Kronik Hemodiyaliz Hastalarında Sıvı Volüm Durumunun Değerlendirilmesinde Biyoelektriksel İmpedans Analizinin Yeri

Öz

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.

Anahtar Kelimeler

• hemodiyaliz,volüm kontrolü,biyoelektriksel impedans,arteriyel sertlik

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

Öz

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.

Anahtar Kelimeler

• hemodialysis,volume control,bioelectrical impedance analysis

Kaynakça

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