title: Comparison of multiple fluid status assessment methods in patients on chronic hemodialysis.
abstract: OBJECTIVE
  Control of hydration status is an important constituent of adequate and efficient hemodialysis (HD) treatment. Nevertheless, there are no precise clinical indices for early recognition of small changes in fluid status of patients undergoing chronic hemodialysis therapy. This study aimed to evaluate and compare the widely used and reliable method of indexed inferior vena cava diameter (IVCDi) with established and more recently available techniques (bioelectrical impedance analysis [BIA], continuous blood volume monitoring [Crit-line], and the B-line score [BLS] with lung ultrasonography) for estimating the hydration status of patients on HD.
  
  
  METHODS
  Fifty-three patients undergoing chronic HD thrice weekly were included in the study. Evaluation of hydration status methods (IVCDi, BLS, BIA, and Crit-line) was performed thrice weekly before and after HD. Receiver operating characteristic curve analysis was performed to evaluate the discriminative power of (methods) the BLS, BIA, and Crit-line for predicting over- and underhydration of patients, as determined by the reference method, IVCDi.
  
  
  RESULTS
  BLS showed the most promising results in predicting overhydration, as determined by IVCDi, compared with BIA and Crit-line and presented a sensitivity of 77% and specificity of 74%. The accuracy of the BLS was higher than that of BIA (0.81 vs. 0.71, p = 0.032) and Crit-line (0.61, p = 0.001). BLS also showed more promising results in predicting underhydration, as determined by IVCDi, than BIA and Crit-line and presented a sensitivity of 78% and a specificity of 73%. The accuracy of the BLS was higher than that of BIA (0.83 vs. 0.76, p = 0.035) and Crit-line (0.50, p < 0.001).
  
  
  CONCLUSIONS
  The BLS is a useful and easily performed technique that has recently become available for accurate evaluation of dry weight and fluid status in patients with end-stage renal disease undergoing chronic HD. This method might help recognize asymptomatic lung congestion in these patients.
authors.affiliation: Department of Nephrology, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupoli, Greece.
authors.forename: Giannis
authors.initials: G
authors.lastname: Alexiadis
authors.affiliation: Department of Nephrology, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupoli, Greece. spanagou@med.duth.gr.
authors.forename: Stelios
authors.initials: S
authors.lastname: Panagoutsos
authors.affiliation: Department of Nephrology, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupoli, Greece.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Roumeliotis
authors.affiliation: Department of Nephrology, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupoli, Greece.
authors.forename: Ilias
authors.initials: I
authors.lastname: Stibiris
authors.affiliation: Department of Nephrology, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupoli, Greece.
authors.forename: Angelos
authors.initials: A
authors.lastname: Markos
authors.affiliation: Department of Nephrology, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupoli, Greece.
authors.forename: Konstantia
authors.initials: K
authors.lastname: Kantartzi
authors.affiliation: Department of Nephrology, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupoli, Greece.
authors.forename: Ploumis
authors.initials: P
authors.lastname: Passadakis
mesh_terms: D000368:Aged; D001811:Blood Volume Determination; D001834:Body Water / Q000502:physiology*; D017097:Electric Impedance; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D006435:Renal Dialysis; D014463:Ultrasonography; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging; D014882:Water-Electrolyte Balance
keywords: Bioelectrical impedance analysis (BIA); Crit-line; Dry weight; Fluid assessment; Hemodialysis patient; Indexed inferior vena cava diameter (IVCDi); Ultrasound lung comets/B-line score (BLS)