Body Fluids in End-Stage Renal Disease: Statics and Dynamics

Abstract

Background: Abnormalities in fluid status in hemodialysis (HD) patients are highly prevalent and are related to adverse outcomes. Summary: The inherent discontinuity of the HD procedure in combination with an often compromised cardiovascular response is a major contributor to this phenomenon. In addition, systemic inflammation and endothelial dysfunction are related to extracellular fluid overload (FO). Underlying this relation may be factors such as hypoalbuminemia and an increased capillary permeability, leading to an altered fluid distribution between the blood volume (BV) and the interstitial fluid compartments, compromising fluid removal during dialysis. Indeed, whereas estimates of extracellular volume by bioimpedance spectroscopy are highly predictive of mortality, absolute BV assessed by the saline dilution technique was predictive of intra-dialytic morbidity. Changes in relative BV during HD are positively related to ultrafiltration rate (UFR) and, at least in some studies, negatively to FO. High UFR is also related to changes in central venous oxygen saturation (S_cvO₂), a marker for tissue perfusion. On the one hand, high UFR and more pronounced declines in S_cvO₂, but on the other hand, flat relative BV curves are also predictive of mortality; the relation between outcome which statics and dynamics of fluid status appears to be complex. Key Message: While technological developments enable the clinician to monitor statics and dynamics of fluid status and hemodynamics during HD in an accessible way, the role of technology-based interventions needs further study.

Flash Glucose Monitoring to Assess Glycemic Control and Variability in Hemodialysis Patients: The GIOTTO Study

“…In fact, it is well known that there may be a time lag between glucose readings in blood and in the interstitial fluid (27). In addition, hemodialysis patients may undergo volume changes among the intracellular, interstitial, and intravascular compartments, especially during hemodialysis sessions (28), but partially also in the interdialytic periods due to factors such as systemic inflammation, endothelial dysfunction, hypoalbuminemia, and increased capillary permeability, leading to intravascular fluid overload (29). These phenomena may further affect the possible difference between glucose measurement in blood and in the interstitial fluid.…”

Absolute blood volume variations during hemodialysis: Does dialysate temperature play a role?

“…1 Achieving accurate fluid balance is a major goal in chronic HD patients, as it is itself an important predictor outcome. 2 During HD, fluid excess is initially removed from circulating blood volume by ultrafiltration. After this initial drop in circulating blood volume, vascular refilling occurs from extravascular compartment in order to preserve hemodynamic stability.…”

“…Intradialytic hypotension is a common complication associated with hemodialysis (HD), occurring in up to 20% or more of dialysis sessions 1 . Achieving accurate fluid balance is a major goal in chronic HD patients, as it is itself an important predictor outcome 2 . During HD, fluid excess is initially removed from circulating blood volume by ultrafiltration.…”

Fibrinogen Fucosylation as a Prognostic Marker of End-Stage Renal Disease in Patients on Peritoneal Dialysis

“…Peritoneal dialysis (PD) is a type of treatment for some patients with end-stage renal disease (ESRD) in which the peritoneum is used as a natural membrane through which osmosis and diffusion take place, eliminating the harmful products of metabolism and excess fluid. However, this procedure can contribute to the appearance of peritonitis and peritoneal membrane damage, as well as systemic inflammation and endothelial dysfunction [ 3 ]. Peritonitis and the loss of mesothelial cell mass correlate with an increase in the content of IgG-related glycans present in peritoneal effluent samples and a decrease in the galactosylation of biantennary glycans [ 4 ].…”