13
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Fluid status evaluation by inferior vena cava diameter and bioimpedance spectroscopy in pediatric chronic hemodialysis

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Evaluation of patient’s dry weight remains challenging in chronic hemodialysis (HD) especially in children. Inferior Vena Cava (IVC) measurement was reported useful to assess fluid overload both in adults and children.

          Methods

          We performed a monocentric prospective study to evaluate the relation between predialytic IVC diameter measurements and hydration status evaluated by physicians and bioimpedance spectroscopy (BIS) and between IVC measurements and persistent hypertension.

          Results

          Forty-eight HD sessions in 16 patients were analyzed. According to physicians, patients were overhydrated in 84.5% of dialysis sessions, 20.8% according to BIS, and 0%, 4.1% and 20.8% according to IVC inspiratory, expiratory and collapsibility index reference curves respectively. There was no correlation between relative overhydration evaluated by BIS and IVC measurements z-scores ( p = 0.20). Patients whose blood pressure normalized after HD had a more dilated maximal IVC diameter before dialysis session than patients with persistent hypertension (median − 0.07SD [−0.8; 0.88] versus −1.61SD [−2.18; −0.74] ( p = 0.03)) with an optimal cut-off of −0.5 SD.

          Conclusions

          In our study, IVC measurement is not reliable to assess fluid overload in children on HD and was not correlated with extracellular fluid volume assessed by BIS measurements. However, IVC measurements might be of interest in differentiating volume-dependant hypertension from volume-independant hypertension.

          Electronic supplementary material

          The online version of this article (10.1186/s12882-017-0793-1) contains supplementary material, which is available to authorized users.

          Related collections

          Most cited references29

          • Record: found
          • Abstract: found
          • Article: not found

          Hemodialysis-induced cardiac injury: determinants and associated outcomes.

          Hemodialysis (HD)-induced myocardial stunning driven by ischemia is a recognized complication of HD, which can be ameliorated by HD techniques that improve hemodynamics. In nondialysis patients, repeated ischemia leads to chronic reduction in left ventricular (LV) function. HD may initiate and drive the same process. In this study, we examined the prevalence and associations of HD-induced repetitive myocardial injury and long-term effects on LV function and patient outcomes. Seventy prevalent HD patients were assessed for evidence of subclinical myocardial injury at baseline using serial echocardiography and followed up after 12 mo. Intradialytic blood pressure, hematologic and biochemical samples, and patient demographics were also collected at both time points. Sixty-four percent of patients had significant myocardial stunning during HD. Age, ultrafiltration volumes, intradialytic hypotension, and cardiac troponin-T (cTnT) levels were independent determinants associated with its presence. Myocardial stunning was associated with increased relative mortality at 12 mo (P = 0.019). Cox regression analysis showed increased hazard of death in patients with myocardial stunning and elevated cTnT than in patients with elevated cTnT alone (P < 0.02). Patients with myocardial stunning who survived 12 mo had significantly lower LV ejection fractions at rest and on HD (P < 0.001). HD-induced myocardial stunning is common, and may contribute to the development of heart failure and increased mortality in HD patients. Enhanced understanding of dialysis-induced cardiac injury may provide novel therapeutic targets to reduce currently excessive rates of cardiovascular morbidity and mortality.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Reappraisal of the use of inferior vena cava for estimating right atrial pressure.

            Estimation of right atrial pressure (RAP) using echocardiographic measurement of the inferior vena caval (IVC) size along with its respirophasic variation is commonly performed despite the paucity of data that critically evaluates this technique. In this study, we systematically evaluated echocardiographic imaging of the IVC for estimation of RAP in 102 patients undergoing right heart catheterization. This study established cut-off values using receiver operating characteristic analysis for 8 different IVC parameters and then prospectively tested these parameters for their ability to predict an elevated RAP. The IVC size cutoff with optimum predictive use for RAP above or below 10 mm Hg was 2.0 cm (sensitivity 73% and specificity 85%) and the optimal IVC collapsibility cutoff was 40% (sensitivity 73% and specificity 84%). Traditional classification of RAP into 5-mm Hg ranges based on IVC size and collapsibility performed poorly (43% accurate) and a new classification scheme is proposed.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study.

              To establish mortality rates, causes of death, and determinants of mortality in children with end-stage renal disease (ESRD), we performed a national long-term follow up study. Mortality rate was determined in all Dutch patients with onset of ESRD at ages 0 to 14 years in the period between 1972 and 1992. Causes of death and mortality determinants were investigated in all patients of this cohort who were born before 1979. Data were derived from the Dutch Registry for patients on renal replacement therapy (RRT), medical charts and National Health Database. Of all 381 patients 85 had died. The overall mortality rate (MR) was 1.57/100 patient-years, and the standardized mortality rate (SMR) was 31.0. The MR for patients 0 to 5 and 6 to 10 years old at onset of ESRD decreased from, respectively, 7.0 (range 0-14.9) to 3.9 (1.2-6.7) and 4.3 (1.1-7.5) to 1.6 (0.3-2.8) between the periods 1972-1981 and 1982-1992. The mortality hazard ratio of relatively long standing dialysis and of long standing hypertension were, respectively, 7.2 (4.4-11.8) and 3.1 (2.1-4.6), of cyclosporine-introduction in transplanted patients 0.3 (0.1-0.4). Overall cerebrovascular accidents (24%) and infections (21%) were the most common causes of death; after 10 years of RRT cardiac death (7/21) was most prevalent. Cardiovascular death was most prominent in dialysis as well as transplanted patients. Survival in children with ESRD has increased over the last 20 years, but the SMR remains high. Early transplantation and a more vigorous approach toward hypertension and infection may be mandatory in order to further reduce mortality.
                Bookmark

                Author and article information

                Contributors
                xtorterue@gmail.com
                d.laurene@yahoo.fr
                marie-alice.macher@aphp.fr
                olivier.niel@aphp.fr
                theresa.kwon@aphp.fr
                georges.deschenes@aphp.fr
                33140032442 , julien.hogan@hotmail.fr
                Journal
                BMC Nephrol
                BMC Nephrol
                BMC Nephrology
                BioMed Central (London )
                1471-2369
                28 December 2017
                28 December 2017
                2017
                : 18
                : 373
                Affiliations
                ISNI 0000 0004 1937 0589, GRID grid.413235.2, Department of Paediatric Nephrology and Hemodialysis, , Hôpital Robert Debré, APHP, ; 48 boulevard Sérurier 75019, 19 Paris Cedex, France
                Article
                793
                10.1186/s12882-017-0793-1
                5746009
                29282003
                df05415f-e5b4-4a77-9775-0727f5d32ed9
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 27 June 2017
                : 12 December 2017
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Nephrology
                inferior vena cava,bioimpedance,hemodialysis,blood pressure,children,dry weight
                Nephrology
                inferior vena cava, bioimpedance, hemodialysis, blood pressure, children, dry weight

                Comments

                Comment on this article