Season affects body composition and estimation of fluid overload in haemodialysis patients: variations in body composition; a survey from the European MONDO database

Broers, Natascha J. H.; Usvyat, Len; Marcelli, Daniele; Bayh, Inga; Scatizzi, Laura; Canaud, Bernard; Sande, Frank M. van der; Kotanko, Peter; Moissl, Ulrich; Kooman, Jeroen P.

doi:10.1093/ndt/gfu367

Cited by 27 publications

(30 citation statements)

References 19 publications

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“…3,4 An analysis of body composition in dialysis patients shows extracellular water content to be seasonal, increasing in spring and summer. 5 This seasonal variation in fluid balance might also be true for the general population. Although seasonality in human physiology is seldom contemplated, evidence suggests that the rate of growth in children is greatest in summer (when resources are most plentiful) and immune activity is greatest in winter (when likelihood of disease exposure increases).…”

Section: Discussionmentioning

confidence: 97%

Seasonality of Ankle Swelling: Population Symptom Reporting Using Google Trends

Liu¹,

Allan²,

Korownyk³

et al. 2016

The Annals of Family Medicine

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In our experience, complaints of ankle swelling are more common in summer, typically from patients with no obvious cardiovascular disease. Surprisingly, this observation has never been reported. To objectively establish this phenomenon, we sought evidence of seasonality in the public's Internet searches for ankle swelling. Our data, obtained from Google Trends, consisted of all related Google searches in the United States from January 4, 2004, to January 26, 2016. Consistent with our expectations and confirmed by similar data for Australia, Internet searches for information on ankle swelling are highly seasonal (highest in midsummer), with seasonality explaining 86% of search volume variability.

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Section: Discussionmentioning

confidence: 97%

Seasonality of Ankle Swelling: Population Symptom Reporting Using Google Trends

Liu¹,

Allan²,

Korownyk³

et al. 2016

The Annals of Family Medicine

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“…The average intra-individual change from summer (July) to winter (November) was 4 mmHg and 2 mmHg for pre-dialysis SBP and DBP respectively. It is now established that BP decreases of a significant amount in summer, although this may not occur in all populations, nor all locations [5,6,8,14,15]. The magnitude of seasonal cycles was greater in older, normotensive or diabetic HD patients.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, indirect effects may occur such as UV-related vitamin D or nitric oxide synthesis, exercise-related perspiration and changes in dietary and water intake [19,20]. Hydration status, a major determinant of BP level in HD patients, is also affected by external temperature and humidity [6,7,14]. Increasing temperature triggers sweating to evacuate body heat, but this is limited in humid environments possibly due to skin saturation in water [21].…”

Section: Figure 4 (Bandw Version)mentioning

confidence: 99%

Blood Pressure Seasonality in Hemodialysis Patients from Five European Cities of Different Latitudes

Duranton

Palma

Stegmayr

et al. 2018

Kidney Blood Press Res

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Background/Aims: Climate influences the regulation of blood pressure (BP). Our objective was to precisely estimate BP seasonality in hemodialysis (HD) patients from five European cities with marked climate differences. Methods: Stable prevalent HD patients from 5 European facilities (Santa Cruz de Tenerife (Spain), Seville (Spain), Montpellier (France), Ottignies (Belgium), Umea (Sweden)) present over the years 1995-1999 were included in this historical longitudinal observational study. Individual monthly averages of pre-dialysis BP level were computed from all facility BP measurements (> 90 000 observations). The association between BP level and location, seasons and meteorological measurements was analyzed by mixed models. Results: 261 patients were included and followed-up for a median duration of 2 years (6903 monthly observations). Pre-dialysis SBP and DBP were minimal in summer (July) and maximal in winter (November and December), and mean changes were respectively 4.2 [3.0; 5.4] and 2.0 [1.3; 2.7] mmHg. Seasonality was confirmed in 4 locations (P_season≤0.001 for SBP and DBP), but not in Umea (both P_season> 0.05). Seasonal changes in DBP were larger in southern locations (P_interaction=0.02). BP level was associated with climate parameters: in a positive manner with humidity or rainfall, and inversely with sunshine duration or temperature. The effects of temperature and rainfall on DBP varied with latitude (P_interaction< 0.02) and were greater in southern locations. Conclusion: BP varies with seasons and climate in different European areas and seasonality can be more important in southern locations. These changes in BP deserve attention as they may be responsible for a significant increase in cardiovascular risk which may be preventable.

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“…Data from the Monitoring Dialysis Outcomes initiative showed comparable differences on a global level, with phase-shifted inverse patterns between the Northern and Southern hemispheres [35]. Interestingly, seasonal differences in body composition, with a higher fat mass in the winter and higher lean body mass in the summer, were observed [31].…”

Section: Seasonal Patternsmentioning

confidence: 95%

“…Yet, in one study in peritoneal dialysis patients, no difference in fluid state, assessed by bioimpedance, over the winter months has been observed [30]. By contrast, in another study evaluating seasonal differences in body composition, fluid overload was higher in the spring and summer period [31]. It is therefore possible that other factors also influence the difference in BP between the different seasons, such as sympathetic activity, vascular tone, and vitamin D levels [32][33][34].…”

Section: Seasonal Patternsmentioning

confidence: 96%

Cycles, Arrows and Turbulence: Time Patterns in Renal Disease, a Path from Epidemiology to Personalized Medicine?

et al. 2018

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Patients with end-stage renal disease (ESRD) experience unique patterns in their lifetime, such as the start of dialysis and renal transplantation. In addition, there is also an intricate link between ESRD and biological time patterns. In terms of cyclic patterns, the circadian blood pressure (BP) rhythm can be flattened, contributing to allostatic load, whereas the circadian temperature rhythm is related to the decline in BP during hemodialysis (HD). Seasonal variations in BP and interdialytic-weight gain have been observed in ESRD patients in addition to a profound relative increase in mortality during the winter period. Moreover, nonphysiological treatment patters are imposed in HD patients, leading to an excess mortality at the end of the long interdialytic interval. Recently, new evidence has emerged on the prognostic impact of trajectories of common clinical and laboratory parameters such as BP, body temperature, and serum albumin, in addition to single point in time measurements. Backward analysis of changes in cardiovascular, nutritional, and inflammatory parameters before the occurrence as hospitalization or death has shown that changes may already occur within months to even 1–2 years before the event, possibly providing a window of opportunity for earlier interventions. Disturbances in physiological variability, such as in heart rate, characterized by a loss of fractal patterns, are associated with increased mortality. In addition, an increase in random variability in different parameters such as BP and sodium is also associated with adverse outcomes. Novel techniques, based on time-dependent analysis of variability and trends and interactions of multiple physiological and laboratory parameters, for which machine-learning approaches may be necessary, are likely of help to the clinician in the future. However, upcoming research should also evaluate whether dynamic patterns observed in large epidemiological studies have relevance for the individual risk profile of the patient.

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Season affects body composition and estimation of fluid overload in haemodialysis patients: variations in body composition; a survey from the European MONDO database

Cited by 27 publications

References 19 publications

Seasonality of Ankle Swelling: Population Symptom Reporting Using Google Trends

Seasonality of Ankle Swelling: Population Symptom Reporting Using Google Trends

Blood Pressure Seasonality in Hemodialysis Patients from Five European Cities of Different Latitudes

Cycles, Arrows and Turbulence: Time Patterns in Renal Disease, a Path from Epidemiology to Personalized Medicine?

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