Monitoring Volume Status Using Bioelectrical Impedance Analysis in Chronic Hemodialysis Patients

Kim, Chae Rim; Shin, Jungho; Hwang, Jin Ho; Kim, Su Hyun

doi:10.1097/mat.0000000000000619

Cited by 23 publications

(29 citation statements)

References 34 publications

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“…Recent studies have shown that volume overload is independently associated with the progression of renal disease, cardiovascular disease and high mortality . In particular, a higher ECW/TBW value, which is a marker of extracellular fluid expansion, predicts high mortality in patients with advanced CKD . On the other hand, the equivalent removal of ICW and ECW by TLV might ameliorate renal interstitial oedema and tubular cell oedema, which may result in an increased renal blood flow .…”

Section: Discussionmentioning

confidence: 99%

“…11,12 In particular, a higher ECW/TBW value, which is a marker of extracellular fluid expansion, 28 predicts high mortality in patients with advanced CKD. 29 On the other hand, the equivalent removal of ICW and ECW by TLV might ameliorate renal interstitial oedema and tubular cell oedema, which may result in an increased renal blood flow. 14,15 In addition, TLV is associated with a lower risk of a worsening renal function, unlike loop diuretics, 16 which predominantly decrease the ECW.…”

Section: Discussionmentioning

confidence: 99%

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Effects of the sodium‐glucose cotransporter 2 inhibitor dapagliflozin on fluid distribution: A comparison study with furosemide and tolvaptan

et al. 2019

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Aim Sodium‐glucose cotransporter 2 (SGLT2) inhibitors are an antihyperglycemic drug with diuretic properties. We recently reported that an SGLT2 inhibitor ameliorated extracellular fluid expansion with a transient increase in urinary Na+ excretion. However, the effects of SGLT2 inhibitors on fluid distribution in comparison to conventional diuretics remain unclear. Methods Forty chronic kidney disease patients with fluid retention (average estimated glomerular filtration rate 29.2 ± 3.2 mL/min per 1.73 m2) were divided into the SGLT2 inhibitor dapagliflozin (DAPA), loop diuretic furosemide (FR) and vasopressin V2 receptor antagonist tolvaptan (TLV). The body fluid volume was measured on days 0 and 7 using a bioimpedance analysis device. Results In all three groups, body weight was significantly and similarly decreased, and urine volume numerically increased for 7 days. Bioimpedance analysis showed that the changes in intracellular water were similar, but that there were significant changes in the extracellular water (ECW) (DAPA −8.4 ± 1.7, FR −12.5 ± 1.3, TLV −7.4 ± 1.5%, P = 0.048). As a result, the change in the ratio of ECW to total body water in the DAPA group was significantly smaller than that in the FR group, but numerically larger than that in the TLV group (DAPA −1.5 ± 0.5, FR −3.6 ± 0.5, TLV −0.5 ± 0.4%, P < 0.001). Conclusion Sodium‐glucose cotransporter 2 inhibitor DAPA predominantly decreased the ECW with a mild increase in urine volume, but the change in the ECW/total body water was smaller than that in patients treated with FR, and larger than that in patients treated with TLV, suggesting that the effects of SGLT2 inhibitors on fluid distribution may differ from those of conventional diuretics.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of the sodium‐glucose cotransporter 2 inhibitor dapagliflozin on fluid distribution: A comparison study with furosemide and tolvaptan

et al. 2019

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“…We recently reported that the SGLT2 inhibitor dapagliflozin predominantly decreased the extracellular volume with a mild increase in the urine volume in DKD patients with fluid retention [7,8]. Importantly, extracellular volume expansion, which is represented as an increased over-hydration index or the ratio of extracellular water (ECW) to total body water (TBW) (ECW/TBW), as measured by bioimpedance analysis (BIA) device, predicts high mortality and adverse cardio-renal outcomes in patients with chronic kidney disease (CKD) [9][10][11][12]. Thus, the reduction in the extracellular volume expansion through SGLT2 inhibition may be a promising cardio-renal protective mechanism in these patients.…”

Section: Introductionmentioning

confidence: 99%

The extracellular volume status predicts body fluid response to SGLT2 inhibitor dapagliflozin in diabetic kidney disease

Ohara

Masuda

Morinari

et al. 2020

Diabetol Metab Syndr

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Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are an antihyperglycemic drug with diuretic action. We recently reported that the SGLT2 inhibitor dapagliflozin ameliorates extracellular volume expansion with a mild increase in urine volume. However, the impact of the pretreatment extracellular volume status on the body fluid response to SGLT2 inhibitors remains unclear. Methods: Thirty-six diabetic kidney disease (DKD) patients were treated with dapagliflozin. The body fluid volume, including intracellular water (ICW), extracellular water (ECW) and total body water (TBW), were measured on baseline and day 7 using a bioimpedance analysis (BIA) device. The ECW/TBW and ECW were used as markers of the extracellular volume status. For a comparison, the extracellular volume status responses to loop diuretic furosemide (n = 16) and vasopressin V2 receptor antagonist tolvaptan (n = 13) were analyzed. Results: The body weight, brain natriuretic peptide and body fluid parameters measured by a BIA (ICW, ECW, TBW, and ECW/TBW) were significantly decreased for 1 week after dapagliflozin administration. The change in the ECW/ TBW in the high-ECW/TBW group (over the median value of 0.413) was significantly higher than in the low-ECW/TBW group (− 2.1 ± 0.4 vs. − 0.5 ± 0.4%, p = 0.006). Only with dapagliflozin treatment (not furosemide or tolvaptan treatment) was the baseline ECW/TBW significantly correlated with the changes in the ECW/TBW (r = − 0.590, p < 0.001) and ECW (r = − 0.374, p = 0.025). Conclusions: The pretreatment extracellular volume status predicts the body fluid response to the SGLT2 inhibitor dapagliflozin in DKD patients. The diminished extracellular fluid reduction effect of dapagliflozin in patients without severe extracellular fluid retention may contribute to maintaining a suitable body fluid status.

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“…[32] Average ECW/TBW ratios were found to be 0.412 in patients with acute heart failure [23] and 0.40 in chronic dialysis patients. [45] Although these averages were higher than the normal reference value, they were lower in patients with chronic diseases than in those who were critically ill.…”

Section: Discussionmentioning

confidence: 84%

Body Composition Analysis in Septic Shock Patients Receiving Protocol-Driven Resuscitation Bundle Therapy: A Prospective Observational Study

Chae¹,

Shin²,

Hong³

et al. 2021

Preprint

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Background: Bio-electrical impedance analysis (BIA) is a rapid, simple, and noninvasive tool for assessing volume status in various diseases. Body composition analysis using BIA may identify factors associated with poor outcomes in critically ill patients. Little is known, however, about the relationship between the results of body composition analysis in the emergency department (ED) and mortality in septic shock patients.Objectives: This study assessed the association between parameters identified by body composition analysis and mortality in patients with septic shock who underwent protocol-driven resuscitation bundle therapy in the ED.Methods: Data were prospectively collected on adult patients with septic shock who underwent protocol-driven resuscitation bundle therapy between December 2019 and December 2020. Body composition was determined in the ED using BIA with the patient in the supine position. Septic shock was defined by sepsis-3 criteria, and the primary outcome was 30-day mortality. Results: The study included 218 patients, of whom 58 (26.6%) died within 30 days. The mean time from ED admission to the measurement of body composition was 5.4 hours. The average ratio of extracellular water (ECW) to total body water (TBW) was significantly higher in non-survivors than in survivors (0.412 vs. 0.400, p=0.001). The optimal ECW/TBW cutoff for predicting 30-day mortality was 0.40, with mortality rates being significantly higher in patients with ECW/TBW >0.4 than in patients with ECW/TBW≦0.4 (37.8% vs. 17.5%, p=0.001). Multivariate analysis showed that ECW/TBW >0.4 (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.05–4.23, p = 0.036), active cancer (OR, 2.39; 95% CI, 1.06–5.38, p=0.036), prothrombin time (OR, 2.77; 95% CI, 1.29–5.93, p=0.009), and initial lactate level (OR, 1.15; 95% CI, 1.03–1.28, p=0.010) were significantly associated with 30-day mortality.Conclusions: The ECW/TBW>0.40 is the only body composition parameter associated with 30-day mortality in patients with septic shock.

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Monitoring Volume Status Using Bioelectrical Impedance Analysis in Chronic Hemodialysis Patients

Cited by 23 publications

References 34 publications

Effects of the sodium‐glucose cotransporter 2 inhibitor dapagliflozin on fluid distribution: A comparison study with furosemide and tolvaptan

Effects of the sodium‐glucose cotransporter 2 inhibitor dapagliflozin on fluid distribution: A comparison study with furosemide and tolvaptan

The extracellular volume status predicts body fluid response to SGLT2 inhibitor dapagliflozin in diabetic kidney disease

Body Composition Analysis in Septic Shock Patients Receiving Protocol-Driven Resuscitation Bundle Therapy: A Prospective Observational Study

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