Skip to main content
Top
Published in: International Urology and Nephrology 3/2010

01-09-2010 | Nephrology – Original Paper

The relationship between chronic volume overload and elevated blood pressure in hemodialysis patients: use of bioimpedance provides a different perspective from echocardiography and biomarker methodologies

Authors: Luminita Voroneanu, Claudiu Cusai, Simona Hogas, Serban Ardeleanu, Mihai Onofriescu, Ionut Nistor, Octavian Prisada, Radu Sascau, David Goldsmith, Adrian Covic

Published in: International Urology and Nephrology | Issue 3/2010

Login to get access

Abstract

Background

Chronic volume overload is very frequent in hemodialysis (HD) patients and is directly associated with hypertension, increased arterial stiffness, left ventricular hypertrophy (LVH), heart failure and ultimately with higher mortality and morbidity. One major issue is that presently there are very few comparative studies of the various methods (clinical, bioimpedance, inferior cava vein diameter (ICV) and Brain Natriuretic Peptide (NT-proBNP)) for volume status evaluation and their correlation with cardiovascular disease.

Methods

In 160 patients treated by chronic HD in our center, euvolemic according to clinical assessment, we performed evaluation of volume status through bioimpedance spectroscopy (BIS), ICV and NT-proBNP, as well as echocardiography, to estimate the left ventricle structure and function.

Results

Despite appearing clinically euvolemic, severe fluid overload, as defined by a relative tissue hydration (RTH)—i.e. fluid overload over extracellular water ratio (FO/ECW)—above 15% was found in 25.6% of patients. Four categories of patients were considered according to pre-HD BP and BIS values. Forty-five percent of patients (group A) had a reasonable control of BP and volume (SBP < 150 mmHg and RTH < 15%), 29.3% (group B) were classified as hypertensive (SBP > 150 mmHg and RTH < 15%), 16.7% (group C) had high blood pressure and marked volume expansion, (SBP > 150 mmHg and RTH > 15%), while 9% (group D) had SBP < 150 mmHg despite RTH > 15%. Assuming that BIS is the most accurate and validated method to assess hydration status, we calculated the positive predictive value for ICV-based evaluation—18%, with a sensitivity of 67% and an important proportion of false negative cases (45%). NT-proBNP was even less accurate: PPV of only 26%, with a sensitivity of 60% and a specificity of only 45% and an extremely high proportion of false positive cases (73%). Group A patients had the best cardio-vascular profile: lowest LV mass and NT-proBNP levels.

Conclusion

Using multi-frequency body impedance spectroscopy, we found a large group of hypertensive and/or fluid-overloaded patients despite apparently being at “dry weight” on clinical evaluation and a marked discrepancy between clinical appearance and fluid status. Of the 4 different methods, assuming BCM “gold standard”, there were major disagreements and discrepancies between the other three methodologies. BCM is a valuable and simple bed-side tool for the correct management of BP and risk stratification in HD patients as it allows for excellent discriminators of more abnormal cardiac and vascular profiles.
Literature
1.
go back to reference Gusbeth-Tatomir P, Covic A (2007) Causes and consequences of increased arterial stiffness in chronic kidney disease patients. Kidney Blood Press Res. 30:97–107CrossRefPubMed Gusbeth-Tatomir P, Covic A (2007) Causes and consequences of increased arterial stiffness in chronic kidney disease patients. Kidney Blood Press Res. 30:97–107CrossRefPubMed
2.
go back to reference Tonelli M, Wiebe N, Culleton B et al (2006) Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 17:2034–2047CrossRefPubMed Tonelli M, Wiebe N, Culleton B et al (2006) Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 17:2034–2047CrossRefPubMed
3.
go back to reference Surekha M, Sridevi D, Ishwarlal J (2002) Accelerated atherosclerosis, dyslipidemia, and oxidative stress in end-stage renal disease. Curr Opin Nephrol Hypertens 11:141–147CrossRef Surekha M, Sridevi D, Ishwarlal J (2002) Accelerated atherosclerosis, dyslipidemia, and oxidative stress in end-stage renal disease. Curr Opin Nephrol Hypertens 11:141–147CrossRef
4.
go back to reference Goodman WG, London G, Amann K et al (2004) Vascular calcification in chronic kidney disease. Am J Kidney Dis 43:572–579CrossRefPubMed Goodman WG, London G, Amann K et al (2004) Vascular calcification in chronic kidney disease. Am J Kidney Dis 43:572–579CrossRefPubMed
5.
go back to reference Kuhlmann MK, Zhu F, Seibert E, Levin NW (2005) Bioimpedance, dry weight and blood pressure control: new methods and consequences. Curr Opin Nephrol Hypertens 14:543–549CrossRefPubMed Kuhlmann MK, Zhu F, Seibert E, Levin NW (2005) Bioimpedance, dry weight and blood pressure control: new methods and consequences. Curr Opin Nephrol Hypertens 14:543–549CrossRefPubMed
6.
go back to reference Ozkahya M, Ok E, Toz H et al (2006) Long-term survival rates in haemodialysis patients treated with strict volume control. Nephrol Dial Transplant 21:3506–3513CrossRefPubMed Ozkahya M, Ok E, Toz H et al (2006) Long-term survival rates in haemodialysis patients treated with strict volume control. Nephrol Dial Transplant 21:3506–3513CrossRefPubMed
7.
go back to reference Agarwal R, Andersen MJ, Pratt HJ (2008) On the importance of pedal edema in hemodialysis patients. Clin J Am Soc Nephrol 3:153–158CrossRefPubMed Agarwal R, Andersen MJ, Pratt HJ (2008) On the importance of pedal edema in hemodialysis patients. Clin J Am Soc Nephrol 3:153–158CrossRefPubMed
8.
go back to reference Leunissen KM, Kouw P, Kooman JP et al (1993) New techniques to determine fluid status in hemodialyzed patients. Kidney Int 41:S50–S56 Leunissen KM, Kouw P, Kooman JP et al (1993) New techniques to determine fluid status in hemodialyzed patients. Kidney Int 41:S50–S56
9.
go back to reference Aurigemma GP, Gaasch WH (2004) Clinical practice. Diastolic heart failure. N Engl J Med 351:1097–1105CrossRefPubMed Aurigemma GP, Gaasch WH (2004) Clinical practice. Diastolic heart failure. N Engl J Med 351:1097–1105CrossRefPubMed
10.
go back to reference Bargnoux AS, Klouche K, Fareh J et al (2008) Prohormone brain natriuretic peptide (proBNP), BNP and N-terminal-proBNP circulating levels in chronic hemodialysis patients. Correlation with ventricular function, fluid removal and effect of hemodiafiltration. Clin Chem Lab Med 46:1019–1024CrossRefPubMed Bargnoux AS, Klouche K, Fareh J et al (2008) Prohormone brain natriuretic peptide (proBNP), BNP and N-terminal-proBNP circulating levels in chronic hemodialysis patients. Correlation with ventricular function, fluid removal and effect of hemodiafiltration. Clin Chem Lab Med 46:1019–1024CrossRefPubMed
11.
go back to reference Kotanko P, Levin NW, Zhu F (2008) Current state of bioimpedance technologies in dialysis. Nephrol Dial Transplant 23:808–812CrossRefPubMed Kotanko P, Levin NW, Zhu F (2008) Current state of bioimpedance technologies in dialysis. Nephrol Dial Transplant 23:808–812CrossRefPubMed
12.
go back to reference Chamney PW, Wabel P, Moissl UM et al (2007) A whole-body model to distinguish excess fluid from the hydration of major body tissues. Am J Clin Nutr 85:80–89PubMed Chamney PW, Wabel P, Moissl UM et al (2007) A whole-body model to distinguish excess fluid from the hydration of major body tissues. Am J Clin Nutr 85:80–89PubMed
13.
go back to reference Moissl UM, Wabel P, Chamney PW et al (2006) Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas 27:921–933CrossRefPubMed Moissl UM, Wabel P, Chamney PW et al (2006) Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas 27:921–933CrossRefPubMed
14.
go back to reference Passauer J, Miller H, Schleser A et al (2007) Evaluation of clinical dry weight assessment in haemodialysis patients by bioimpedance-spectroscopy. J Am Soc Nephrol 18A:256 Passauer J, Miller H, Schleser A et al (2007) Evaluation of clinical dry weight assessment in haemodialysis patients by bioimpedance-spectroscopy. J Am Soc Nephrol 18A:256
15.
go back to reference Wizemann V, Wabel P, Chamney C et al (2009) The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant 24:1574–1579CrossRefPubMed Wizemann V, Wabel P, Chamney C et al (2009) The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant 24:1574–1579CrossRefPubMed
16.
go back to reference Wabel P, Moissl U, Chamney C et al (2008) Towards improved cardiovascular management: the necessity of combining blood pressure and fluid overload. Nephrol Dial Transplant 23:2965–2971CrossRefPubMed Wabel P, Moissl U, Chamney C et al (2008) Towards improved cardiovascular management: the necessity of combining blood pressure and fluid overload. Nephrol Dial Transplant 23:2965–2971CrossRefPubMed
17.
go back to reference Devolder I, Verleysen A, Vijt D, Vanholder R, Van Biesen B (2010) Body composition, hydration and related parameters in hemodialysis versus peritoneal dialysis patients. Perit Dial Int (in press) Devolder I, Verleysen A, Vijt D, Vanholder R, Van Biesen B (2010) Body composition, hydration and related parameters in hemodialysis versus peritoneal dialysis patients. Perit Dial Int (in press)
18.
go back to reference Essig M, Escoubet B, de Zuttere D et al (2008) Cardiovascular remodeling and extracellular fluid excess in early stages of chronic kidney disease. Nephrol Dial Transplant 23:239–248CrossRefPubMed Essig M, Escoubet B, de Zuttere D et al (2008) Cardiovascular remodeling and extracellular fluid excess in early stages of chronic kidney disease. Nephrol Dial Transplant 23:239–248CrossRefPubMed
19.
20.
go back to reference Moissl UM, Wabel P, Chamney PW et al (2006) Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas 27:921–933CrossRefPubMed Moissl UM, Wabel P, Chamney PW et al (2006) Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas 27:921–933CrossRefPubMed
21.
go back to reference Wabel P, Chamney P, Moissl U (2007) Reproducibility of bioimpedance spectroscopy for the assessment of body composition and dry weight. J Am Soc Nephrol 18:A255CrossRef Wabel P, Chamney P, Moissl U (2007) Reproducibility of bioimpedance spectroscopy for the assessment of body composition and dry weight. J Am Soc Nephrol 18:A255CrossRef
22.
go back to reference Daugirdas JT (1993) Second generation logarithmic estimates of single-pool variable volume Kt/V: an analysis of error. J Am Soc Nephrol 4:1205–1213PubMed Daugirdas JT (1993) Second generation logarithmic estimates of single-pool variable volume Kt/V: an analysis of error. J Am Soc Nephrol 4:1205–1213PubMed
23.
go back to reference Brennan JM, Ronan A, Goonewardena S et al (2006) Handcarried ultrasound measurement of the inferior vena cava for assessment of intravascular volume status in the outpatient hemodialysis clinic. Clin J Am Soc Nephrol 1:749–753CrossRefPubMed Brennan JM, Ronan A, Goonewardena S et al (2006) Handcarried ultrasound measurement of the inferior vena cava for assessment of intravascular volume status in the outpatient hemodialysis clinic. Clin J Am Soc Nephrol 1:749–753CrossRefPubMed
24.
go back to reference Prontera C, Emdin M, Zucchelli GC, Ripoli A, Passino C, Clerico A (2003) Natriuretic peptides (NPs): automated electrochemiluminescent immunoassay for N-terminal pro-BNP compared with IRMAs for ANP and BNP in heart failure patients and healthy individuals. Clin Chem 49:1552–1554CrossRefPubMed Prontera C, Emdin M, Zucchelli GC, Ripoli A, Passino C, Clerico A (2003) Natriuretic peptides (NPs): automated electrochemiluminescent immunoassay for N-terminal pro-BNP compared with IRMAs for ANP and BNP in heart failure patients and healthy individuals. Clin Chem 49:1552–1554CrossRefPubMed
25.
go back to reference Charra B, Laurent G, Chazot C et al (1996) Clinical assessment of dry weight. Nephrol Dial Transplant 11(Suppl 2):16–19PubMed Charra B, Laurent G, Chazot C et al (1996) Clinical assessment of dry weight. Nephrol Dial Transplant 11(Suppl 2):16–19PubMed
26.
go back to reference Sommerer C, Beimler J, Schwenger V et al (2007) Cardiac biomarkers and survival in haemodialysis patients. Eur J Clin Invest 37:350–356CrossRefPubMed Sommerer C, Beimler J, Schwenger V et al (2007) Cardiac biomarkers and survival in haemodialysis patients. Eur J Clin Invest 37:350–356CrossRefPubMed
27.
go back to reference Machek P, Jirka T, Moissl U, Chamney P, Wabel P (2010) Guided optimization of fluid status in haemodialysis patients. Nephrol Dial Transplant 25:538–544CrossRefPubMed Machek P, Jirka T, Moissl U, Chamney P, Wabel P (2010) Guided optimization of fluid status in haemodialysis patients. Nephrol Dial Transplant 25:538–544CrossRefPubMed
28.
go back to reference Goldsmith D, Covic A (2009) Blood pressure control in CKD stage 5D patients–are we more or less certain what to do in 2009? Nephrol Dial Transplant 14:3597–3601CrossRef Goldsmith D, Covic A (2009) Blood pressure control in CKD stage 5D patients–are we more or less certain what to do in 2009? Nephrol Dial Transplant 14:3597–3601CrossRef
29.
30.
go back to reference Leypoldt JK, Cheung AK, Delmez JA (2002) Relationship between volume status and blood pressure during chronic hemodialysis. Kidney Int 61:266–275CrossRefPubMed Leypoldt JK, Cheung AK, Delmez JA (2002) Relationship between volume status and blood pressure during chronic hemodialysis. Kidney Int 61:266–275CrossRefPubMed
31.
go back to reference Bos W, Bruin S, wan Olden RW et al (2000) Cardiac and hemodynamic effects of hemodialysis and ultrafiltration. Am J Kidney Dis 35:819–826CrossRefPubMed Bos W, Bruin S, wan Olden RW et al (2000) Cardiac and hemodynamic effects of hemodialysis and ultrafiltration. Am J Kidney Dis 35:819–826CrossRefPubMed
32.
go back to reference Agarwal R (2005) Hypertension in chronic kidney disease and dialysis: pathophysiology and management. Cardiol Clinics 23:237–248CrossRef Agarwal R (2005) Hypertension in chronic kidney disease and dialysis: pathophysiology and management. Cardiol Clinics 23:237–248CrossRef
33.
go back to reference Li Z, Lacson E, Lowrie EG et al (2006) The epidemiology of systolic blood pressure and death risk in hemodialysis patients. Am J Kidney Dis 48:606–615CrossRefPubMed Li Z, Lacson E, Lowrie EG et al (2006) The epidemiology of systolic blood pressure and death risk in hemodialysis patients. Am J Kidney Dis 48:606–615CrossRefPubMed
34.
go back to reference D’Amico G, Locatelli F (2002) Hypertension in dialysis: pathophysiology and treatment. J Nephrol 15:438–445PubMed D’Amico G, Locatelli F (2002) Hypertension in dialysis: pathophysiology and treatment. J Nephrol 15:438–445PubMed
Metadata
Title
The relationship between chronic volume overload and elevated blood pressure in hemodialysis patients: use of bioimpedance provides a different perspective from echocardiography and biomarker methodologies
Authors
Luminita Voroneanu
Claudiu Cusai
Simona Hogas
Serban Ardeleanu
Mihai Onofriescu
Ionut Nistor
Octavian Prisada
Radu Sascau
David Goldsmith
Adrian Covic
Publication date
01-09-2010
Publisher
Springer Netherlands
Published in
International Urology and Nephrology / Issue 3/2010
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI
https://doi.org/10.1007/s11255-010-9767-y

Other articles of this Issue 3/2010

International Urology and Nephrology 3/2010 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.