An evaluation of blood volume changes during ultrafiltration pulses and natriuretic peptides in the assessment of dry weight in hemodialysis patients

Pol, Anouk C. M. Van De; Frenken, L.A.M.; Moret, Karin; Baumgarten, Ruben; Sande, Frank M. van der; Beerenhout, C.M.; Kooman, Jeroen P.; Leunissen, Karel M.L.

doi:10.1111/j.1542-4758.2007.00154.x

Cited by 34 publications

(26 citation statements)

References 26 publications

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“…BNP data have been rarely analyzed with BVM. Both van de Pol et al [19] and De Mauri et al [20] reported that a higher refilling rate with a flatter BVM slope was associated with higher BNP level, reflecting fluid overload. No comparison exists between these tools in managing fluid in chronic HD patients.…”

Section: Discussionmentioning

confidence: 99%

Brain Natriuretic Peptide Is a Marker of Fluid Overload in Incident Hemodialysis Patients

et al. 2017

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Background/Aims: Brain natriuretic peptide (BNP) is secreted by cardiomyocytes under stretch condition. High blood levels are associated with decreased patient survival in heart failure patients and in hemodialysis (HD) patients. We report the monthly BNP change in the first months of HD therapy in incident patients and its relationship with fluid removal and cardiac history (CH). Methods: All patients starting HD therapy in our unit from May 2008 to December 2012 were retrospectively analyzed. Every month (M1 to M6), BNP was assessed before a midweek dialysis session. CH, monthly pre- and postdialysis blood pressure, and postdialysis body weight were collected. Results: A total of 236 patients were included in the analysis. The median BNP at HD start was 593 (175-1,433) pg/mL, with a significant difference between CH- and CH+ patients (291 vs. 731 pg/mL, p < 0.0001). Mortality was significantly higher in patients in the higher BNP tertile. BNP decreased significantly between M1 and M2 and then plateaued. The BNP change between M1 and M2 and between M1 and M6 was significantly correlated with the initial fluid removal. Applying stepwise multiple regression, the BNP change between M1 and M2 was significantly and independently related to fluid removal. The BNP level at M6 was also related to patient survival. Conclusions: We confirm that in incident HD patients, BNP level is related to fluid excess and cardiac status. The BNP decrease in the first months of HD therapy is related to fluid excess correction. BNP appears as an important tool to evaluate hydration status correction after HD onset.

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Section: Discussionmentioning

confidence: 99%

Brain Natriuretic Peptide Is a Marker of Fluid Overload in Incident Hemodialysis Patients

et al. 2017

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“…Similar to our results, in many patients with left ventricular dysfunction, parameters indicating ventricular diastolic dysfunction were increased, rising to 86% in the series reported by Kalfallah et al [12], and clinical symptoms of ventricular failure were often absent. In these dialysis outpatients, echocardiography was a very useful marker to assess volume overload [13,14] using the diameter of the inferior vena cava. Because it is difficult to obtain the diameter of the inferior vena cava in these patients, and in accord with other authors [15], we think that LA diameter and volume may improve the morphophysiologic expression of volume overload and may reduce the probability of assessment errors.…”

Section: Discussionmentioning

confidence: 99%

Plasma Brain Natriuretic Peptide Levels in Cardiac Function Assessment in Chronic Dialysis Patients

et al. 2011

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Background: Brain natriuretic peptide (BNP) is elevated in patients with end-stage renal disease and could reflect left ventricular dysfunction. Aim: To evaluate the plasma levels of BNP in two groups of asymptomatic patients on different dialysis programs and to correlate their variations with echocardiographic parameters. Methods: Group A consisted of 36 patients on chronic hemodialysis (HD), and group B included 38 patients on continuous ambulatory peritoneal dialysis (CAPD). ECG and echocardiography were performed, and concomitantly plasma BNP levels were determined before and after a regular 4-hour session in HD patients and before performing a dialysate exchange in patients on CAPD. Results: BNP values in group A were found to be higher than in group B (419 ± 76 vs. 193 ± 56 pg/ml; p < 0.03). The cutoff point which discriminated both groups was 194 pg/ml (sensitivity: 64% and specificity: 76%; p = 0.001). Significant differences were found with respect to the following echocardiographic data (group A vs. group B): left atrial (LA) size (40 ± 13 vs. 34 ± 1 mm), LA volume (59 ± 16 vs. 41 ± 32 ml), transmitral flow E/A (1.17 ± 0.01 vs. 0.9 ± 0.06), the movement of the mitral valve annulus e/a (tissue Doppler imaging; 1.19 ± 0.15 vs. 1.05 ± 0.13) and left ventricular mass index (133 ± 10 vs. 108 ± 11). Conclusion: Patients on CAPD had lower levels of BNP, and echocardiographic findings indicated decreased volume overload. In asymptomatic patients, marked increases in BNP levels may reflect early stages of pathological processes that precede the development of apparent cardiac manifestations (left ventricular hypertrophy). Only echocardiographic parameters of cardiac dysfunction should be used as diagnostic criteria.

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“…Comparative studies have generally favored methods based on bioimpedance measurements, which provide an assessment of extracellular and intracellular volume and total body water. [2][3][4] A variant of this technique in which continuous intradialytic measurements are confined to the calf shows particular promise because the relative volume of excess extracellular fluid is greatest in the lower extremities. 5 During dialysis, plasma refilling is more dynamic from the leg in comparison with the trunk or arms, suggesting that the calf could be used as a window to monitor intradialytic changes in whole-body extracellular fluid volume.…”

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Recent Advances in the Prevention and Management of Intradialytic Hypotension

Palmer

Henrich

2008

Journal of the American Society of Nephrology

158

124

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A symptomatic reduction in BP during or immediately after dialysis occurs in approximately 20 to 30% of dialysis sessions. The treatment includes stopping or slowing the rate of ultrafiltration, placing the patient in the Trendelenburg position, decreasing the blood flow rate, and restoring intravascular volume. Such episodes predispose the patient to leave the dialysis unit volume overloaded and if repetitive can lead to inadequate clearance. Intradialytic hypotension and orthostatic hypotension after the procedure are significant and independent risk factors affecting mortality in dialysis patients. 1 This clinical commentary focuses on recent advances in the prevention and management of intradialytic hypotension.Dialysis hypotension is the result of an inadequate cardiovascular response to the reduction in blood volume that occurs when a large volume of water is removed during a short period of time. In a typical dialysis procedure, an ultrafiltrate volume that is equal to or greater that the entire plasma volume is often removed.Despite the large ultrafiltrate volume, plasma volume typically decreases by only approximately 10 to 20%. This ability to maintain plasma volume during ultrafiltration requires mobilization of fluid from the interstitial into the intravascular space. Vascular refilling is influenced by both patient-specific and treatment-related factors that dictate the distribution of water between the body fluid compartments.The amount of interstitial fluid available for vascular refilling is influenced by the dry weight set for the patient. When the volume of interstitial fluid is small, any ultrafiltrate volume will more likely be associated with hemodynamic instability. This explains the development of hypotension when patients undergo dialysis below their true dry weight. By contrast, increased amounts of interstitial fluid will expand the volume of fluid accessible for refilling of the intravascular space and, therefore, decrease the likelihood of hypotension. In most patients, a dry weight that minimizes the amount of interstitial fluid present is selected because chronic volume overload has long-term deleterious effects on the cardiovascular system.The determination of dry weight is largely assessed empirically by trial and error. The dry weight is set at the weight below which unacceptable symptoms, such as cramping, nausea, and vomiting, or hypotension occur. The dry weight is highly variable in many patients and can fluctuate with intercurrent illnesses (e.g., diarrhea, infection) and with changes in hematocrit (as with erythropoietin). A number of methods have been proposed to define more objectively the dry weight of the patient (Table 1). Comparative studies have generally favored methods based on bioimpedance measurements, which provide an assessment of extracellular and intracellular volume and total body water. 2-4 A variant of this technique in which continuous intradialytic measurements are confined to the calf shows particular promise because the relative volume of excess extrac...

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An evaluation of blood volume changes during ultrafiltration pulses and natriuretic peptides in the assessment of dry weight in hemodialysis patients

Cited by 34 publications

References 26 publications

Brain Natriuretic Peptide Is a Marker of Fluid Overload in Incident Hemodialysis Patients

Brain Natriuretic Peptide Is a Marker of Fluid Overload in Incident Hemodialysis Patients

Plasma Brain Natriuretic Peptide Levels in Cardiac Function Assessment in Chronic Dialysis Patients

Recent Advances in the Prevention and Management of Intradialytic Hypotension

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