Evaluation of factors affecting time to achieve dry weight among hemodialysis patients using bioimpedance spectroscopy (original) (raw)
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Clinical assessment of dry weight
Nephrology Dialysis Transplantation, 1996
Unsatisfactory control of blood pressure (BP) leading to an increased rate of cardiovascular events is the main cause of mortality in haemodialysis. BP control has deteriorated since haemodialysis session times have been reduced. Inadequate BP control most often is due to a failure to achieve and maintain dry weight. Dry weight and normotension have been gradually omitted in the goals of dialysis, satisfactory dialysis being reduced to an 'adequate' urea Kt/V. Ideal dry body weight needs a reappraisal. What is dry weight? How should it be clinically assessed, established and maintained in patients? The problems encountered in estimating dry weight can be solved at the bedside in most cases. The additional laboratory, echography and impedancemetry methods are research tools that hopefully can be made simpler and lower in cost so they can be used everyday at the bedside. In the mean time, with the exception of ambulatory blood pressure measurement, one must rely on careful and repeated clinical observation to determine and maintain dry weight.
Journal of Clinical Nursing, 2012
The main objective of the study was to correlate the target dry weight in haemodialysis (HD) patients as assessed clinically by nephrologists to those measured by the Body Composition Monitor (BCM - Fresenius) machine. The second objective was to compare pre and postdialysis changes of extracellular fluid and clinical parameters. Clinical assessment of target dry weight in HD patients remains problematic. Inaccurate dry weight resulted in hypovolaemic or overhydration states. The BCM (Fresenius) utilises bioimpedance technology for body fluid monitoring and has been extensively validated. This was a prospective cross-sectional study on consecutive patients who underwent HD and gave informed consent. Methods. The target dry weights of these patients were first assessed by their attending nephrologists and appropriate ultrafiltration prescribed. Their body fluid statuses were then measured with the BCM before and after HD treatment. Eighty HD patients (37 men, 43 women) with a mean age of 55 ± 13 years and a mean duration on HD of 71 ± 56 months were studied. The dry weight measured by BCM significantly correlated with dry weight assessed by the nephrologists. The mean dry weight was higher when assessed by the nephrologists compared to that by BCM. Only systolic blood pressure and not other components of blood pressure reduced after HD treatments. The BCM is a rapid and easy-to-use tool that can help HD nursing staffs to adjust patients' dry weights between nephrologists' reviews thus optimising HD therapy and patient outcomes. We propose that experienced HD nursing staff be trained in the use of the BCM or other simple bioimpedance machines to help monitor patient overhydration and approximate dry weight in consultation with the nephrologists responsible for the care of these patients so as to obviate excessive residual overhydration between nephrology reviews.
Reliability of Blood Pressure Parameters for Dry Weight Estimation in Hemodialysis Patients
Therapeutic Apheresis and Dialysis, 2012
Chronic volume overload resulting from interdialytic weight gain and inadequate fluid removal plays a significant role in poorly controlled high blood pressure. Although bioimpedance has been introduced as an accurate method for assessing hydration status, the instrument is not available in general hemodialysis (HEMO) centers. This study was conducted to explore the correlation between hydration status measured by bioimpedance and blood pressure parameters in chronic HEMO patients. Multifrequency bioimpedance analysis was used to determine pre-and post-dialysis hydration status in 32 stable HEMO patients. Extracellular water/total body water (ECW/TBW) determined by sum of segments from bioimpedance analysis was used as an index of hydration status. The mean age was 57.9 Ϯ 16.4 years. The mean dry weight and body mass index were 57.7 Ϯ 14.5 kg and 22.3 Ϯ 4.7 kg/m 2 , respectively. Pre-dialysis ECW/TBW was significantly correlated with only pulse pressure (r = 0.5, P = 0.003) whereas post-dialysis ECW/TBW had significant
Multifrequency bioimpedance in assessment of dry weight in haemodialysis
Nephrology Dialysis Transplantation, 1996
The use of multifrequency bioimpedance (MFB) for determination of dry weight (DW) in haemodialysis (HD) patients was evaluated in three studies. In Study 1, the fluid state [total body water (TBW) and extracellular volume (ECV)] was measured by MFB in 82 normotensive patients, 41 hypertensive patients and in 30 healthy subjects. TBW and ECV were expressed as per cent of body weight (BW). In Study 2, DW of five hypertensive HD patients was gradually decreased during 3 months and ECV (MFB) and blood pressure (48 h ambulatory blood pressure monitoring) were measured at the beginning and end of study. In Study 3, we measured the fluid status repeatedly by MFB and the diameter of the inferior vena cava (DIVC) by ultrasound before, during and 2 h post-HD.
Journal of Turgut Ozal Medical Center
Aim: Maintaining euvolemia is an important purpose in patients on hemodialysis therapy. Multiple-frequency bioimpedance spectroscopy (BIS) appears to be a useful and appropriate technique for assessing hydration status and body composition in hemodialysis patients.The aims of this study were to determine the pre and post hemodialysis hydration status of the pediatric hemodialysis patients by BIS and compare the dry weight determined by BIS to established by clinically. Material and Methods: Body Composition Monitor (BCM; Fresenius Medical Care, Germany) was performed in 13 pediatric hemodialysis patients in a single center. Patients were measured at the midweek session, once immediately before and once 30 minutes after dialysis. Pre-and post-HD weights, blood pressures, were collected on the day of the BCM measurements. Results: Seven (53.8%) of the 13 patients were male and 6 (46.2%) were female. The mean age ranged from 11.92 ± 3.13 (5.7-16) years and duration time ranged from 7 to 54 months, and the median duration of dialysis was 11 months. Dry weights which was determined clinically were higher than those calculated by BCM. A significant difference was found between mean values (34,71 ± 12,68 versus 33,71 ± 12,16 kg, Δ: 1 ± 1,51, p = 0.035). There was a high positive correlation between dry weights measured by BCM and dry weight established by nephrologists (r = 0.993, p <0.001). Conclusion: In assessing dry weight, BCM appears to be a quick and easy-to-use tool that can assist the clinician in hemodialysis treatment and optimizing patient outcomes.
Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation, 2017
This prospective study uses calf bioimpedance spectroscopy (cBIS) to guide the attainment of dry weight (DWcBIS) in chronic hemodialysis (HD) patients. The primary aim of this study was to evaluate whether body composition is altered when fluid status is reduced to DWcBIS. Target post-HD weight was gradually reduced from baseline (BL) until DWcBIS was achieved. DWcBIS was defined as the presence of both flattening of the curve of extracellular resistance and the attainment calf normalized resistivity in the normal range during the dialysis treatment. Extracellular volume (ECV), intracellular volume, and total body water (TBW) were measured using whole body BIS (Hydra 4200). Fluid overload, lean body mass, and fat mass were calculated according to a body composition model. Seventy-three patients enrolled and 60 completed the study (55 ± 13 years, 49% male). Twenty-eight patients (25% diabetes) achieved DWcBIS, whereas 32 patients (47% diabetes) did not. Number of treatment measuremen...
Background. Maintenance of the optimal fluid status in hemodialysis patients is still a challenging task in daily clinical practice. A bioelectric impedance technique has been applied for evaluation of hydration status in the dialysis population in recent years, but serial observations of its role in clinical dry weight determination are lacking. In this study, serial follow-up data of a body composition monitor based on bioimpedance spectroscopy (BCM-BIS) applied in dialysis patients were analyzed to define the technique's feasibility, precision and possible role in dry weight determination. Methods. BCM-BIS was applied monthly to 194 hemodialysis patients for 6 months. Intra-patient precision was analyzed. Bland-Altman analysis and repeated-measures analysis of variance (ANOVA) were used to define the relationship between the dry weights determined by BCM-BIS and by clinical judgment. Results. The coefficients of variation (CVs) of fluid parameters were <5%. Serial changes in dry weight differences were compared in groups with different post-dialysis hydration status and dry weight differences decreased gradually. Bland-Altman analysis revealed that the range of these differences was significantly narrower towards the latter part of the study. The upper limit of agreement with 95% confidence interval (CI) was 1.47 L and the lower limit was −3.02 L. Conclusions. BCM-BIS is precise and can be easily applied in the clinical setting. Discrepancy between the dry weights determined by BCM-BIS and by clinical judgment significantly decreased during the study. It is sensitive in dry weight determination, especially for those patients with obvious over-hydration (OH) by BCM-BIS. Patients with post-dialysis OH results beyond some critical values (>1.5 L or <−3 L) should be closely monitored.