Optimal fluid control can normalize cardiovascular risk markers and limit left ventricular hypertrophy in thrice weekly dialysis patients

Abstract

Increased hemodialysis frequency can make fluid overload easier to treat, although most patients are still treated thrice weekly. Chronic fluid overload is associated with left ventricular hypertrophy and elevated serum cardiac biomarkers, recognized as mortality risk factors. Serum cardiac troponin T (cTnT), N-terminal prohormone brain natriuretic peptide (NT-proBNP), left ventricular mass index by cardiac magnetic imaging, and ambulatory blood pressure was measured in 30 thrice weekly hemodiafiltration patients. Time-averaged fluid overload (TAFO) was quantified by bioimpedance spectroscopy. In the study group, left ventricular hypertrophy was found to be 26% by cardiac magnetic resonance. Ambulatory blood pressure was 130 mmHg (112-151) requiring a low equivalent dose of medication of 0.25 units (0-1). Significantly, lower levels of left ventricular mass index (P < 0.05) were associated in those patients with TAFO <1 L or NT-proBNP <1200 pg/mL or cTnT <0.1 ug/L. In the subgroups, 16 patients had normal cTnT (<0.03 ug/L), 16 patients had NT-proBNP <400 pg/mL, and 20 patients had TAFO <1 L. Nine patients had both cTnT <0.03 ug/L and NT-proBNP <400 pg/mL. Normally hydrated thrice-weekly hemodiafiltration patients can have cardiac biomarker and TAFO levels indistinguishable from the normal healthy population. Obtaining TAFO by bioimpedance monitoring can offer a practical alternative to serum cardiac biomarkers.

Cardiac Troponin T and Hydration Status as Prognostic Markers in Hemodialysis Patients

“…Their study of thrice-weekly hemofiltration, a more physiological dialytic method avoiding substantial fluid imbalance, instead of HD, resulted in improved cTnT and N-terminal pro-brain natriuretic peptide values. In the current study, a lack of correlation between SBP, DBP and cTnT elevation on all-cause mortality indirectly confirms the results of Velasco et al [23], suggesting that large interdialytic weight gains requiring increase of UF lead to greater intra-and post-dialytic BP drops, which most likely are as unfavorable as increased but stable BP. Our finding of no direct correlation between cTnT, OH% and the incidence of AMI (only a tendency for cTnT) is in contrast to previous studies [16,24] .…”

“…Velasco et al [23] performed an experiment to confirm the negative influence of HD on patients' fluid balance. Their study of thrice-weekly hemofiltration, a more physiological dialytic method avoiding substantial fluid imbalance, instead of HD, resulted in improved cTnT and N-terminal pro-brain natriuretic peptide values.…”

Bioimpedance-Guided Fluid Management in Hemodialysis Patients

“…New noninvasive bedside tools, such as bioimpedance spectroscopy (BIS), facilitate objective assessment of fluid status. Fluid status can be expressed as pre-or postdialytic fluid overload, but to assess the cardiovascular condition of a patient, the timeaveraged fluid overload (TAFO) seems to better reflect the long-term cardiovascular load (6).…”

High-sensitivity troponin measurements: challenges and opportunities for the laboratory and the clinician

“…In patients with renal disease, a different dialysis regime reduced troponin elevation. 49 These are observational studies and intervention trials are required, as observation or risk prediction may not translate into an effective intervention, 50 but the findings are intriguing. In conclusion, the use of hs troponin measurements offers significant possibilities to improve patient flow in patients presenting with chest pain or suspected AMI.…”