engleski

Assesment of the Volume Status in Dialysis Patients

INTRODUCTION. To determine the overhydration as common complication of end–stage renal disease (ESRD) as it can lead to high blood pressure. In purpose of achieving optimal fluid balance and regulation of blood pressure, it's important to define ˝dry weight˝ which is not quite simple job. We compared several methods: cardiothoracic index (CTI), NT-proBNP in serum, colapsibility index of inferior vena cava (CI) and the newest method which is not in common use - multifrequency bioimpedance spectroscopy (BIS) yet. PATIENTS AND METHODS. We examined 52 hemodialysis patients at the University Hospital Center Rijeka and Dialysis Center Mali Lošinj at the midweek dialysis session. In patients where cardiothoracic index was greater than 50% , we counted as heart hypertrophy due to volume overload. NT-proBNP serum value 10 times greater than our laboratory reference (>1000 pg/ml) were counted as marker of volume overload. IC values <40% represented intravascular hiperhydration, 40-75% normohydration, and values >70% dehydration. We measured patients hydration status using BIS method with BCM-Body Composing Monitor (Fresenius Medical Care, Germany). We desinfected patients fist and foot on the same body side, pasted two electrodes, having in mind that red electrode always went distal and connected patient to the device and the measurment of about one minute was done. RESULTS. We had good correlation between all methods. BCM vs NT-proBNP (r=0, 08174 ; P=0, 6305). BCM vs KTI (r=0, 06721 ; P=0, 6926). BCM vs IK (r=0, 01183 ; P=0, 9446). NT-proBNP vs KTI (r=0, 2292 ; P=0, 1724). NT-proBNP vs IK (r=0, 3017 ; P=0, 0695). KTI vs IK (r=0, 04331 ; P=0, 7991). CONCLUSION. Using BIS method in estimating volume status in haemodialysis patients is as effective as standard methods but more safe and applicable. Variabilities of CI were due to subjectivity of the diagnostic method itself. Further investigations including more patients are required before confirming this method to be a standard clinical practice. Nevertheless, the first results confirmed in our study are promising.

Dialysis ; Dry weight

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