Multi-Method Complex Approach for Hydration Assessment Does Not Detect a Hydration Difference in Hemodialysis versus Peritoneal Dialysis Patient

Abstract

Assessment of hydration status is essential in monitoring the effectiveness of renal replacement therapy and is usually based on physical examination. However, comparisons of hydration status achieved with different dialysis methods are not conclusive. We compared the hydration status of patients on chronic hemodialysis (HD, n = 60) and peritoneal dialysis (PD, n = 20) in a comprehensive assessment including physical examination and additional methods. The mean age of the 80 chronically dialyzed patients (53 males, 27 females) was 58.1 ± 13.9 years. The clinical evaluation took into account the presence of peripheral edema, dyspnea, and crackling over the lung fields. Additional tests included lung ultrasound, electrical bioimpedance (performed in 79 patients), impedance cardiography, ultrasound assessment of large abdominal vessels (performed in 79 patients), select echocardiographic parameters (obtained in 78 patients), and serum NT-proBNP concentration. Residual diuresis volume was significantly higher in the PD group. We found no significant differences between the two groups in any other baseline characteristics or in the results of the clinical examination or additional tests. The use of different methods for assessing hydration does not allow differentiation of patients treated with dialysis in terms of the dialysis technique used. Therefore, it seems reasonable to use common algorithms to objectify the hydration status of these patients.

Cardiac geometry, function, and remodeling patterns in patients under maintenance hemodialysis and peritoneal dialysis treatment

“…Similarly, in a smaller study including 65 hemodialysis and 52 PD patients, eccentric LVH was more common only in overhydrated hemodialysis patients compared to the total PD patients [33]. In a more recent study comparing hydration status, measured with lung ultrasound, vena cava diameter, bioimpedance analysis, and N ‐terminal pro‐brain natriuretic peptide, between 60 hemodialysis and 20 PD unmatched patients, results showed no significant differences between groups in any of the volume‐related parameters, whereas LVMi was marginally higher in hemodialysis compared to the PD group (181.59 [range: 108.72–382.28] vs. 150.99 [range: 106.47–256.70]; p = 0.063) [34]. A case‐control study including 22 hemodialysis and 24 PD patients has found no significant differences in the prevalence of LVH (77% vs. 71%), as well as in LVMi (149 ± 40 vs. 134 ± 32 g/m 2 ), LVEDD (4.91 ± 0.59 vs. 5.04 ± 0.66), and LA diameter (3.70 ± 0.50 vs. 4.03 ± 0.54) [35].…”

Chronic Kidney Disease and Heart Failure–Everyday Diagnostic Challenges

“…The examination typically includes a blood pressure measurement and assessments of the presence and severity of peripheral edema and the detection of crackles over the pulmonary fields. However, these assessments are not sufficient to make a reliable assessment of the degree of fluid overload [19][20][21]. Moreover, it remains challenging to assess the correct hydration status in patients that require dialysis.…”

“…Moreover, it remains challenging to assess the correct hydration status in patients that require dialysis. Consequently, the medical examination results are objectified with additional methods; for example, the whole body electrical bioimpedance can be measured; ultrasound can be performed to assess inferior vena cava compliance; or ultrasound can be performed to assess pulmonary congestion [21]. Each of these methods has advantages and limitations (Table 1).…”