Assessment and management of fluid overload in children on dialysis

Hayes, Wesley; Paglialonga, Fabio

doi:10.1007/s00467-018-3916-4

Cited by 26 publications

(17 citation statements)

References 68 publications

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“…In fact, ABW changes are highly affected by dietary changes and physiological child growth, limiting its value for tracking hydration status changes in children on PD. 5 Furthermore, we outlined that Re-OH changes were more strongly correlated to BP status and sAlb changes compared to the other BIS parameters. Although ECW/TBW and E/I levels have been related to fluid overload in adult patients, 14,27 the fact that they are influenced by the ICW and therefore confounded by the patients’ nutritional status, restricting their accuracy in the estimation of fluid status variations.…”

Section: Discussionmentioning

confidence: 84%

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Tracking hydration status changes by bioimpedance spectroscopy in children on peritoneal dialysis

et al. 2020

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Background: This 6-month prospective longitudinal study investigates the association between hydration status changes using bioimpedance spectroscopy (BIS) and systolic blood pressure (SBP), pulse pressure (PP), and serum albumin (sAlb) changes in children on peritoneal dialysis (PD). Methods: Thirteen patients (median age: 12.58 years) were enrolled. Normal hydration, moderate hydration, severe overhydration, and dehydration were defined as −7% ≤ relative overhydration (Re-OH) < +7%, +7% ≤ Re-OH < +15%, Re-OH ≥ +15%, and Re-OH < −7%, respectively. Automated office blood pressure z-score, sAlb, and weight z-score were recorded. Results: Fifty-two Re-OH measurements were recorded: three in five, four in five, five in two, and seven in one patient, respectively. SBP was higher and sAlb lower in cases with severe overhydration (9 readings) ( p < 0.001, p < 0.001), but distribution of these parameters did not differ between normal hydration/dehydration (28 readings) and moderate overhydration (15 readings) cases. In patients with hydration status change, SBP and PP were higher while sAlb lower in cases with higher hydration status level ( p = 0.026, p = 0.05, and p = 0.109, respectively). In all patients, visit-to-visit SBP, PP, and sAlb changes were correlated to Re-OH changes ( rs = 0.693, p < 0.001; rs = 0.643, p < 0.001; rs = −0.444, p = 0.008, respectively) but not to weight changes ( rs = 0.052, p = 0.754; rs = 0.034, p = 0.838; rs = −0.156, p = 0.378, respectively). Visit-to-visit Re-OH changes, which were >+4% or <−4%, were linearly correlated to SBP ( r = 0.858, p < 0.001), PP ( r = 0.757, p < 0.001), and sAlb ( r = −0.699, p = 0.002) changes. Conclusion: In children on PD, longitudinal Re-OH changes are superior to weight changes in assessing volume-dependent variations of SBP, PP, and sAlb. Routine BIS application, rather than single BIS measurements, seems useful in the intra-patient monitoring of hydration status.

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Section: Discussionmentioning

confidence: 84%

“…Clinical assessment of hydration cannot accurately detect subtle changes in hydration status. 5 Current research interest has been focused on the development of noninvasive technological tools, designed to provide more objective data concerning the hydration status, in order to help the clinician in the determination of dry weight.…”

Section: Introductionmentioning

confidence: 99%

Tracking hydration status changes by bioimpedance spectroscopy in children on peritoneal dialysis

et al. 2020

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“…We used the Fresenius body composition monitor (Fresenius Medical Care, Homburg, Germany), which is the most widely used BIS device in children on dialysis [ 10 ]. In patients on HD, BIS was performed immediately before the dialysis session.…”

Section: Methodsmentioning

confidence: 99%

“…In children, fluid status assessment is even more challenging because of the continuous increase in lean body weight with growth. Therefore, more objective methods to assess fluid status are necessary; these include bioimpedance spectroscopy (BIS), inferior vena cava (IVC) parameters, relative blood volume monitoring, N-terminal pro-brain natriuretic peptide (NT-proBNP), and lung ultrasound [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Relevance of Fluid Volume Status Assessment by Bioimpedance Spectroscopy in Children Receiving Maintenance Hemodialysis or Peritoneal Dialysis

Park

Min

Lim

et al. 2020

JCM

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Bioimpedance spectroscopy (BIS) is a noninvasive method used to evaluate body fluid volume status in dialysis patients, but reports on its effectiveness in pediatrics are scarce. We investigated the correlation between BIS and clinical characteristics and identified the changes in patients whose dialysis prescription was modified based on BIS. The medical records of children on maintenance dialysis who had undergone BIS between 2017 and 2019 were reviewed. Of the 49 patients, 14 were overhydrated, based on the >15% proportion of overhydration relative to extracellular water (OH/ECW) measured by BIS. Intake of ≥two antihypertensive medications was noted in the majority (85.7%) of children with fluid overload and only in 48.6% of those without fluid overload (p = 0.017). Elevated blood pressure despite medication use was significantly more common in patients with fluid overload than in those without fluid overload (78.6% vs. 45.7%, p = 0.037). Of the 14 overhydrated children, 13 (92.9%) had significant changes in body weight, OH/ECW, the number of antihypertensive drugs, left ventricular end-diastolic diameter, and cardiothoracic ratio after the change in dialysis prescription. BIS is a useful and noninvasive method to assess fluid status in dialysis children. Long-term follow-up and correlation with a more objective clinical indicator of fluid overload is necessary to verify the clinical effectiveness of BIS.

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“…Other methods, such as bioimpedance spectroscopy, are used to estimate total body water, lean and adipose mass, tissue extracellular water, and overhydration; inferior vena cava collapsibility index; relative blood volume monitoring; N-terminal probrain natriuretic peptide; and lung ultrasound were all shown to have limitations, mostly through single-centre studies. Fluid overload has mostly been tested in specific clinical settings [41][42][43][44][45][46][47][48][49].…”

Section: Route Of Feedingmentioning

confidence: 99%

Nutritional Assessment and Management in Paediatric Chronic Kidney Disease

Azzouz

Safdar

Awaleh

et al. 2021

Journal of Nutrition and Metabolism

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Nutrition in paediatrics has always been one of the most important factors for optimal growth. Children with chronic kidney disease (CKD) need special consideration for better long-term outcomes, including nutritional status, optimal height, and cognitive function. Nonetheless, there are many obstacles to overcome to attain optimal linear growth and nutritional status in children with CKD. This review highlights the need for tools to assess the growth parameters in CKD. In addition, recommendations for dietary intake play a major role in controlling electrolyte disturbances in patients with CKD. For example, it is still unclear whether it is better to restrict phosphate sources in inorganic, organic, or food additives. The review also summarises different factors such as fluid intake, route of feeding, and essential nutrients that require particular attention in paediatric patients with CKD. In summary, a multidisciplinary team is needed to devise individual nutritional plans to achieve the best outcome and improve the quality of life of patients.

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Assessment and management of fluid overload in children on dialysis

Cited by 26 publications

References 68 publications

Tracking hydration status changes by bioimpedance spectroscopy in children on peritoneal dialysis

Tracking hydration status changes by bioimpedance spectroscopy in children on peritoneal dialysis

Clinical Relevance of Fluid Volume Status Assessment by Bioimpedance Spectroscopy in Children Receiving Maintenance Hemodialysis or Peritoneal Dialysis

Nutritional Assessment and Management in Paediatric Chronic Kidney Disease

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