Guided optimization of fluid status in haemodialysis patients

Abstract

Background. Achieving normohydration remains a non-trivial issue in haemodialysis therapy. Guiding the haemodialysis patient on the path between fluid overload and dehydration should be the clinical target, although it can be difficult to achieve this target in practice. Objective and clinically applicable methods for the determination of the normohydration status on an individual basis are needed to help in the identification of an appropriate target weight.Methods. The aim of this prospective trial was to guide the patient population of a complete dialysis centre towards normohydration over the course of approximately 1 year. Fluid status was assessed frequently (at least monthly) in haemodialysis patients (n = 52) with the body composition monitor (BCM), which is based on whole body bioimpedance spectroscopy. The BCM provides the clinician with an objective target for normohydration. The patient population was divided into three groups: the hyperhydrated group (relative fluid overload >15% of extracellular water (ECW); n = 13; Group A), the adverse event group (patients with more than two adverse events in the last 4 weeks; n = 12; Group B) and the remaining patients (n = 27; Group C).Results. In the hyperhydrated group (Group A), fluid overload was reduced by 2.0 L (P < 0.001) without increasing the occurrence of intradialytic adverse events. This resulted in a reduction in systolic blood pressure of 25 mmHg (P = 0.012). Additionally, a 35% reduction in antihypertensive medication (P = 0.031) was achieved. In the adverse event group (Group B), the fluid status was increased by 1.3 L (P = 0.004) resulting in a 73% reduction in intradialytic adverse events (P < 0.001) without significantly increasing the blood pressure.Conclusion. The BCM provides an objective assessment of normohydration that is clinically applicable. Guiding the patients towards this target of normohydration leads to better control of hypertension in hyperhydrated patients, less intradialytic adverse events and improved cardiac function.

Prognostic Value of Aortic Stiffness and Calcification for Cardiovascular Events and Mortality in Dialysis Patients

“…The complementary prognostic information provided by these simple investigations is of major importance for identifying subpopulations that may benefit from a specific intervention and for the design of future randomized trials in patients with chronic kidney disease. Recent studies have demonstrated that brachial pulse pressure, a proxy of arterial stiffness, is an important parameter to take into account when deciding on fluid removal and dry weight (8,9). For the management of hyperphosphatemia, the choice of phosphate binder (calcium-versus noncalcium-containing) may be influenced by the degree of vascular calcification, if the available data on the adverse effect of calcium salts on the progression of vascular calcification and outcome are confirmed (10 -12).…”

Extracellular Fluid Excess Is Significantly Associated With Coronary Artery Calcification in Patients With Chronic Kidney Disease

“…Bioelectrical impedance analysis (BIA) is a method of assessing ECF status by measuring the impedance of the body to applied electric currents of different frequencies 9, 10. Accumulating evidence suggests that strict BIA‐guided fluid management has a beneficial impact on blood pressure, arterial stiffness, left ventricular hypertrophy, and survival in patients undergoing dialysis 11, 12…”

Volume Status in Patients on Peritoneal Dialysis: The Role of Apelin and Bio-Impedance Spectroscopy

“…27,28 Sipahi et al 29 found BIS findings to be related with echocardiographic findings of OH in PD patients.…”