title: Clinical judgment is the most important element in overhydration assessment of chronic hemodialysis patients.
abstract: BACKGROUND
  The assessment of hydration status remains a challenging task in hemodialysis (HD) management. There are only limited data available on the relevance of clinical decisions in the estimation of dialysis overhydration (OH). The objective of this study was to examine the significance of clinical judgment in the assessment of pre-dialysis OH.
  
  
  METHODS
  We compared the performance of three methods of OH assessment: (1) clinical judgment guided by a single clinical examination with (2) multifrequency bioimpedance analysis (BIA) and (3) complex systematic clinical approach. We additionally studied the associations of these methods with selected laboratory and imaging parameters.
  
  
  RESULTS
  Any of the single parameters alone reached a sufficient level of accuracy for reliable prediction of OH. Clinical judgment was the single most important factor in OH estimation, and also had the highest contribution when in combination with other parameters. BIA reliably measured extracellular fluid, but the automatically calculated OHBIA exhibited a substantial degree of inaccuracy that precludes the use of BIA as a standard at present. The combination of clinical judgment with additional clinical parameters had the highest prediction accuracy for OH. Among the parameters studied, vena cava collapsibility index and calf circumference showed the strongest association with OH. Echocardiography, cardiothoracic index, atrial natriuretic peptide levels and spirometry did not have acceptable sensitivity.
  
  
  CONCLUSIONS
  The systematic clinical approach combining physician and patient inputs, laboratory and imaging data enables an individualized decision and a superior accuracy in OH assessment.
authors.affiliation: Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany. vaskorad@gmail.com
authors.forename: Radovan
authors.initials: R
authors.lastname: Vasko
authors.forename: Gerhard A
authors.initials: GA
authors.lastname: Müller
authors.forename: Brian B
authors.initials: BB
authors.lastname: Ratliff
authors.forename: Klaus
authors.initials: K
authors.lastname: Jung
authors.forename: Sarah
authors.initials: S
authors.lastname: Gauczinski
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Koziolek
mesh_terms: D000368:Aged; D001834:Body Water; D017097:Electric Impedance; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000175:diagnosis*; D007600:Judgment; D007676:Kidney Failure, Chronic / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D014869:Water Intoxication / Q000175:diagnosis*