Fluid status assessment in hemodialysis patients and the association with outcome

Dekker, Marijke; Kooman, Jeroen P.

doi:10.1097/mnh.0000000000000409

Cited by 31 publications

(37 citation statements)

References 26 publications

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“…; Dasgupta et al . ; Dekker & Kooman ; Tabinor & Davies ). For fluid management interventions to be successful they must be considered as part of a multidisciplinary team.…”

Section: Discussionmentioning

confidence: 99%

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Systematic Fluid Assessment in Haemodialysis: Development and Validation of A Decision Aid

Stenberg

Keane

Lindberg

et al. 2019

Journal of Renal Care

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SUMMARY Background About a third of patients undergoing haemodialysis have poorly controlled fluid status, which may affect survival. Clinical assessment is subjective and imprecise, which has led to the increasing use of devices based on bioimpedance spectroscopy (BIS). However, BIS cannot provide a simple target applicable to all patients. Our aim was to develop and validate a decision aid combining clinical assessment of fluid status with information from BIS in target weight determination. Methods The decision aid was based on empirical experience and a literature review identifying physiological parameters already used in the clinical assessment of fluid status. Content validity was established by patient representatives, interdisciplinary stakeholders and external experts, who assessed item relevance and comprehensiveness. Reliability was assessed by inter‐rater agreement analysis between nurses assessing typical patient cases. Results The decision aid for Recognition and Correction of Volume Alterations (RECOVA) consists of three parts (1) a scoring system; (2) thresholds and triggers; (3) a decision aid algorithm. Agreement between raters in the assessment of symptoms was almost perfect, with Intraclass Correlation Coefficient > 0.90. Agreement in clinical response was only fair, but increased to moderate, with training and self‐reported confidence. Conclusion RECOVA may enable systematic clinical assessment of fluid status, facilitating early recognition of fluid alterations, and incorporation of bioimpedance into target weight management. However, implementation into clinical practice will require training of staff. Clinical intervention studies are required to evaluate if RECOVA facilitates response to and correction of recognised fluid alterations.

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“…; Dasgupta et al . ; Dekker & Kooman ; Tabinor & Davies ). For fluid management interventions to be successful they must be considered as part of a multidisciplinary team.…”

Section: Discussionmentioning

confidence: 99%

“…About a third of patients have poorly controlled fluid status (Moissl et al . ) and even minor deviations from normal fluid status may affect survival (Dekker & Kooman ).…”

Section: Introductionmentioning

confidence: 99%

Systematic Fluid Assessment in Haemodialysis: Development and Validation of A Decision Aid

Stenberg

Keane

Lindberg

et al. 2019

Journal of Renal Care

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“…Chronic overhydration has been identified as an independent predictor of mortality in hemodialysis patients. [1][2][3] Overhydration is associated with inflammation, 4 left ventricular hypertrophy, left ventricular dilation, arterial hypertension, and the eventual development of congestive heart failure. 5,6 More than 25% of all hemodialysis patients are overhydrated, while a large proportion have a fluid deficit.…”

Section: Introductionmentioning

confidence: 99%

Brain natriuretic peptide reflects individual variation in hydration status in hemodialysis patients

Stenberg

Melin

Lindberg

et al. 2019

Hemodialysis International

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Introduction: Fluid management in hemodialysis patients is a controversial topic. Brain natriuretic peptide (BNP) is secreted from the heart in response to volume overload, and may be a marker of overhydration in hemodialysis patients. Our aim was to investigate the correlation between BNP and overhydration in a cohort of hemodialysis patients, and to find out whether BNP and overhydration correlate in repeated measurements within individuals with elevated BNP. Methods: The study was prospective, observational, and had a cross‐sectional part and a longitudinal follow‐up. The distribution of BNP was investigated in a cohort of 64 hemodialysis patients. Blood samples and bioimpedance spectroscopy measurements were performed before midweek dialysis. Subsequently, 11 study participants with elevated BNP concentrations (>500 pg/mL) were assessed in another nine dialysis sessions each. These individuals also had their cardiac function and heart rate variability (HRV) examined. Findings: BNP was above 500 pg/mL in 38% of the participants, and correlated positively with overhydration (rs = 0.381), inflammation and malnutrition, but not with systolic blood pressure. In comparison to participants with BNP below 500 pg/mL, participants with elevated BNP were older, had lower muscle strength, lower bodyweight and lower levels of hemoglobin and albumin. Echocardiography revealed cardiac anomalies in all 11 participants in the longitudinal follow‐up, and HRV, as measured by SDNN, was pathologically low. In repeated measurements, the between‐individuals variation of BNP in relation to overhydration was greater (SD = 0.581) than the within‐person variation (SD = 0.285). Discussion: BNP correlates positively to overhydration, malnutrition, and inflammation. In a subgroup of patients with elevated BNP, who are mainly elderly and frail, BNP reflects individual variation in hydration status, and hence seems to be a modifiable marker of overhydration. These data suggest that BNP is best applied for measuring changes in hydration status within an individual over time.

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“…Especially BIS, most notably by using the 3 compartment model, has shown to be related to outcome in various studies [3,59,60], with an optimal survival found to be within a quite narrow range (pre-dialytic OH between -1.1 and +1.1 L) [61]. Also, pre-dialytic fluid depletion was associated with outcome but interestingly only when accompanied by low pre-dialytic systolic blood pressure [46].…”

Section: Can Technology Aid the Clinical Decision Process?mentioning

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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Fluid status assessment in hemodialysis patients and the association with outcome

Cited by 31 publications

References 26 publications

Systematic Fluid Assessment in Haemodialysis: Development and Validation of A Decision Aid

Systematic Fluid Assessment in Haemodialysis: Development and Validation of A Decision Aid

Brain natriuretic peptide reflects individual variation in hydration status in hemodialysis patients

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

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