An evaluation of blood volume changes during ultrafiltration pulses and natriuretic peptides in the assessment of dry weight in hemodialysis patients.
Changes in blood volume (BV) during dialysis as well as plasma levels of brain natriuretic peptide (BNP) and N-terminal (NT) pro-BNP levels are possible tools to assess dry weight in hemodialysis (HD) patients. The aim of the study was to compare these parameters with other non-invasive techniques used to assess dry weight in HD patients, and to study their relation with intradialytic hypotension (IDH) and the presence of cardiovascular disease BV changes during HD, both during regular dialysis and during an ultrafiltration pulse, plasma levels of NT pro-BNP and BNP, and vena cava diameter index (VCDI) were assessed in a cohort of 66 HD patients, which was subdivided according to tertiles of total body water (TBW) corrected for body weight, assessed by bioimpedance analysis. Parameters were also related to the presence of IDH and history of cardiovascular disease. The decline in BV during regular dialysis and during an ultrafiltration pulse, as well as VCDI and BNP were significantly different between the tertiles of normalized TBW, but refill after the ultrafiltration pulse and NT pro-BNP were not. Only VCDI and the decline in BV during regular dialysis were significantly different between patients with or without IDH. Vena cava diameter index, BNP, and NT pro-BNP were significantly higher in patients with cardiovascular disease. Using bioimpedance as the reference method, changes in BV, either during regular dialysis or during an ultrafiltration pulse, as well as VCDI and BNP are all indicative of hydration state in dialysis patients, but refill after an ultrafiltration pulse is not. Only VCDI and BV changes were related to IDH. The presence of cardiovascular disease appears to influence both VCDI as well as BNP.
van de Pol
Anouk C M
AC
Atrium Hospital Medical Centre, Gelderse vallei Hospital, Ede, The Netherlands.
Frenken
Leon A
LA
Moret
Karin
K
Baumgarten
Ruben
R
van der Sande
Frank M
FM
Beerenhout
Charles M
CM
Kooman
Jeroen P
JP
Leunissen
Karel M
KM
D001810:Blood Volume; D001834:Body Water; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000097:blood; D015331:Cohort Studies; D017583:Hemodiafiltration; D006801:Humans; D007022:Hypotension / Q000209:etiology; D045265:Natriuretic Peptides / Q000097:blood*; D014684:Venae Cavae
D045265:Natriuretic Peptides