Background and Aims OL-HDF provides multiple advantages and benefits to patients compared to conventional high-flow hemodialysis (HFHD). Current monitors have a wide variety of biosensors and devices that provide continuous information on the patient's biological parameter and the efficiency of the dialysis session. Monofrequency bioimpedance (BIVA) provides information regarding the state of hydration (HE) and nutrition (EN) of our patients. Method Observational study in 493 patients, distributed in 8 dialysis centers and with a three different model of dialysis monitor. Demographic data, dialysis techniques and regimens, mean values for one month of ultrafiltration rate readings and KT are analyzed. The continuous measurement of DD is estimated by the ion dialysance biosensor. The OL-HDF technique is post-dilutional. The BIVA measurement is performed between 10 and 30 minutes after the end of the session. The Kt/V is estimated from the total TBW (V) by BIVA, using the Watson and Hume-Wiers formulas. Statistical analysis: descriptive, t-Student for statistics of groups and independent samples, Chi square for the association in cross tables. Results See Table 1. Conclusion Obtaining lower dialysis dose values in OL-HDF than in HFHD in some monitor models, despite longer dialysis times and greater dialyzer surface area, is probably due to dilution due to post- re-infusion and/or to the positioning of the dialysance sensors within the hydraulic circuit. This makes us think about the advisability of maintaining urea Kt/V measurements, by laboratory, to ensure adequate dialysis quality.
Background and Aims The skeletal muscle index (SMI) is an impedance parameter that assesses muscle mass, and the phase angle (PA) is inversely related to strength and muscle mass in hemodialysis patients. Both parameters may represent useful and inexpensive tools to identify sarcopenic patients. Method The presence of sarcopenia was analyzed in 348 normohydrated patients in 5 hemodialysis centers by means of vector bioimpedance using the BIA101 BIVA PRO equipment. To do this, the skeletal muscle index (SMI) and the phase angle (PA) are evaluated as markers of muscle mass and strength, respectively. Results Mean SMI and PA were 8.64 ± 1.5 and 5.2 ± 0.9. The mean PA was 5.6 ± 0.9 in those with SMI within normality (9.2 ± 1.9) (p<0.001). In moderate and severe sarcopenics patients, the means of SMI (8.9 ± 1.2 vs 7.5 ± 0.9) and PA (5.3 ± 0.86 vs 4.7 ± 0.67) were significantly lower (p < 0.001) (Table 1). In patients on standard hemodialysis, the PA (P = .02) and the SMI (P = .004) were significantly lower. The PA (P = .014) and the SMI (p < 0.01) were significantly lower in the female gender but the number of sarcopenic patients was higher among the men (p< 0.001). The cut-off value of PA, which predicted a higher risk of sarcopenia, was 3.5 in all patients (95% CI, 0.60-0.71; P = .0001; 100% sensitivity, 96% specificity ); 3.55 for men (95% CI, 0.57-0.78; P = .003; 100% sensitivity, 94% specificity) and 3.65 for women (95% CI, 0.60-0.73 ; P = .0001; 100% sensitivity, 96% specificity) (Fig. 1). In the logistic regression analysis, male gender, standard hemodialysis technique, and PA were associated with a higher risk of sarcopenia (Table 2). Conclusion PA is a good predictor of sarcopenia in hemodialysis patients.
Background and Aims Altered fluid status and inadequate fluid management, independently and concurrently with depletion of lean mass adversely affect patients’ quality of life, outcomes and prognosis of hemodialysis (HD) patients, both standard (HD) and Hemodiafiltration on-line (HDFOL). Method We conducted a population-based on 470 patients, retrospective longitudinal cohort study, to determine the physical characteristics of bioimpedance measurements and indexes obtained by BIVA on maintenance HD and HDFOL patients, and to analyze the hydration status of the extra and intracellular compartments. The Propensity Score Matching (PSM) procedure, matches case records with similar control records. It first runs a logistic regression with the case/control group variable as the dependent variable. Then it selects a match for each case from the control group based on the PSM from the logistic regression. Euhydrated and Overhydrated groups were macheted separately. Results see Table 1, Figure 1 and 2. Conclusion 1) Compared to standard HD, the HDFOL technique maintains a better water balance between the intracellular and extracellular spaces, especially when the patient is euhydrated. In overhydrated patients, although the ECW/ICW ratio is high, it is lower in patients on HDFOL. 2) The stability of cell membranes in HDFOL is better than in HD. 3) For an adequate assessment of any of the parameters measured directly or derived from the BIA, it must be a “sine qua non” condition that the patient is in a state of euhydration. 4) In hemodialysis patients, the phase angle, must first be considered as a marker of hydration status, and then as a marker of nutritional status.
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