Kronik Hemodiyaliz Hastalarında Sıvı Volüm Durumunun Değerlendirilmesinde Biyoelektriksel İmpedans Analizinin Yeri

Abstract

Amaç: Kronik hemodiyaliz (HD) tedavisi altındaki hastalarda morbidite ve mortalitenin en önemli sebebi olan kardiyovasküler hastalık ve komplikasyonlarından kaçınmak için, optimal sıvı durumunun elde edilmesi kritik bir önem taşır. Biz çalışmamızda kronik HD hastalarında, biyoelektriksel impedans analizi’nin (BİA) sıvı durumunun değerlendirilmesinde klinik ve ekokardiyografik incelemelere ek bir katkısı olup olmadığını saptamayı amaçladık. Gereç, Yöntem Ve Bulgular: Çalışma en az 3 aydır kronik HD tedavisi uygulanmakta olan 46 hasta ile yapıldı. Katılımcıların 0 ve 3. aylarda klinik ve biyokimyasal incelemelerine ek olarak, BİA, nabız dalga hızı (NDH), ekokardiyografik vena kava inferior çapı, 24 saatlik ambulatuvar kan basıncı takibi yapıldı. Hastaların ortalama BİA ile tespit edilen total vücut sıvısı 0. ay ve 3. ayda sırasıyla - 0,65±3,30 ve -0,30±1,49 litre olarak tespit edildi. İki ölçümün karşılaştırılması istatistiksel olarak anlamlı bulunmadı (p:.141). Ekokardiyografik vena kava inferior çapları 0. ve 3. ayda sırası ile 13,3±3,02 ve 15,9±3,32 mm olarak bulundu. 3. aydaki vena kava inferior çapının başlangıçtakinden anlamlı olarak geniş olduğu görüldü. (p< .005). Başlangıç ve 3. Aydaki Kt/Vüre, hematolojik ve biyokimyasal parametreler, ambulatuvar kan basıncı izlemi verileri ve NDH ölçümleri arasında da istatistiksel anlamlı fark saptanmadı. Sonuç: Çalışma bulgularımız kronik HD hastalarında sıvı volüm durumunun değerlendirilmesinde HD seansı sonrasında yapılan BİA verilerinin klinik bulgulara bir üstünlüğü olmadığını göstermiştir. Bu hasta grubunda sıvı volüm durumunu belirleyecek ideal yöntemin bulunması için daha ileri çalışmalara gereksinim vardır.

Keywords

• hemodiyaliz,volüm kontrolü,biyoelektriksel impedans,arteriyel sertlik

The role of Bioelectrical Impedance Analysis In Assessment Of Fluid Volume Status In Chronic Hemodialysis Patients

Abstract

Aim: In order to avoid cardiovascular disease and its complications, which is the most important cause of morbidity and mortality in patients under chronic hemodialysis (HD), it is critical to obtain optimal fluid status. In this study, we aimed to determine whether bioelectrical impedance analysis (BIA) has an additional contribution to clinical and echocardiographic examinations in the assessment of fluid status in chronic HD patients. Materials, Methods and Results: The study was conducted with 46 patients who had been treated with chronic HD for at least 3 months. In addition to clinical and biochemical examinations, BIA, pulse wave velocity (PVW), echocardiographic inferior diameter of the vena cava, and 24-hour ambulatory blood pressure were monitored at 0 and 3 months. The mean total body fluid detected by BIA was 0,65 ± 3,30 and -0,30 ± 1,49 liters at 0 months and 3 months, respectively. Comparison of the two measurements was not statistically significant (p: .141). Echocardiographic diameters of the inferior vena cava were 13.3 ± 3.02 and 15.9 ± 3.32 mm, respectively, at 0 and 3 months. The inferior diameter of the vena cava at 3 months was significantly larger than the initial diameter. (p <.005). No statistically significant difference was found between Kt/Vurea, hematological and biochemical parameters, ambulatory blood pressure monitoring data and NDH measurements at baseline and at 3 months. Conclusion: Our study findings showed that BIA data obtained after HD session did not have any superiority to clinical findings in the evaluation of fluid volume status in chronic HD patients. Further studies are needed to find the ideal method to determine the fluid volume in this patient group.

Keywords

• hemodialysis,volume control,bioelectrical impedance analysis

References

1. 1. Lin YP, Chen CH, Yu WC, Hsu TL, Ding PY, Yang WC. Left ventricular mass and hemodynamic overload in normotensive hemodialysis patients. Kidney Int. 2002;62(5):1828-38.
2. 2. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55(13):1318-27.
3. 3. Verbeke F, Van Biesen W, Honkanen E, Wikstrom B, Jensen PB, Krzesinski JM, et al. Prognostic value of aortic stiffness and calcification for cardiovascular events and mortality in dialysis patients: outcome of the calcification outcome in renal disease (CORD) study. Clin J Am Soc Nephrol. 2011;6(1):153-9.
4. 4. Chongthanakorn K, Tiranathanagul K, Susantitaphong P, Praditpornsilpa K, Eiam-Ong S. Effective determination of dry weight by intradialytic bioimpedance analysis in hemodialysis. Blood Purif. 2009;27(3):235-41.
5. 5. Wabel P, Chamney P, Moissl U, Jirka T. Importance of whole-body bioimpedance spectroscopy for the management of fluid balance. Blood Purif. 2009;27(1):75-80.
6. 6. Charra B. 'Dry weight' in dialysis: the history of a concept. Nephrol Dial Transplant. 1998;13(7):1882-5.
7. 7. Wizemann V, Schilling M. Dilemma of assessing volume state--the use and the limitations of a clinical score. Nephrol Dial Transplant. 1995;10(11):2114-7.
8. 8. Kouw PM, Kooman JP, Cheriex EC, Olthof CG, de Vries PM, Leunissen KM. Assessment of postdialysis dry weight: a comparison of techniques. J Am Soc Nephrol. 1993;4(1):98-104.

9. 9. Agarwal R, Kelley K, Light RP. Diagnostic utility of blood volume monitoring in hemodialysis patients. Am J Kidney Dis. 2008;51(2):242-54.
10. 10. Dasselaar JJ, Huisman RM, de Jong PE, Franssen CF. Measurement of relative blood volume changes during haemodialysis: merits and limitations. Nephrol Dial Transplant. 2005;20(10):2043-9.
11. 11. Katzarski KS, Nisell J, Randmaa I, Danielsson A, Freyschuss U, Bergstrom J. A critical evaluation of ultrasound measurement of inferior vena cava diameter in assessing dry weight in normotensive and hypertensive hemodialysis patients. Am J Kidney Dis. 1997;30(4):459-65.
12. 12. Brennan JM, Ronan A, Goonewardena S, Blair JE, Hammes M, Shah D, et al. Handcarried ultrasound measurement of the inferior vena cava for assessment of intravascular volume status in the outpatient hemodialysis clinic. Clin J Am Soc Nephrol. 2006;1(4):749-53.
13. 13. Matthie J, Zarowitz B, De Lorenzo A, Andreoli A, Katzarski K, Pan G, et al. Analytic assessment of the various bioimpedance methods used to estimate body water. J Appl Physiol (1985). 1998;84(5):1801-16.
14. 14. Matthie J, Zarowitz B, De Lorenzo A, Andreoli A, Katzarski K, Pan G, et al. Analytic assessment of the various bioimpedance methods used to estimate body water. Journal of applied physiology (Bethesda, Md : 1985). 1998;84(5):1801-16.
15. 15. Kotanko P, Levin NW, Zhu F. Current state of bioimpedance technologies in dialysis. Nephrol Dial Transplant. 2008;23(3):808-12.
16. 16. Chamney PW, Kramer M, Rode C, Kleinekofort W, Wizemann V. A new technique for establishing dry weight in hemodialysis patients via whole body bioimpedance. Kidney Int. 2002;61(6):2250-8.
17. 17. Wabel P, Moissl U, Chamney P, Jirka T, Machek P, Ponce P, et al. Towards improved cardiovascular management: the necessity of combining blood pressure and fluid overload. Nephrol Dial Transplant. 2008;23(9):2965-71.
18. 18. Park J, Yang WS, Kim SB, Park SK, Lee SK, Park JS, et al. Usefulness of segmental bioimpedance ratio to determine dry body weight in new hemodialysis patients: a pilot study. Am J Nephrol. 2009;29(1):25-30.
19. 19. Chung AW, Yang HH, Kim JM, Sigrist MK, Brin G, Chum E, et al. Arterial stiffness and functional properties in chronic kidney disease patients on different dialysis modalities: an exploratory study. Nephrol Dial Transplant. 2010;25(12):4031-41.
20. 20. Kanbay M, Afsar B, Gusbeth-Tatomir P, Covic A. Arterial stiffness in dialysis patients: where are we now? Int Urol Nephrol. 2010;42(3):741-52.
21. 21. London G, Guerin A, Pannier B, Marchais S, Benetos A, Safar M. Increased systolic pressure in chronic uremia. Role of arterial wave reflections. Hypertension. 1992;20(1):10-9.
22. 22. Ellis KJ, Bell SJ, Chertow GM, Chumlea WC, Knox TA, Kotler DP, et al. Bioelectrical impedance methods in clinical research: a follow-up to the NIH Technology Assessment Conference. Nutrition. 1999;15(11-12):874-80.
23. 23. Hur E, Usta M, Toz H, Asci G, Wabel P, Kahvecioglu S, et al. Effect of fluid management guided by bioimpedance spectroscopy on cardiovascular parameters in hemodialysis patients: a randomized controlled trial. Am J Kidney Dis. 2013;61(6):957-65.
24. 24. Kushner RF, de Vries PM, Gudivaka R. Use of bioelectrical impedance analysis measurements in the clinical management of patients undergoing dialysis. The American journal of clinical nutrition. 1996;64(3 Suppl):503S-9S.
25. 25. Guida B, De Nicola L, Trio R, Pecoraro P, Iodice C, Memoli B. Comparison of vector and conventional bioelectrical impedance analysis in the optimal dry weight prescription in hemodialysis. Am J Nephrol. 2000;20(4):311-8.
26. 26. Passauer J, Petrov H, Schleser A, Leicht J, Pucalka K. Evaluation of clinical dry weight assessment in haemodialysis patients using bioimpedance spectroscopy: a cross-sectional study. Nephrol Dial Transpl. 2010;25(2):545-51.
27. 27. Arias M, Masso E, Gomez M, Rodas L, Broseta J, Vera M, et al. Are currently used bioimpedance methods in hemodialysis comparable for calculating dialysis dose? Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy. 2019.
28. 28. Vujicic B, Dorcic G, Babic V, Rundic A, Devcic B, Simac DV, et al. Comparison of clinical assessment and multifrequency bioimpedance analysis as methods of estimating volume status in peritoneal dialysis patients - A single-center experience. Clinical nephrology. 2019;91(6):334-43.
29. 29. Cakiroglu U, Akdam H, Eryilmaz U, Akgullu C, Ozbek O, Buyukozturk AK, et al. The effect of hemodialysis on the body composition and cardiovascular disease markers in recently diagnosed end stage renal disease patients. Revista da Associacao Medica Brasileira (1992). 2018;64(4):354-60.
30. 30. Kim CR, Shin JH, Hwang JH, Kim SH. Monitoring Volume Status Using Bioelectrical Impedance Analysis in Chronic Hemodialysis Patients. ASAIO journal (American Society for Artificial Internal Organs : 1992). 2018;64(2):245-52.
31. 31. Onofriescu M, Mardare NG, Segall L, Voroneanu L, Cusai C, Hogas S, et al. Randomized trial of bioelectrical impedance analysis versus clinical criteria for guiding ultrafiltration in hemodialysis patients: effects on blood pressure, hydration status, and arterial stiffness. Int Urol Nephrol. 2012;44(2):583-91.
32. 32. Charra B, Calemard M, Laurent G. Importance of treatment time and blood pressure control in achieving long-term survival on dialysis. Am J Nephrol. 1996;16(1):35-44.
33. 33. Voroneanu L, Cusai C, Hogas S, Ardeleanu S, Onofriescu M, Nistor I, et al. The relationship between chronic volume overload and elevated blood pressure in hemodialysis patients: use of bioimpedance provides a different perspective from echocardiography and biomarker methodologies. Int Urol Nephrol. 2010;42(3):789-97.