Effects of Volume Overload and Current Techniques for the Assessment of Fluid Status in Patients with Renal Disease

Ekinci, Can; Karabork, Merve; Siriopol, Dimitrie; Dinçer, Neris; Covic, Adrian; Kanbay, Mehmet

doi:10.1159/000487702

Cited by 66 publications

(61 citation statements)

References 160 publications

(223 reference statements)

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“…Intense focus on fluid dynamics, including interdialytic fluid load, ultrafiltration intensity, and cardiovascular sequalae thereof, is probably needed [45]. Regardless of the intensity of HD, bioimpedance spectroscopy, lung ultrasonography, and pulmonary artery catheterization could be used to guide volume management [46].…”

Section: Resultsmentioning

confidence: 99%

Contemporary Trends in Clinical Outcomes among Dialysis Patients with Medicare Coverage

Weinhandl

Ray²,

Kubisiak³

et al. 2019

Am J Nephrol

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Background: The dialysis patient population in the United States continues to grow. Trends in rates of death and hospitalization among dialysis patients have important consequences for outpatient dialysis capacity and Medicare spending. Objectives: To estimate contemporary trends in rates of death and hospitalization among dialysis patients in the United States, overall and within subgroups. Methods: We used Medicare Limited Data Sets (100% sample) in 2014–2017 to estimate trends in rates of death and hospitalization among dialysis patients with Medicare Parts A and B enrollment. We used seasonal autoregressive integrated moving average models to identify secular trends in the incidence of outcomes. Results: There were 631,075 unique patients; 222,924 deaths; and 1,876,779 hospital admissions. Weekly risks of both death and hospitalization exhibited strong seasonality. However, overall weekly risks of death were 34.9, 35.4, 35.2, and 35.7 deaths per 10,000 patients in 2014–2017, respectively (p = 0.47, from a likelihood ratio test of secular trend). The overall weekly risk of hospitalization was 3.08, 3.05, 3.11, and 3.11% in 2014, 2015, 2016, and 2017, respectively (p = 0.30). There were significant secular trends in risk of death in subgroups defined by black race and residency in South Atlantic states (p < 0.05). There were also secular trends in risk of hospitalization in subgroups defined by age 20–44 years, concurrent enrollment in Medicaid, and residency in South Central states. Conclusion: For the first time since the beginning of this century, rates of both death and hospitalization among dialysis patients with Medicare fee-for-service coverage have stagnated. The reasons for this change are unknown and require detailed assessment. Persistent lack of change in clinical outcomes may alter the future expectations about dialysis patient population growth.

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Section: Resultsmentioning

confidence: 99%

Contemporary Trends in Clinical Outcomes among Dialysis Patients with Medicare Coverage

Weinhandl

Ray²,

Kubisiak³

et al. 2019

Am J Nephrol

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“…The seriousness of hyperhydration is from long-time well known in ESKD patients [19], but more recently was also discussed in non-dialysis CKD. For example, Hung S-C et al found euvolemia in a little less than half (48%) from a cohort of 338 adults with stage 3 to 5 non-dialysis CKD [20], percentage which is very similar to our observations (52% patients with OH in normal range).…”

Section: Discussionmentioning

confidence: 99%

Renal anemia and hydration status in non-dialysis chronic kidney disease: Is there a link?

et al. 2018

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Rationale Anemia, a common feature in chronic kidney disease (CKD), has multiple contributors to its pathogenesis. Besides the well recognized erythropoietin and iron deficiencies, hydration status might be involved. Objective To assess the prevalence and correlations of anemia, iron deficiency and overhydration in patients with stage 2 to 5 CKD. Methods and Results This cross-sectional study enrolled 125 erythropoietin and iron therapy naïve non-dialysis CKD patients, without a identifiable cause of anemia. Parameters of hematological, iron, inflammatory and nutritional status were measured. The overhydration parameter (OH) assessed by bioimpedance spectroscopy was used to characterize hydration status. The prevalence of decreased hemoglobin (Hb) <110g/L increased along CKD stages from 0% to 40% (p=0.008). Fluid overload (OH >1L) and lower serum albumin (<40g/L) were more common in stage 5 versus stage 3 CKD (53% vs. 10%, p<0.001, and 27% vs. 3%, p=0.02, respectively), suggesting a potential dilutional reduction in serum proteins. Conversely, decreased iron stores (ferritin <100mcg/L) and iron availability (transferrin saturation, TSAT<0.20) were similarly prevalent irrespective of kidney function decline. Hemoglobin was positively correlated with estimated glomerular filtration rate (eGFR), serum albumin, and transferrin saturation, but inversely with OH. However, in a model of multiple linear regression which explained 32% of hemoglobin variation, only eGFR and overhydration remained the independent predictors of anemia. Discussion As fluid overload is a common denominator for hemoglobin and TSAT levels, and is closely related to the declining kidney function, it should be considered in the management of renal anemia, at least in advanced CKD.

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“…In our opinion, different ethnicities are not barriers to performing BIS measurement. In occurrence of bad data, fluid assessment should be guided by clinical assessment until a valid BIS measurement is obtained, and if conflicting results are found in BISmeasurement of haemodialysis patients, fluid assessment should always be guided by clinical assessment primarily, since evidence on the benefit of BIS is still scarce (Covic et al 2017;Ekinci et al 2018).…”

Section: Systematic Fluid Assessment In Haemodialysismentioning

confidence: 99%

“…; Ekinci et al . ). Evidence of the impact of BIS‐guided fluid management on survival is still lacking (Covic et al .…”

Section: Introductionmentioning

confidence: 97%

“…Since clinical assessment of fluid status is subjective and imprecise there is increasing use of devices based on bioimpedance spectroscopy (BIS) technology (Stenberg et al 2016;Ekinci et al 2018). Evidence of the impact of BIS-guided fluid management on survival is still lacking (Covic et al 2017) and one limitation of the current adoption of this technology is the use of it in isolation rather than as a part of clinical assessment.…”

Section: Introductionmentioning

confidence: 99%

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Systematic Fluid Assessment in Haemodialysis: Development and Validation of A Decision Aid

Stenberg

Keane

Lindberg

et al. 2019

Journal of Renal Care

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SUMMARY Background About a third of patients undergoing haemodialysis have poorly controlled fluid status, which may affect survival. Clinical assessment is subjective and imprecise, which has led to the increasing use of devices based on bioimpedance spectroscopy (BIS). However, BIS cannot provide a simple target applicable to all patients. Our aim was to develop and validate a decision aid combining clinical assessment of fluid status with information from BIS in target weight determination. Methods The decision aid was based on empirical experience and a literature review identifying physiological parameters already used in the clinical assessment of fluid status. Content validity was established by patient representatives, interdisciplinary stakeholders and external experts, who assessed item relevance and comprehensiveness. Reliability was assessed by inter‐rater agreement analysis between nurses assessing typical patient cases. Results The decision aid for Recognition and Correction of Volume Alterations (RECOVA) consists of three parts (1) a scoring system; (2) thresholds and triggers; (3) a decision aid algorithm. Agreement between raters in the assessment of symptoms was almost perfect, with Intraclass Correlation Coefficient > 0.90. Agreement in clinical response was only fair, but increased to moderate, with training and self‐reported confidence. Conclusion RECOVA may enable systematic clinical assessment of fluid status, facilitating early recognition of fluid alterations, and incorporation of bioimpedance into target weight management. However, implementation into clinical practice will require training of staff. Clinical intervention studies are required to evaluate if RECOVA facilitates response to and correction of recognised fluid alterations.

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Effects of Volume Overload and Current Techniques for the Assessment of Fluid Status in Patients with Renal Disease

Cited by 66 publications

References 160 publications

Contemporary Trends in Clinical Outcomes among Dialysis Patients with Medicare Coverage

Contemporary Trends in Clinical Outcomes among Dialysis Patients with Medicare Coverage

Renal anemia and hydration status in non-dialysis chronic kidney disease: Is there a link?

Systematic Fluid Assessment in Haemodialysis: Development and Validation of A Decision Aid

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