Vector length as a proxy for the adequacy of ultrafiltration in hemodialysis

Pillon, Luana; Piccoli, Antônio; Lowrie, Edmund G.; Lazarus, J. Michael; Chertow, Glenn M.

doi:10.1111/j.1523-1755.2004.00881.x

Cited by 101 publications

(77 citation statements)

References 20 publications

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“…The RXc mean graph provides further interesting and more complete information on this issue. As already pointed out (32,33) and in agreement with previous data on peritoneal dialysis patients (34), the occurrence in patients with CKD of short mean impedance vectors that are associated with a small PhA strongly indicates the presence of fluid overload. Similarly, when conventional predictive BIA equations were used to predict body compartments, TBW was slightly increased in both male and female patients with CKD.…”

Section: Discussionsupporting

confidence: 89%

Early Changes in Bioelectrical Estimates of Body Composition in Chronic Kidney Disease

Bellizzi

Scalfi²,

Terracciano³

et al. 2006

Journal of the American Society of Nephrology

110

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The aim of this study was to detect the potential occurrence of early abnormalities of body composition in patients with chronic kidney disease (CKD) at first referral to an outpatient nephrology clinic. Eighty-four patients with CKD (49 men and 35 women) were compared with 604 healthy control subjects (298 men and 306 women). Anthropometry and bioelectrical impedance analysis (BIA) were performed in all participants, whereas renal function, laboratory tests for nutritional status, and nutrient intake were assessed in the CKD group only. Creatinine clearance was 27.8 ؎ 13.8 and 27.4 ؎ 13.0 ml/min per 1.73 m 2 in male and female patients with CKD, respectively. No patient showed peripheral edema; frank malnutrition, defined by presence of serum albumin <3.5 g/dl plus body mass index <20 kg/m 2 ; or protein intake <0.6 g/kg per d. At the BIA, patients with CKD showed lower resistance (R) and abnormal mean impedance vectors for the bivariate normal distribution of R/height and reactance/height. Phase angle also was reduced (؊22%), especially in patients with diabetes. When BIA-derived data were considered, total body water was slightly higher (؉4.3% in men; ؉3.5% in women) and body cell mass was lower (؊6.7% in men; ؊7.7% in women) in patients with CKD. No difference in either BIA parameters or nutritional indexes was observed among various CKD stages. Despite the absence of overt malnutrition, patients with CKD exhibit altered BIA variables from the early phases of renal disease. These alterations are related to the renal dysfunction, are more marked in the presence of diabetes, and mainly indicate the presence of overhydration in the absence of edema. Therefore, BIA represents an attractive clinical tool to detect impairment of body composition from the early stages of CKD.

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Section: Discussionsupporting

confidence: 89%

Early Changes in Bioelectrical Estimates of Body Composition in Chronic Kidney Disease

Bellizzi

Scalfi²,

Terracciano³

et al. 2006

Journal of the American Society of Nephrology

110

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“…Current assessment of ECF volume status in this population is surprisingly crude. Promising techniques such as online blood volume monitoring, 176 routine measurement of inferior vena cava diameter, 177 noninvasive lung water measurement, 178 lung ultrasound, 179 and routine bioimpedance assessment 180 remain understudied or can actually cause harm. Blood levels of brain natriuretic peptide correlate with left ventricular filling pressures in the general population and in people with non-dialysis-dependent CKD.…”

Section: Preventing/controlling Ecf Volume Overloadmentioning

confidence: 99%

Epidemiology and Mechanisms of Uremia-Related Cardiovascular Disease

2016

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Abstract-Patients with chronic kidney disease and end-stage renal disease are at 5-to 10-fold higher risk for developing cardiovascular disease (CVD) than age-matched controls. Clinically, CVD in this population manifests as coronary artery disease, arrhythmias, stroke, or congestive heart failure. Beyond the traditional risk factors (eg, diabetes mellitus and hypertension), uremia-specific factors that arise from accumulating toxins also contribute to the pathogenesis of CVD.In this review, we summarize the literature on the epidemiology of both traditional and uremia-related CVD and focus on postulated mechanisms of the latter. P. Jousset, MD, 1 describing common causes of death among patients with Bright disease C hronic kidney disease (CKD) is an increasingly urgent public health concern that is projected to grow worldwide at a rate of 8% annually, with the fastest growth expected in developing nations.2,3 It has long been known that patients with kidney failure are predisposed to cardiovascular disease (CVD) that manifests clinically in various forms, including coronary artery disease, atrial or ventricular arrhythmias, myocardial infarction, stroke, or congestive heart failure. Over the last 30 years, it has become clear that the risk of CVD increases early in the course of progressive kidney disease and that the epidemiology, pathophysiology, prevention, and treatment of CVD and CKD are closely related and interdependent. 4 In this review, we initially describe the epidemiology of CVD among people with CKD, noting the limitations of available research. We then discuss common risk factors for CVD (traditional and nontraditional) and key shared aspects of its pathophysiology with CKD. Next we describe emerging diagnostic tools and novel therapies that may help to delay or prevent end-stage renal disease (ESRD) and to curtail the escalating burden of cardiorenal disease. In the final section, we discuss the health services and health policy challenges that CKD and its inextricably linked CVD morbidities pose worldwide, particularly for low-and middle-income countries (LMICs). Phenotypes and Epidemiology of CVD in Patients With CKDPatients with CKD and some forms of CVD share a number of risk factors and underlying pathophysiological mechanisms that, by virtue of their similarities, offer opportunities to improve their management. The epidemiology of 4 of the commonest clinical phenotypes of CVD associated with CKD is discussed below. Coronary Artery DiseaseCoronary artery disease (CAD) is a leading cause of death among people with advanced CKD. Clinical syndromes compatible with CAD (including angina and myocardial infarction) are exceedingly common in patients with nondialysis-dependent CKD, and the incidence of myocardial

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“…Conceptually, this is strongly supported by the observations in this study; however, when using this approach, which still relies on the strict use of algorithms, we were not able to observe a relationship between excess fluid and comorbidity using the BIAderived volumes alone, only when the measured TBW D volumes were substituted, indicating the additional value of obtaining an absolute individual value for TBW when estimating fluid excess. Previous longitudinal studies using BIA to detect changes in body composition usually focused on within-dialysis treatment changes, examining vector length, total body, or segmental changes associated with acute fluid removal (21)(22)(23) or changes in derived ECF volume in the short term, in an attempt to define the appropriate dry weight for a patient (24). Generally, these studies have been able to identify relative changes in resistance and impedance in keeping with short-term fluid shifts, although they have not usually been validated with paired changes using isotopic dilution methods.…”

Section: Discussionmentioning

confidence: 99%

Combining Near-Subject Absolute and Relative Measures of Longitudinal Hydration in Hemodialysis

Chan¹,

McIntyre²,

Smith³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: The feasibility and additional value of combining bioimpedance analysis (BIA) with nearsubject absolute measurement of total body water using deuterium dilution (TBW D ) in determining longitudinal fluid status was investigated.Design, setting, participants, & measurements: Fifty-nine hemodialysis patients (17 female; age 58.4 ؎ 16.1 yr; body mass index 27.0 ؎ 5.4) were enrolled into a 12-mo, two-center, prospective cohort study. Deuterium concentration was measured in breath by flowing-afterglow mass spectrometry using a validated protocol ensuring full equilibration with the TBW; BIA was measured using a multifrequency, multisegmental device. Comorbidity was quantified by the Stoke score. Clinicians were blinded to body composition data.Results: At baseline and 12 mo, there was an incremental discrepancy between TBW BIA and TBW D volumes such that greater comorbidity was associated with increasing overhydration. Forty-three patients who completed the study had no longitudinal differences in the prescribed or achieved postdialysis weights. In contrast, TBW D increased without a change in TBW BIA (mean difference ؊0.10 L). Changes in TBW and lean body mass differed according to baseline comorbidity; without comorbidity, BIA also identified an increase in TBW and lean body mass, whereas with increasing comorbid burden, BIA failed to demonstrate increases in tissue hydration identified by TBW D .Conclusions: Combined near-patient measurements of absolute and BIA-estimated TBW are achievable in a dialysis facility by identifying changes in body composition not fully appreciated by routine assessment. BIA underestimates tissue overhydration that is associated with comorbidity, resulting in reduced sensitivity to longitudinal increases during a 12-mo period.

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Vector length as a proxy for the adequacy of ultrafiltration in hemodialysis

Abstract: Shorter predialysis bioimpedance vectors, indicating greater soft tissue hydration, were associated with diminished survival in hemodialysis patients. These findings validate clinical observations linking longevity to maintenance of dry body weight.

Cited by 101 publications

References 20 publications

Early Changes in Bioelectrical Estimates of Body Composition in Chronic Kidney Disease

Early Changes in Bioelectrical Estimates of Body Composition in Chronic Kidney Disease

Epidemiology and Mechanisms of Uremia-Related Cardiovascular Disease

Combining Near-Subject Absolute and Relative Measures of Longitudinal Hydration in Hemodialysis

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