Evaluation of clinical dry weight assessment in haemodialysis patients using bioimpedance spectroscopy: a cross-sectional study

Passauer, Jens; Петров, H М; Schleser, Andreas; Leicht, Joachim; K, Pucalka

doi:10.1093/ndt/gfp517

Cited by 131 publications

(142 citation statements)

References 12 publications

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“…The complementary prognostic information provided by these simple investigations is of major importance for identifying subpopulations that may benefit from a specific intervention and for the design of future randomized trials in patients with chronic kidney disease. Recent studies have demonstrated that brachial pulse pressure, a proxy of arterial stiffness, is an important parameter to take into account when deciding on fluid removal and dry weight (8,9). For the management of hyperphosphatemia, the choice of phosphate binder (calcium-versus noncalcium-containing) may be influenced by the degree of vascular calcification, if the available data on the adverse effect of calcium salts on the progression of vascular calcification and outcome are confirmed (10 -12).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Aortic Stiffness and Calcification for Cardiovascular Events and Mortality in Dialysis Patients

Verbeke

Biesen

Honkanen

et al. 2011

Clinical Journal of the American Society of Nephrology

200

166

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SummaryBackground and objectives Radiographic calcification and arterial stiffness each individually are predictive of outcome in dialysis patients. However, it is unknown whether combined assessment of these intermediate endpoints also provides additional predictive value.Design, setting, participants, & measurements Scoring of abdominal aortic calcification (AAC) using plain lateral abdominal x-ray and measurement of carotid-femoral pulse wave velocity (PWV) were performed in a cohort of 1084 prevalent dialysis patients recruited from 47 European dialysis centers.Results During a follow-up of 2 years, 234 deaths and 91 nonfatal cardiovascular (CV) events occurred. Compared with the lowest tertile of AAC, the risk of an event was increased by a factor 3.7 in patients with a score of 5 to 15 (middle tertile), and by a factor 8.6 in patients with scores of 16 to 24. Additionally, each 1-m/s increase in PWV was associated with a 15% higher risk. At higher AAC (scores Ն5), the effect of PWV was attenuated because of a negative PWV ϫ AAC interaction (hazard ratio [HR]: 0.895 and 0.865 for middle and upper AAC tertiles). After accounting for age, diabetes, and serum albumin, AAC and PWV remained independent predictors of outcome.Conclusions AAC and central arterial stiffness are independent predictors of mortality and nonfatal CV events in dialysis patients. The risk associated with an increased PWV is less pronounced at higher levels of calcification. Assessment of AAC and PWV is feasible in a clinical setting and both may be used for an accurate CV risk estimation in this heterogeneous population.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Aortic Stiffness and Calcification for Cardiovascular Events and Mortality in Dialysis Patients

Verbeke

Biesen

Honkanen

et al. 2011

Clinical Journal of the American Society of Nephrology

200

166

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“…Currently, fluid and salt restrictions are the principle means used to minimize IDWG and thereby, rapid UF rates, but research and clinical experience show that adherence to these otherwise physiologically sound interventions is difficult (7,8). As a result, as many as 25%-50% of patients on HD are chronically volume-expanded, and many patients are routinely exposed to high UF rates (9). To mitigate risk from hypervolemia and fluid removal practices, novel approaches to fluid management are needed.…”

Section: Introductionmentioning

confidence: 99%

Patient-Stated Preferences Regarding Volume-Related Risk Mitigation Strategies for Hemodialysis

Flythe

Mangione

Brunelli

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Larger weight gain and higher ultrafiltration rates have been associated with poorer outcomes among patients on dialysis. Dietary restrictions reduce fluid-related risk; however, adherence is challenging. Alternative fluid mitigation strategies include treatment time extension, more frequent dialysis, adjunct peritoneal dialysis, and wearable ultrafiltration devices. No data regarding patient preferences for fluid management exist. A survey was designed, tested, and administered to assess patient-stated preferences regarding fluid mitigation.Design, setting, participants, & measurements A written survey concerning fluid-related symptoms, patient and treatment characteristics, and fluid management preferences was developed. The cross-sectional survey was completed by 600 patients on hemodialysis at 18 geographically diverse ambulatory facilities. Comparisons of patient willingness to engage in volume mitigation strategies across fluid symptom burden, dietary restriction experience, and patient characteristics were performed.Results Final analyses included 588 surveys. Overall, if allowed to liberalize fluid intake, 44.6% of patients were willing to extend treatment time by 15 minutes. Willingness to extend treatment time was incrementally less for longer treatment extensions; 12.2% of patients were willing to add a fourth weekly treatment session, and 13.5% of patients were willing to participate in nocturnal dialysis three nights per week. Patients more bothered by their fluid restrictions (versus less bothered) were more willing to engage in fluid mitigation strategies. Demographic characteristics and symptoms, such as cramping and dyspnea, were not consistently associated with willingness to engage in the proposed strategies. More than 25% of patients were unsure of their dry weights and typical interdialytic weight gains.Conclusions Patients were generally averse to treatment time extension.15 minutes. Patients more bothered (versus less bothered) by their prescribed fluid restrictions were more willing to engage in volume mitigation strategies. Additional study of patient-stated preferences in hemodialysis treatment practices is needed to guide patient care and identify deficiencies in patient treatment and disease-related knowledge.

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“…Bioimpedance spectroscopy represents a different approach to the assessment of fluid status and this analytic technique mainly uses the electrical properties of biological cells and fluids (33)(34)(35). The Body Composition Monitor is a bioimpedance spectroscopy device for clinical use, validated by isotope dilution methods (6), and reference body composition methods (7), and has been used in hemodialysis patients (21,(36)(37)(38). Moving patients into the normohydration target range leads to a better control of hypertension (38,39), fewer intradialytic adverse events and improved cardiac function (38,40).…”

Section: Türk Nefroloji Diyaliz Ve Transplantasyon Dergisi Turkish Nementioning

confidence: 99%

The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients

Hür¹,

Budak²,

Mağden³

et al. 2017

Turk Neph Dial Transpl

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OBJECTIVE: Hypervolemia and malnutrition are often undiagnosed risk factors for hemodialysis (HD). Our aim was to investigate the long-term effects of hypervolemia and malnutrition evaluated by bioimpedance spectroscopy (BIS) on survival. (Clinical Trials. Gov Identifier: NCT01468363). MATERIAL and METHODS:A total of 431 Prevalent HD patients were followed for 32.2±14.4 months. The patients underwent BIS measurement, a medical history was obtained, and routine tests were analyzed at the baseline and at the end of the study. Hospitalizations and complications of HD were recorded. RESULTS:The mean age was 59.4±14.6 (10-92) years with a total of 431 (53.6% males) patients of which 125 died. The percentage of diabetics was 47%, erythropoietin use 67%, and diuretic use 40%. Predialysis systolic blood pressure (BP) was 133.4±25.8 and diastolic BP 79.2±12.4 mm Hg.The rate of diabetes, and the number of hospitalizations and blood transfusions were higher in the patients who died. Diastolic BP as a clinical hypervolemia finding, BIS hypervolemia indicator of over hydration (OH), and extracellular water (ECW) were all increased, and fat tissue index as a malnutrition finding was decreased in patients who died. There were significant rates of anemia and hypoalbuminemia in this group as well.The cumulative survival was lower in hypervolemic patients as assessed by relative hydration status OH/ECW. CONCLUSION:Hypervolemia and malnutrition are the long-term mortality indicators in hemodialysis. Early diagnosis and treatment is important. Clinical findings may not be sufficient and laboratory and BIS methods can be used for diagnosis. Ölen hastaların diyabet oranı, hastaneye yatışları ve kan transfüzyon sayıları daha fazla idi. Ölen hastalarda: klinik hipervolemi bulgularından diyastolik kan basıncı, BİS hipervolemi göstergesi olan aşırıhidrasyon (OH), Hücredışı su (ECW), artmış, malnütrisyon bulgusu olarak yağ kitle endeksi azalmıştı. Bu grupta anlamlı anemi ve hipoalbuminemi mevcuttu.

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Evaluation of clinical dry weight assessment in haemodialysis patients using bioimpedance spectroscopy: a cross-sectional study

Abstract: BIS is an interesting, objective method to support clinical DWA. Further studies should be performed to investigate beneficial clinical effects of this approach.

Cited by 131 publications

References 12 publications

Prognostic Value of Aortic Stiffness and Calcification for Cardiovascular Events and Mortality in Dialysis Patients

Prognostic Value of Aortic Stiffness and Calcification for Cardiovascular Events and Mortality in Dialysis Patients

Patient-Stated Preferences Regarding Volume-Related Risk Mitigation Strategies for Hemodialysis

The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients

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