Higher extracellular fluid volume in women is concealed by scaling to body surface area

Peters, A. M.; Seshadri, Nagabhushan; Neilly, Mark; Perry, Laura J.; Hooker, Claire A.; Howard, Bethany; Sobnack, R.; Irwin, A. G.; Dave, Surendra; Snelling, Hayley; Grüning, Thomas; Patel, Neva; Shabo, Gregory; Williams, Nigel; Barnfield, Mark C.; Lawson, Richard

doi:10.3109/00365513.2013.819524

Cited by 7 publications

(5 citation statements)

References 21 publications

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“…Hyponatremia was commoner and more severe in males in this study. This finding is in disagreement with a previous study that found hyponatremia commoner in females [16]. It is however in agreement with Mannheimer et al who reported that hyponatremia and comorbidities associated with it are commoner in men [17].…”

Section: Discussioncontrasting

confidence: 96%

Pre-Operative Hyponatremia in a High Dependency Cardiovascular Surgical Center of a Tertiary Health Facility in Nigeria: Risk Factors, Prevalence, Clinical Correlates and Treatment Outcome. A Retrospective Cohort Study

Uduagbamen¹,

Sanusi²,

Udom³

et al. 2020

OJIM

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Introduction: Hyponatremia is the commonest electrolyte derangement seen in medical and surgical wards and in high dependency treatment units. It is associated with prolonged hospital stay, high economic burden and increased morbidity and mortality. Hyponatremia is well reported in medical and surgical conditions but literature is scanty concerning its relationship with treatment outcome in patients managed in high dependency heart and vascular surgical centers. Objectives: To determine the prevalence, determinants, clinical correlates and outcome of pre-operative hyponatremia. Methods: Retrospective study involving patients that had surgery (cardiac and vascular) between January 2015 and December 2019. Data were obtained from patients' case files, perioperative and intensive unit charts. All participants with preoperative hyponatremia had their serum sodium corrected to ≥135 mmol before surgical incision and those with hypernatremia had their sodium corrected to <145 mmol. The socio-demographic, clinical, laboratory findings were entered. Statistical analysis was done using student's t-test and Chi square. Results: Of the 305 participants (186 males and 119 females), pre-operative How to cite this paper: Uduagbamen,

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Section: Discussioncontrasting

confidence: 96%

Pre-Operative Hyponatremia in a High Dependency Cardiovascular Surgical Center of a Tertiary Health Facility in Nigeria: Risk Factors, Prevalence, Clinical Correlates and Treatment Outcome. A Retrospective Cohort Study

Uduagbamen¹,

Sanusi²,

Udom³

et al. 2020

OJIM

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“…The convention of indexing glomerular filtration rate to BSA attempts to normalize kidney function across populations of differing body size but may be inappropriate when a more precise estimation of kidney function is needed or in patients with extreme body sizes. Adding to the complexity, there is a disproportionate relation between extracellular volume (ESV) and BSA [ 40 ], and a higher ECV in women may be concealed by scaling to BSA [ 41 ]. The use of absolute values has been shown to improve the performance of estimation of individual kidney function [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Estimation of kidney function in patients with primary neuromuscular diseases: is serum cystatin C a better marker of kidney function than creatinine?

et al. 2021

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Background Using serum creatinine leads to an overestimation of kidney function in patients with primary neuromuscular disorders, and reduced kidney function may remain undetected. Cystatin C (CysC) could provide a better estimation. Aim To evaluate the precision, accuracy, and bias of two creatinine-, one cystatin C-based and one combined equation to estimate glomerular filtration rate (eGFR) in patients with primary neuromuscular disease. Patients and methods Of the 418 patients initially identified at the out-patient clinic, data on kidney function was obtained for 145 adult patients (age 46 ± 14 years, BMI 26 ± 6 kg/m2) with primary neuromuscular disease. Kidney function was measured by iohexol clearance, and blood samples for serum creatinine and CysC were drawn simultaneously. Bias was defined as the mean difference between eGFR and measured iohexol clearance, and accuracy as the proportion of eGFRs within ± 10% (P10) of measured clearance. Results Kidney function (iohexol clearance) was 81 ± 19 (38–134) ml/min/1.73m2. All equations overestimated kidney function by 22–60 ml/min/1.73m2. eGFR CysC had the lowest bias overall 22 (95% CI 20–26) ml/min/1.73m2 also at all levels of kidney function we evaluated (at 30–59 ml/min/1.73m2 bias was 27 (95% CI 21–35), at 60–89 it was 25 (95% CI 20–28) and at ≥ 90 it was 12 (95% CI 7–22)). eGFR CysC also had the best accuracy in patients with reduced kidney function (P10 was 5.9% at 30–59 ml/min/1.73m2). Conclusions Cystatin C-based estimations of kidney function performed better than creatinine-based ones in patients with primary neuromuscular disease, but most importantly, all evaluated equations overestimated kidney function, especially in patients with reduced kidney function. Therefore, kidney function should be measured by gold-standard methods when precision and accuracy are needed. Graphic abstract

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“…Their data suggested that scaling UF rate to body mass would result in a very uneven level of risk if a single target were chosen for both men and women divided by body mass (6). For example, the average UF rate in the cohort was 13 ml/kg/hr, and the risk (31). Of interest, the ECV/BSA relationship was more consistent across quintiles of BMI than ECV/weight, but ECV scaled to body surface area was slightly (7%) higher, while ECV scaled to lean body was slightly (9%) lower, in men than in women.…”

Section: Scaling Arguments Based On Outcomes Datamentioning

confidence: 91%

“…Relationship between ECV /Weight and the quintile of body mass index according to data from Peters et al. . Of interest, the ECV / BSA relationship was more consistent across quintiles of BMI than ECV /weight, but ECV scaled to body surface area was slightly (7%) higher, while ECV scaled to lean body was slightly (9%) lower, in men than in women.…”

Section: Extracellular Fluid Volumementioning

confidence: 99%

Hemodialysis Ultrafiltration Rate Targets Should Be Scaled to Body Surface Area Rather than to Body Weight

Daugirdas

Schneditz

2017

Seminars in Dialysis

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The association between higher ultrafiltration rates and poor outcomes in hemodialysis patients has received increased attention, to the point that various regulatory entities are considering adding ultrafiltration rate as a quality measure to be monitored and controlled. Most of the discussion to date has focused on ultrafiltration rate scaled to body weight, or more correctly, body mass (ml/hour per kg). One outcome study suggests that ultrafiltration rate might best be not scaled at all to body size, as modestly higher ultrafiltration rate in very small-size patients may be associated with some survival benefit, probably via increased dietary intake. Outcomes studies also suggest that the risk of exceeding a weight-scaled ultrafiltration target may be magnified in very large patients, and that body weight-scaled ultrafiltration targets in such patients should be set a lower level. Here, we present an analysis, based on physiological hemodynamic arguments, that it would be better to scale ultrafiltration rate to body surface area rather than to body mass. Whatever ultrafiltration rate is scaled to, attempts to restrict ultrafiltration rate by limiting interdialytic weight gain in small, possibly malnourished patients, should be done cautiously, to prevent an inadvertent lowering of intake of calories and dietary protein.

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Higher extracellular fluid volume in women is concealed by scaling to body surface area

Abstract: Lean tissue in women contains more extracellular water than in men, a difference that is obscured by scaling to BSA. The likely problem with BSA is its insensitivity to body composition.

Cited by 7 publications

References 21 publications

Pre-Operative Hyponatremia in a High Dependency Cardiovascular Surgical Center of a Tertiary Health Facility in Nigeria: Risk Factors, Prevalence, Clinical Correlates and Treatment Outcome. A Retrospective Cohort Study

Pre-Operative Hyponatremia in a High Dependency Cardiovascular Surgical Center of a Tertiary Health Facility in Nigeria: Risk Factors, Prevalence, Clinical Correlates and Treatment Outcome. A Retrospective Cohort Study

Estimation of kidney function in patients with primary neuromuscular diseases: is serum cystatin C a better marker of kidney function than creatinine?

Hemodialysis Ultrafiltration Rate Targets Should Be Scaled to Body Surface Area Rather than to Body Weight

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