Association between OH/ECW and echocardiographic parameters in CKD5 patients not undergoing dialysis

Abstract

BackgroundEchocardiography is the most valuable tool for assessing cardiac abnormalities of chronic kidney disease (CKD) patients even though it has its limitations, including high equipment cost and the need for specialized personnel. Assessment of volume status is important not only for volume management, but also for prevention of cardiovascular disease of the CKD patients. Recently, bioimpedance is gaining acceptance as a way to quantitatively assess patient hydration status at bedside.Methods127 patients who were admitted for planning their first dialysis treatment were enrolled. The echocardiography and bioimpedance spectroscopy (BIS) were performed. The association between echocardiographic data and clinical values such as NT-proBNP and OH/ECW was examined.ResultsOH/ECW, which indicates relative fluid overload, was positively associated with LA dimension (r = 0.25, P = 0.007), LAVI (r = 0.32, P < 0.001), and E/e´ ratio (r = 0.38, P < 0.001). While OH/ECW was not significantly associated with echocardiographic values such as LVEDD, LVEDV, LVMI, and LVEF, NT-proBNP were significantly associated with all echocardiographic parameters. Multivariate logistic regression analysis showed E/e´ ratio (odds ratio, 1.14 [95% confidence interval (CI), 1.01 to 1.29]; P = 0.031), NT-proBNP (odds ratio, 4.78 [95% CI, 1.51 to 15.11]; P = 0.008), and albumin (odds ratio, 0.22 [95% CI, 0.08 to 0.66]; P = 0.007) were significantly associated with OH/ECW.ConclusionsSince OH/ECW measured by BIS is associated with echocardiographic parameters related to diastolic dysfunction, preliminary screening through laboratory findings, including serum albumin in conjunction with OH/ECW and NT-proBNP, may find patient with risk of diastolic dysfunction. Our study suggests that a timely detection of fluid overload in patients with CKD as well as their proper treatment may help reduce diastolic dysfunction. Further research may be needed to validate the consistency of this association across other stages of CKD.

The Association Between Extracellular Water-to-Total Body Water Ratio and Therapeutic Durability for Advanced Lung Cancer

“…Among the BIA parameters, the extracellular water to total body water ratio (ECW/TBW) is a useful indicator for nutritional assessments (7,9), as it measures the body's water balance in the blood and interstitial fluid (i.e., an edema index), with malnutrition being reflected in an increased proportion of extracellular water (9). A high ECW/TBW is also reportedly useful for identifying a poor general condition and predicting clinical outcomes among patients with chronic liver diseases (10)(11)(12), renal disorders (13,14), heart failure (15,16), and critical illness (9). However, we are not aware of any data regarding the relationship between ECW/TBW and lung cancer outcomes.…”

Prediction of Heart Function and Volume Status in End-Stage Kidney Disease Patients through N-Terminal Pro-Brain Natriuretic Peptide

“…One study found no association between extracellular water (%) and NT-proBNP in patients receiving peritoneal dialysis [ 25 ]. In case of pre-dialysis CKD patients, many studies have shown that OH measured by BIS and NT-proBNP were correlated [ 26 , 27 , 28 ]. In our study, when OH was analyzed by subgroup, there was a significant association with NT-proBNP in HD patients.…”

Relationship between volume status and possibility of pulmonary hypertension in dialysis naive CKD5 patients

“…The overhydration (OH) value can be calculated from the difference between the normal ECW and actual measured ECW [24]. OH/ECW greater than or equal to 15% was defined as fluid overload [20]. Patients were in supine position.…”

“…Recently, bioimpedance spectroscopy (BIS) performed at the bedside has gained popularity because it is a non-invasive, quick and relatively affordable method to quantitatively assess the volume status of the patient, although only a small number of studies have examined the relationship between volume status and PH [6, 8, 18, 19]. We previously reported that increased E/e´ ratio, reflecting left ventricular diastolic dysfunction (LVDD), was strongly associated with fluid overload in CKD patients [20]. LVDD may contribute to the development of PH by causing an elevated left atrial pressure [14].…”