Clinical assessment of dry weight (original) (raw)
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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
Background Achieving and maintaining dry weight appears to be an effective strategy for controlling and maintaining normotension among hypertensive patients on hemodialysis (HD). Objective The present study aimed to determine the time at which the majority of patients achieve postdialysis dry weight using bioimpedance spectroscopy (BIS). Methods A total of 220 HD patients were prospectively assessed for fluid overload using the Fresenius body composition monitor (BCM). BCM readings were taken at 30 and 45 min postdialysis. Results Among the 220 patients included in this study, 120 (54.5%) achieved a euvolemic state at 30 min, and 25 (11.4%) achieved it at 45 min according to the BCM. In the multivariate analysis, vascular access other than arteriovenous fistula (AVF) (OR = 0.286, p value = 0.049) and cardiovascular disease (OR = 0.384, p value = 0.026) had a statistically significant negative association and receiving HD at Hospital Universiti Sains Malaysia (HUSM) (OR = 2.705, p value = 0.008) had a statistically significant positive association with achieving a euvolemic state at 30 min. Conclusion This suggests that assessing the hydration status at 45 min postdialysis in all patients or in those with identified risk factors for not achieving a euvolemic state at 30 min will provide a relatively accurate assessment for most patients. Strengths and limitations of the study • This study involved heterogeneous group of patients from tertiary-level teaching hospital of Malaysia. • Use of Fresenius body composition monitor (BCM) for dry-weight analysis. • To the best of the authors' knowledge, the current study is strengthened by its prospective nature, and it is the first study to evaluate and suggest the optimal time for dry weight assessments in a clinical setting. • For determining the predictors of achieving a euvolemic state at 30 min, multivariate analysis was conducted. • Nevertheless, a multicenter study with a large sample size and longer follow-up time is needed to confirm the findings of the current study.
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.
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 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&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; dry weights between nephrologists&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; 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.
Kidney International, 1993
Non.invasive monitoring of blood volume during hemodialysis: Its relation with post-dialytic dry weight. Hemodialysis has a profound effect on fluid balance. Since fluid is initially withdrawn from the intravascular compartment, blood volume will decrease rapidly. A fluid shift (refill) from the overhydrated interstitium towards the intravascular compartment counteracts hypovolemia. Underestimation of postdialytic dry weight will cause interstitial dehydration and consequently a low refill capacity. This can cause hypovolemia-induced hypotension, a serious problem in the daily practice of hemodialysis: during one out of three sessions a hypotensive episode occurs. Clinical criteria to estimate post-dialytic dry weight are insensitive. We have developed non-invasive methods to estimate dry weight and changes in blood volume (BY) more accurately. The aim of this study was to investigate the relation between hydration state of the patient and changes in BY during treatment. Therefore, 37 hemodialysis patients were divided into three groups according to their post-dialytic extracellular fluid volume (EFV), which was measured by means of the non-invasive conductivity method: de-(N = 11), normo-(N = 18), and overhydrated (N = 8). Using an on-line optical reflection method, changes in BY were measured continuously during hemodialysis. BY decrease, corrected for ultrafiltration, was stronger in the dehydrated (4.4 1 .5%/liter) than in the normohydrated (3.3 1.5%/liter) and overhydrated (2.7 1.9%/liter) groups. In the dehydrated group, the frequency of hypotensive episodes (48.5 20.2%) was significantly greater compared to the conductivity technique and BY was monitored continuously using an optical reflection method [12, 13] The ultimate aim was an early detection of hypovolemia in order to prevent hypotension. Methods
Blood Purification, 2012
Background: The relationship between predialysis blood pressure (BP) and hemodialysis (HD) patient outcomes is controversial. We report the evolution of predialysis BP in incident patients treated with the dry weight method and its relationship with patients’ outcomes. Methods: Between January 2000 and 2009, 308 patients started HD treatment. Fluid was progressively removed. The patients were encouraged to accept long-hour dialysis session and to follow a salt-restricted diet. BP and body weight (BW) were recorded and analyzed at start (week 1, W1) and weeks 8, 12, 26 and 52. Results: The predialysis systolic BP decreased from 142.1 at W1 to 130.7 mm Hg at W52. Postdialysis BW decreased from W1 to W8 (–5.0 ± 4.5%). It was correlated with the decrease of the predialysis systolic BP at W26 and W52. Whereas the patient survival was significantly lower in the lower predialysis systolic BP tertile at W1 like in previous reports calling this phenomenon ‘reverse epidemiology’, no relations...