engleski

Body Composition Monitor: A New Tool for the Assessment of Volume-dependent Hypertension in the Patients on the Maintenance Hemodialysis

Background: The control of blood pressure has been one of the main problems of dry weight management on the basis that fluid accumulation predisposes to hypertension in the end stage renal disease patients. Non-invasive bioimpedance spectroscopy with a body composition model has been validated against other methods to assess fluid status. Aim: To evaluate the deviation in hydration status from normal ranges (ΔHS) as the cause of hypertension in the patients on the maintenance hemodialysis (HD) and to identify the different patient groups that result from measurements of pre-dialysis systolic blood pressure (BPsys) and ΔHS alone. Methods: ΔHS is measured in 219 prevalent HD patients from three centers using a new multifrequency bioimpedance spectroscopy device (BCM-Body Composition Monitor, Fresenius Medical Care, Germany), before the second dialysis session in the week. Patients with a pacemaker or implanted defibrillator, amputation of a major extremity, pregnancy or lactation period were excluded. BPsys is measured using the Riva-Rocci-Korotkoff method (mercury sphygmomanometer) after 5 minutes of rest. Both measurements were done with the patient in the supine position. The average of the two last measurements by sphygmomanometer was used in the analysis. The data were used to generate a graphical tool (HRP-hydration reference plot) which allows rapid differentiation between hypotensive and hypertensive patients as well as distinguishing fluid overload from the state of normohydration. Results: In normohydration-normotension group (BPsys>150 mmHg, ΔHS<2, 5 L) we found 49 (23%) patients. In volume dependent hypertension group (BPsys>150 mmHg, ΔHS>2, 5 L) we found 93 (42%) patients. In possible essential hypertension group (BPsys>150 mmHg, ΔHS<1, 1 L) we found 35 (16%) patients. In overhydration but not reflected in BPsys group (BPsys<140 mmHg, ΔHS>2, 5 L) we found 40 (18%) patients. In underhydration-hypotension group (BPsys <100 mmHg, ΔHS>1, 1 L) we found two patients (1%). Conclusion: The multifrequency bioimpedance spectroscopy method allows detecting of fluid overload in a safe and easy manner. According to this, more objective choice of strategies for the optimal treatment of hypertension and fluid overload in the maintenance HD patients can be selected.

Hypertension; Dialysis; Dry weight

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