and lower ECF/ICF ratio; G2, lower GNRI and lower ECF/ICF ratio; G3, higher GNRI and higher ECF/ICF ratio; and G4, lower GNRI and higher ECF/ICF ratio. Analysis of these groups revealed 10-year survival rates of 91.2%, 67.2%, 0%, and 0% in G1, G2, G3, and G4, respectively. The aHR for G4 versus G1 was 43.4 (95%CI 12.2–279.8). Adding the GNRI alone, the ECF/ICF ratio alone, or both to the established risk model improved the net reclassification improvement by 0.444, 0.793 and 0.920, respectively. Similar results were obtained for cardiovascular mortality. In conclusion, the ECF/ICF ratio was independently associated with GNRI and could predict mortality in patients undergoing hemodialysis. Combining the GNRI and ECF/ICF ratio could improve mortality predictions.