title: Optimal fluid control can normalize cardiovascular risk markers and limit left ventricular hypertrophy in thrice weekly dialysis patients.
abstract: Increased hemodialysis frequency can make fluid overload easier to treat, although most patients are still treated thrice weekly. Chronic fluid overload is associated with left ventricular hypertrophy and elevated serum cardiac biomarkers, recognized as mortality risk factors. Serum cardiac troponin T (cTnT), N-terminal prohormone brain natriuretic peptide (NT-proBNP), left ventricular mass index by cardiac magnetic imaging, and ambulatory blood pressure was measured in 30 thrice weekly hemodiafiltration patients. Time-averaged fluid overload (TAFO) was quantified by bioimpedance spectroscopy. In the study group, left ventricular hypertrophy was found to be 26% by cardiac magnetic resonance. Ambulatory blood pressure was 130 mmHg (112-151) requiring a low equivalent dose of medication of 0.25 units (0-1). Significantly, lower levels of left ventricular mass index (P < 0.05) were associated in those patients with TAFO <1 L or NT-proBNP <1200 pg/mL or cTnT <0.1 ug/L. In the subgroups, 16 patients had normal cTnT (<0.03 ug/L), 16 patients had NT-proBNP <400 pg/mL, and 20 patients had TAFO <1 L. Nine patients had both cTnT <0.03 ug/L and NT-proBNP <400 pg/mL. Normally hydrated thrice-weekly hemodiafiltration patients can have cardiac biomarker and TAFO levels indistinguishable from the normal healthy population. Obtaining TAFO by bioimpedance monitoring can offer a practical alternative to serum cardiac biomarkers.
authors.affiliation: John Stevenson Lynch Renal Unit, NHS Ayrshire & Arran, Kilmarnock, UK.
authors.forename: Nestor
authors.initials: N
authors.lastname: Velasco
authors.forename: Paul
authors.initials: P
authors.lastname: Chamney
authors.forename: Peter
authors.initials: P
authors.lastname: Wabel
authors.forename: Ulrich
authors.initials: U
authors.lastname: Moissl
authors.forename: Toufeeq
authors.initials: T
authors.lastname: Imtiaz
authors.forename: Elaine
authors.initials: E
authors.lastname: Spalding
authors.forename: Mark
authors.initials: M
authors.lastname: McGregor
authors.forename: Andrew
authors.initials: A
authors.lastname: Innes
authors.forename: Ian
authors.initials: I
authors.lastname: MacKay
authors.forename: Rajan
authors.initials: R
authors.lastname: Patel
authors.forename: Alan
authors.initials: A
authors.lastname: Jardine
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001826:Body Fluids / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000150:complications; D003430:Cross-Sectional Studies; D058266:Dielectric Spectroscopy / Q000379:methods; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood* / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012307:Risk Factors; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D014336:Troponin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain