engleski

COMPARATIVE ANALYSIS OF DIAGNOSTIC METHODS FOR VOLUME STATUS ESTIMATION AND INTRADIALYTIC HYPOTENSION PREVENTION IN MAINTENANCE HAEMODIALYSIS PATIENTS

INTRODUCTION AND AIMS: To estimate volume status in maintenance haemodialysis (HD) patients by cardio-thoracic ratio (CTR) method, serum level of N-terminal brain natriuretic peptide (NTpro-BNP), colapsibility index (CI) of inferior vena cava method and by multifrequency bioimpendance analysis (BIA). We also wanted to make a correlation of these methods and to perform a dry weight correction according to the multifrequency BIA results of patient's volume status. According to that intervention we expected to decrease a number of patients with symptomatic intradialytic hypotension (IDH). METHODS: 128 patients on maintenance HD were tested for eligibility in Clinical Hospital Center Rijeka, Croatia, and 65 of them were enrolled in the study. According to the frequency of IDH patients were divided in two groups: 38 patients with frequent symptomatic IDH, and 27 patiens without frequent symptomatic IDH. Volume status was estimated in all patients by four methods: CTR, NTpro-BNP, multifrequency BIA and CI of inferior vena cava, at the beginning of the study and after six months. During a follow up period, dry weight of the patients was corrected by multifrequency BIA after one and three months, respectively. Results of volume status estimated by all four methods were correlated, and also was a frequency of symptomatic IDH and the beginning and at the end of the study. RESULTS: The mean age of the patiens was 64, 98 ± 11, 73 years, range from 38 to 85 years, and 35 (53, 85%) were men. The most common underlying renal disease was diabetic nephropathy in 19 (29%) patients. Comparative analysis of the volume status estimation by CTR, multifrequency BIA, IK of inferior vena cava, and NTproBNP indicated a significant correlation (at the beginning of the study and after six months). The number of symptomatic IDH in 38 (58%) patients decreased to the 11 (17%) patients at the end of follow up (p<0, 001). Risk factors for development of symptomatic IDH were older age (P=0, 041), and diabetes (p<0, 001). CONCLUSIONS: There is a great incidence of symptomatic IDH in the patients on the maintenance HD. The interdialytic weight gain, and the number of symptomatic IDH decreased by dry weight correction according to the multifrequency BIA. Comparative analysis of four methods for volume status estimation indicates a good correlation. Multifrequency BIA is objective, fast, non-invasive, without X-ray emission and highly reproducible method which could be used for volume status estimation and symptomatic IDH prevention in maintenance HD patients.

Dialysis ; Intradialytic hypotension ;

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