Are there any further modalities for prediction of subclinical volume overload in advanced stages of chronic kidney disease?

Abstract

Background: Subclinical volume overload in chronic kidney disease (CKD) patient represents a debatable issue. Although many tools were used to detect volume overload in such patients, many non-specific results were due to presence of comorbidities. Bioimpedance spectroscopy is an objective fluid status assessment method, which is shown superior to classical methods in many studies. Combining some of these tools may improve their accuracy and specificity. Inferior vena cava collapsibility index (IVCCI) with brain natriuretic peptide (BNP) can be combined for more specific volume assessment. This study was performed to assess the usage of combined IVCCI and BNP levels in CKD patients to predict subclinical volume overload. Methods: One hundred and ten patients with CKD (stages 4 and 5) not on dialysis and having normal left ventricular systolic function were included in this study. Exclusion criteria were: (1) patients with other causes of raised BNP than volume overload and (2) patients on diuretics. A complete medical history was obtained, and thorough examination and laboratory tests were performed for all included patients. IVCCI and BNP serum levels were evaluated. The patients who exhibited an overhydration (OH)/extracellular water (ECW) ratio of >15% were considered to have volume overload. Results: Twenty-six patients (23.6%) had subclinical hypervolemia as diagnosed by OH/ECW ratio of >15%. IVCCI ≤ 38% had higher diagnostic performance than BNP ≥ 24 pg/mL. Combining both IVCCI ≤ 38% and BNP ≥ 24 pg/mL increased the specificity and positive predictive value for detection of subclinical hypervolemia. Conclusion: Combined elevated BNP level and decreased IVCCI are more precise tools for subclinical volume overload detection in CKD patients.

Relation between carotid intimal medial thickness and left ventricular mass and left ventricular mass indices in maintenance hemodialysis patients

“…A recent study by Wang et al on 129 HD patients documented the predictive value of NT-pro-BNP in the assessment of volume overload in hemodialysis patients with or without EF declines [36]. Baki et al found that combined elevation of BNP level and decreased IVC collapsibility index were sensitive markers for subclinical volume overload detection in CKD patients [37].…”

Therapeutic roles of thiazides and loop diuretics in blood pressure control and renal protection against chronic kidney disease

“…Extracellular volume overload has been reported even in early stage of CKD [ 4 ]. However, a significant number of patients have subclinical volume overload without evident clinical signs [ 5 , 6 ]. Such existence of extracellular volume increase can be detected by noticing impressive blood pressure reduction when diuretics are added in a situation of uncontrolled hypertension during the use of antihypertensive agents other than diuretics [ 4 , 5 ].…”

“…However, a significant number of patients have subclinical volume overload without evident clinical signs [ 5 , 6 ]. Such existence of extracellular volume increase can be detected by noticing impressive blood pressure reduction when diuretics are added in a situation of uncontrolled hypertension during the use of antihypertensive agents other than diuretics [ 4 , 5 ]. Doubt on the effectiveness and safety related to use of diuretics in CKD patients has been present for many years.…”