Monitoring Fluid Status at the Outpatient Level: The Need for More Precision

McDonald, Ken

doi:10.1111/j.1751-7133.2010.00171.x

Cited by 13 publications

(11 citation statements)

References 22 publications

(22 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, congestion can go unrecognized, as it is sometimes not clinically evident [2]. Addi-tional objective measures of congestion in agreement with simple clinical examination may be helpful in such a setting [3].…”

Section: Introductionmentioning

confidence: 99%

Multiparametric approach to congestion for predicting long-term survival in heart failure

Massari¹,

Scicchitano

Iacoviello

et al. 2020

Journal of Cardiology

View full text Add to dashboard Cite

Background: Congestion is a marker of adverse prognosis in patients with heart failure (HF). In addition to brain natriuretic peptide (BNP), estimated plasma volume status (ePVS), bioimpedance vector analysis (BIVA), and blood urea nitrogen/creatinine ratio (BUN/Cr) are emerging as new markers for congestion. The aim of this study was to evaluate the prognostic value of BNP, ePVS, BIVA, and BUN/Cr in HF. Methods: We analyzed the data from 436 patients with acute or chronic heart failure (AHF, n = 184, and CHF, n = 252, respectively). BNP, ePVS, hydration index (HI%), and BUN/Cr were collected from all patients at admission. The endpoint was all-cause mortality. Results: Ninety-two patients died after a median follow-up of 463 days (IQR: 287-669). The cumulative mortality of all of the patients was 21% (31% and 13% in AHF and CHF, respectively, p < 0.0001). The optimal cutoffs for death occurrence were BNP: >441 pg/mL, ePVS: >5.3 dL/gr, HI: >73.8%, BUN/Cr: >25. Multivariate Cox regression analysis maintained an independent predictive value for mortality (HR 2. 1, HR 2.2, HR 2.1, and HR 1.7; C-index 0.756). AHF status was no longer associated with death. Together, these variables explained 40% of the risk of death (R 2 adjusted = 0.40). Patients with all four parameters below or above their optimal cutoff had mortality rates of 4% and 59%, respectively. Conclusions: BNP, ePVS, BIVA, and BUN/Cr at admission provide independent and complementary prognostic information in patients with HF and, when combined, explain the 40% risk of death in these patients independent from the acute or chronic HF condition.

show abstract

Section: Introductionmentioning

confidence: 99%

Multiparametric approach to congestion for predicting long-term survival in heart failure

Massari¹,

Scicchitano

Iacoviello

et al. 2020

Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…Based on these results, it appears there is a large change in bioimpedance with modest stress compared with the bioimpedance changes normally seen clinically [1,2,39,40]. Further, this approach may allow investigators to gather more meaningful information in that the data collected is based on a process that replicates the clinical exam, eliciting information on fluid content based on tissue viscoelastic response to stress.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, interest has grown in attempts at quantitative assessment of tissue hydration using BIS in many disease states [1,2,3]. In addition, the tissue response to stress in the setting of edema has recently been the subject of study as a quantitative tool for edema assessment [4,5,6].…”

Section: Introductionmentioning

confidence: 99%

The feasibility of using compression bioimpedance measurements to quantify peripheral edema

Koziol

Pitre

Bull

et al. 2014

Journal of Electrical Bioimpedance

View full text Add to dashboard Cite

The accurate assessment of body fluid volume is important in many clinical situations, especially in the determination of "dry weight" in a dialysis setting. Currently, no clinically applicable diagnostic system exists to determine the mechanical properties that accurately characterize peripheral edema in an objective and quantitative manner. We have developed a method for quantifying the impact of compression on the electrical properties of tissue by measuring stress-induced changes in bioimpedance (BIS). Using this method, we simultaneously measured the impedance and mechanical response of a tissue mimicking material (tofu) under both quasi-static and dynamic loading conditions. Our results demonstrate a temporal quantification of viscoelastic properties using a viscoelastic phantom tissue model.

show abstract

“…Therefore, accurate determination of fluid status is a critical aspect of care of this population. Early detection of emerging fluid overload would allow for prompt intervention, potentially aborting clinical deterioration and avoiding hospitalization [22]. While many strategies are available to determine fluid status of patients, all are compromised by less-than-optimal sensitivity and specificity [23].…”

Section: Congestion Monitoringmentioning

confidence: 99%

Salt and water imbalance in chronic heart failure

2011

View full text Add to dashboard Cite

In chronic heart failure (CHF), neurohumoral systems, which help to maintain circulatory homeostasis, are maladaptive and responsible for disease progression and congestion in the long term. The activation of sympathetic hormones and renin-angiotensin-aldosterone system (RAAS), in addition to non-osmotic vasopressin release, up-regulation of aquoporine 2 and renal sodium transporters, and renal resistance to natriuretic peptide lead to a salt- and water-avid state. A primary decrease in cardiac output and arterial vasodilatation brings about arterial underfilling, which activates neuro-humoral reflexes and systems. The heart disease is the primum movens, but the kidney is the end organ responsible for increased tubular reabsorption of sodium and water. The most important hemodynamic alteration in the kidneys is constriction of glomerular efferent arterioles, which increases intraglomerular pressure and hence glomerular filtration rate. The resulting changes in intrarenal oncotic and hydrostatic pressures promote tubular reabsorption. Over time, a gradually falling glomerular filtration rate, due to CHF progression, medications or chronic kidney injury due to comorbidities, becomes more critical in sodium/water imbalance. Moreover, long-term use of diuretics can lead to a diuretic-resistant state, which necessitates the use of higher doses further activating RAAS, often at the expense of worsening renal function. However, every patient is a case in itself and the general pathophysiology of hydro-saline balance may be different in each subject. A mechanism can prevail over others and the kidney may have different responses to the same diuretic. So, it is necessary to customize each individual's long-term therapy, tailoring medical treatment according to clinical profiles, comorbidities and renal function, introducing active control of body weight by the patient himself, fluid restriction, a less restricted sodium intake, flexibility of diuretic doses, early and personalized ambulatory follow-up, and congestion monitoring by bioelectrical impedance vector analysis, BNP, inferior vena cava ultrasonography or echocardiographic e/e(1) ratio or pulmonary capillary wedge pressure.

show abstract

Monitoring Fluid Status at the Outpatient Level: The Need for More Precision

Cited by 13 publications

References 22 publications

Multiparametric approach to congestion for predicting long-term survival in heart failure

Multiparametric approach to congestion for predicting long-term survival in heart failure

The feasibility of using compression bioimpedance measurements to quantify peripheral edema

Salt and water imbalance in chronic heart failure

Contact Info

Product

Resources

About