Comparison of multiple fluid status assessment methods in patients on chronic hemodialysis

Alexiadis, G; Panagoutsos, Stelios; Roumeliotis, Stefanos; Stibiris, Ilias; Markos, Angelos; Kantartzi, Konstantia; Passadakis, Ploumis

doi:10.1007/s11255-016-1473-y

Cited by 33 publications

(36 citation statements)

References 51 publications

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“…In order to evaluate overall body fluid status, blood pressure, body weight, and edema severity are often used as indicators of fluid status. In order to achieve a more precise estimation, these measurements have been combined with different techniques, such as relative blood volume monitoring, pulmonary ultrasonography, measurement of the inferior vena cava diameter, and bioimpedance . These methods are used to various degrees in the clinical setting, but no single method has had a proven substantial effect on survival.…”

Section: Introductionmentioning

confidence: 99%

Intravascular volumes evaluated by a carbon monoxide rebreathing method in patients undergoing chronic hemodialysis

Bomholt

Larsson

Rix

et al. 2020

Hemodialysis International

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Introduction: Treatment of fluid overload and anemia remains a challenge in patients undergoing hemodialysis. Hypervolemia can be evaluated using a carbon monoxide (CO) rebreathing method by which blood volume (BV), plasma volume (PV), and red blood cell volumes (RBCV) can be determined. We hypothesized that recurrent hypervolemia would cause hemoglobin (Hb) levels to be in the anemic range without a concurrent reduction in RBCV in patients undergoing hemodialysis.Methods: BV, PV, and RBCV were determined by a CO rebreathing test in 19 patients with type 2 diabetes undergoing chronic hemodialysis. The tests were performed 20 minutes before initiating dialysis, and the measured intravascular volumes were compared with predicted normal intravascular volumes according to Nadler's equation. Before initiating dialysis, Hb and blood pressure were measured, and edema severity was graded.Findings: Measured BV was higher in 17 out of the 19 patients with a median of 71.1 (62.4--76.9) mL/kg and higher than the predicted BV of 58.3 (53.5-59.9) mL/kg (P < 0.001). The measured PV was found to be higher in all patients. RBCV was measured as 25.2 (23.4-28.2) mL/kg with a predicted volume of 25.9 (22.4-26.7) mL/kg (P = 0.56). Eighteen patients were anemic as determined by Hb concentrations (defined as Hb < 13 g/dL for men and <12 g/dL for women), and nine were anemic according to RBCV. Discussion:The CO rebreathing test is a new approach to measuring intravascular volumes in hemodialysis patients. Compared with predicted intravascular volumes, the predialysis BV was expanded in the majority with elevated PV as the main cause. No overall difference in RBCV was found between the measured and predicted volumes. According to predialysis Hb levels, all but one patient was anemic, but according to the measured RBCV, only nine were in the anemic range, indicating dilution of Hb.

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Section: Introductionmentioning

confidence: 99%

Intravascular volumes evaluated by a carbon monoxide rebreathing method in patients undergoing chronic hemodialysis

Bomholt

Larsson

Rix

et al. 2020

Hemodialysis International

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“…This finding may be largely dependent on the time lag in plasma refilling. Alexiadis et al reported that the number of B-lines has better discriminative power for predicting over-and underhydration, as determined by the IVC dimensions [2]. Mallamaci et al suggested that the detection of extracellular water in the lung compartment constitutes a reliable tool for the prognosis of overhydration and is thus amenable to intervention [19].…”

Section: Discussionmentioning

confidence: 99%

“…Lung ultrasound has recently been shown to be a useful, noninvasive technique for the assessment of extravascular lung water [2]. The most commonly observed finding was a comet tail artifact fanning out from the lung-wall interface and spreading upwards to the edge of the screen, previously named a "B-line" [3].…”

Section: Introductionmentioning

confidence: 99%

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Associations between fluid removal and number of B-lines, peak early mitral inflow wave velocity, and inferior vena cava dimensions in hemodialysis patients

et al. 2017

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Background: The inferior vena cava (IVC) dimensions represent the right ventricular preload, whereas the peak early mitral inflow wave velocity (peak E-velocity) represents the left ventricular preload. On the other hand, B-lines represent extravascular lung water. The aim of this study was to evaluate possible acute changes in the IVC dimensions, peak E-velocity, and number of B-lines during hemodialysis therapy. Methods: A total of 55 consecutive patients receiving maintenance hemodialysis were enrolled in this study. We performed echo-graphic examinations at three time points (just after the start, during the middle, and just before the end of the hemodialysis therapy). We then investigated the changes in the IVC dimensions, peak E-velocity, and number of B-lines. Results: The peak E-velocity decreased from 80 ± 26 cm/s at the start of the therapy to 58 ± 22 cm/s during the middle and 51 ± 21 cm/s at the end of the therapy. The IVC dimensions also decreased from 15 ± 4 mm at the start of the therapy to 12 ± 3 mm during the middle and 11 ± 3 mm at the end of the therapy. The number of B-lines also decreased from 12 ± 5 at the start of the therapy to 9 ± 4 during the middle and 5 ± 3 at the end of the therapy. The changes in the peak E-velocity and IVC dimensions were significantly greater during the first half of the dialysis period than during the second half of the dialysis period (P < 0.0001 and P < 0.0001, respectively). On the other hand, the changes in the number of B-lines during these periods were significantly smaller during the first half of the dialysis period than during the second half of the dialysis period (P = 0.0016). Conclusions: We showed that the peak E-velocity and the IVC dimensions were reduced mainly during the first half of the dialysis period, while the number of B-lines showed a significant decrease mainly during the last half of the dialysis period. Even if the IVC dimensions are reduced sufficiently, caution is needed as lung congestion may still exist.

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“…Patients in whom dry weight was reached according to this operational definition, using long dialysis hours in combination with meticulous sodium restriction have lower extracellular volume and better survival [41][42][43]. In general, dry weight is assumed to coincide with normalization of ECV, although substantial differences may be observed between clinical judgment and information obtained by additional technologies [44,45]. Interestingly, in a cohort study in 639 PD patients, 28% of the population was fluid overload, defined as OH: ECV ratio > 7%, in combination with a normal or low blood pressure [1].…”

Section: The Dry Weight Conceptmentioning

confidence: 99%

Body Fluids in End-Stage Renal Disease: Statics and Dynamics

Kooman

Sande²

2018

Blood Purif

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Background: Abnormalities in fluid status in hemodialysis (HD) patients are highly prevalent and are related to adverse outcomes. Summary: The inherent discontinuity of the HD procedure in combination with an often compromised cardiovascular response is a major contributor to this phenomenon. In addition, systemic inflammation and endothelial dysfunction are related to extracellular fluid overload (FO). Underlying this relation may be factors such as hypoalbuminemia and an increased capillary permeability, leading to an altered fluid distribution between the blood volume (BV) and the interstitial fluid compartments, compromising fluid removal during dialysis. Indeed, whereas estimates of extracellular volume by bioimpedance spectroscopy are highly predictive of mortality, absolute BV assessed by the saline dilution technique was predictive of intra-dialytic morbidity. Changes in relative BV during HD are positively related to ultrafiltration rate (UFR) and, at least in some studies, negatively to FO. High UFR is also related to changes in central venous oxygen saturation (S_cvO₂), a marker for tissue perfusion. On the one hand, high UFR and more pronounced declines in S_cvO₂, but on the other hand, flat relative BV curves are also predictive of mortality; the relation between outcome which statics and dynamics of fluid status appears to be complex. Key Message: While technological developments enable the clinician to monitor statics and dynamics of fluid status and hemodynamics during HD in an accessible way, the role of technology-based interventions needs further study.

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Comparison of multiple fluid status assessment methods in patients on chronic hemodialysis

Abstract: The BLS is a useful and easily performed technique that has recently become available for accurate evaluation of dry weight and fluid status in patients with end-stage renal disease undergoing chronic HD. This method might help recognize asymptomatic lung congestion in these patients.

Cited by 33 publications

References 51 publications

Intravascular volumes evaluated by a carbon monoxide rebreathing method in patients undergoing chronic hemodialysis

Intravascular volumes evaluated by a carbon monoxide rebreathing method in patients undergoing chronic hemodialysis

Associations between fluid removal and number of B-lines, peak early mitral inflow wave velocity, and inferior vena cava dimensions in hemodialysis patients

Body Fluids in End-Stage Renal Disease: Statics and Dynamics

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