title: Fluid volume expansion and depletion in hemodialysis patients lack association with clinical parameters.
abstract: BACKGROUND
  Achievement of normal volume status is crucial in hemodialysis (HD), since both volume expansion and volume contraction have been associated with adverse outcome and events.
  
  
  OBJECTIVE
  The objectives of this study are to assess the prevalence of fluid volume expansion and depletion and to identify the best clinical parameter or set of parameters that can predict fluid volume expansion in HD patients.
  
  
  METHODS
  This study is cross-sectional.
  
  
  METHODS
  This study was conducted in three hemodialysis units.
  
  
  METHODS
  In this study, there are 194 HD patients.
  
  
  METHODS
  Volume status was assessed by multifrequency bio-impedance spectroscopy (The Body Composition Monitor, Fresenius) prior to the mid-week HD session.
  
  
  RESULTS
  Of all patients, 48 % (n = 94) were volume-expanded and 9 % of patients were volume-depleted (n = 17). Interdialytic weight gain was not different between hypovolemic, normovolemic, and hypervolemic patients. Fifty percent of the volume-expanded patients were hypertensive. Paradoxical hypertension was very common (31 % of all patients); its incidence was not different between patient groups. Intradialytic hypotension was relatively common and was more frequent among hypovolemic patients. Multivariate regression analysis identified only four predictors for volume expansion (edema, lower BMI, higher SBP, and smoking). None of these parameters displayed both a good sensitivity and specificity.
  
  
  CONCLUSIONS
  The volume assessment was performed once.
  
  
  CONCLUSIONS
  The study indicates that volume expansion is highly prevalent in HD population and could not be identified using clinical parameters alone. No clinical parameters were identified that could reliably predict volume status. This study shows that bio-impedance can assist to determine volume status. Volume status, in turn, is not related to intradialytic weight gain and is unable to explain the high incidence of paradoxical hypertension.
authors.affiliation: Department of Medicine, Division of Nephrology, University of Alberta, 11-107 CSB, Edmonton, AB T6G 2G3 Canada.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Kalainy
authors.affiliation: Department of Medicine, Division of Nephrology, University of Alberta, 11-107 CSB, Edmonton, AB T6G 2G3 Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Reid
authors.affiliation: Department of Medicine, Division of Nephrology, University of Alberta, 11-107 CSB, Edmonton, AB T6G 2G3 Canada.
authors.forename: Kailash
authors.initials: K
authors.lastname: Jindal
authors.affiliation: Department of Medicine, Division of Nephrology, University of Alberta, 11-107 CSB, Edmonton, AB T6G 2G3 Canada.
authors.forename: Neesh
authors.initials: N
authors.lastname: Pannu
authors.affiliation: Department of Medicine, Division of Nephrology, University of Alberta, 11-107 CSB, Edmonton, AB T6G 2G3 Canada ; Department Physiology, University of Alberta, Edmonton, Canada.
authors.forename: Branko
authors.initials: B
authors.lastname: Braam
keywords: Bio-impedance; Extracellular fluid volume; Hemodialysis; Hypertension