Pneumatic Compression, But Not Exercise, Can Avoid Intradialytic Hypotension: A Randomized Trial

2017 ◽  
Vol 45 (5) ◽  
pp. 409-416 ◽  
Author(s):  
Valeria R.C. Álvares ◽  
Camila D. Ramos ◽  
Benedito J. Pereira ◽  
Ana Lucia Pinto ◽  
Rosa M.A. Moysés ◽  
...  
Keyword(s):  
Blood Pressure Measurement ◽  
Extracellular Fluid ◽  
Bioelectrical Impedance ◽  
Phosphate Removal ◽  
Crossover Fashion ◽  
Intradialytic Hypotension ◽  
Ultrafiltration Rate ◽  
Induced Hypotension ◽  
Conventional Hemodialysis ◽  
Fluid Parameters

Background: Conventional hemodialysis (HD) is associated with dialysis-induced hypotension (DIH) and ineffective phosphate removal. As the main source of extracellular fluid removed during HD are the legs, we sought to reduce DIH and increase phosphate removal by using cycling and pneumatic compression, which would potentially provide higher venous return, preserving central blood flow and also offering more phosphate to the dialyzer. Methods: We evaluated 21 patients in a randomized crossover fashion in which each patient underwent 3 different HD: control; cycling exercise during the first 60 min; and pneumatic compression during the first 60 min. Data obtained included bioelectrical impedance, hourly blood pressure measurement, biochemical parameters, and direct quantification of phosphate through the dialysate. DIH was defined as a drop in mean arterial pressure (MAP) ≥20 mm Hg. Results: There was no difference in the ultrafiltration rate (p = 0.628), delta weight (p = 0.415), delta of total, intra and extracellular body water among the control, cycling, and pneumatic compression (p = 0.209, p = 0.348, and p = 0.467 respectively). Delta MAP was less changed by pneumatic compression when compared to control, cycling, and pneumatic compression respectively (-4.7 [-17.2, 8.2], -4.7 [-20.5, -0.2], and -2.3 [-8.1, 9.0] mm Hg; p = 0.021). DIH occurred in 43, 38, and 24% of patients in control, cycling, and pneumatic compression respectively (p = 0.014). Phosphate removal did not increase in any intervention (p = 0.486). Higher phosphate removal was dependent on ultrafiltration, pre dialysis serum phosphate, and higher parathyroid hormone. Conclusion: Pneumatic compression during the first hour of dialysis was associated with less DIH, albeit there was no effect on fluid parameters. Neither exercise nor pneumatic compression increased phosphate removal.

scholarly journals The body water compartments in women with preeclampsia in the peripartum period

2021 ◽  
Vol 17 (7) ◽  
pp. 20-23
Author(s):  
O.M. Klygunenko ◽  
O.О. Marzan
Keyword(s):  
Pregnant Women ◽  
Extracellular Fluid ◽  
Subsequent Development ◽  
Bioelectrical Impedance ◽  
Body Water ◽  
Fluid Volume ◽  
The Body ◽  
Severe Preeclampsia ◽  
Water Compartments ◽  
Total Fluid

Background. Preeclampsia in pregnant women is a threatening condition that causes significant water imbalance, particularly hyperhydration of the extracellular fluid compartment. The condition is the result of the main pathogenetic processes — endothelial dysfunction and the subsequent development of hypoproteinemia. The changes can be detected by measuring body water compartments. Objective: to investigate the effect of a standard intensive care on the body water compartment indicators in women with moderate to severe preeclampsia. Materials and methods. Ninety patients divided into three groups were examined: non-pregnant healthy women, pregnant women with healthy pregnancy, and women whose pregnancy was complicated by moderate to severe preeclampsia. Body water compartments were measured by non-invasive bioelectrical impedance analysis. Results. Pregnancy complicated by preeclampsia is accompanied by an increase in total fluid volume at 34–40 weeks due to an increase in both the extracellular and intracellular water compartments, but with a predominance of the extracellular compartment. By the 7th day of the postpartum period, there is a tendency to decrease the total fluid volume, however, interstitial and intracellular edema can be still observed. Conclusions. The results of the bioelectrical impe-dance analysis of the body water compartments show that additional methods of treatment are needed to correct the body water compartments in women with preeclampsia.

Intradialytic Hypotension as an Independent Risk Factor for Long-Term Mortality in Maintaining Hemodialysis Patients: A 5-Year Follow-Up Cohort Study

2018 ◽  
Vol 45 (4) ◽  
pp. 320-326 ◽  
Author(s):  
Jinbo Yu ◽  
Zhonghua Liu ◽  
Bo Shen ◽  
Jie Teng ◽  
Jianzhou Zou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Mortality Rate ◽  
Independent Risk Factor ◽  
Left Ventricular ◽  
Intradialytic Hypotension ◽  
Ultrafiltration Rate ◽  
Long Term Mortality

Aims: This study aimed to assess risk factors of intradialytic hypotension (IDH) and the association of prognosis and IDH among maintenance hemodialysis (MHD) patients. Methods: Among 293 patients, 117 were identified with IDH (more than 4 hypotensive events during 3 months). The association between IDH and survival was evaluated. Results: The incidence of IDH was 39.9%. Age, ultrafiltration rate, N-terminal pro-B-type natriuretic peptide (NT-proBNP), albumin, β2-microglobulin (β2MG), and aortic root inside diameter (AoRD) were independently associated with IDH. During the 5-year follow-up, 84 patients died with a mortality rate 5.2 per 100 person-year. IDH-prone patients had a higher all-cause mortality rate. IDH and left ventricular mass index were independent risk factors for death (HR 1.655, 95% CI 1.061–2.580; HR 1.008, 95% CI 1.001–1.016). Conclusion: IDH is an independent risk factor for long-term mortality in MHD patients. Patients with older age, high ultrafiltration rate, high level of serum NT-proBNP and β2MG, hypoalbuminemia, and shorter AoRD are at high risk of IDH.

Phosphate removal model: An observational study of low-flux dialyzers in conventional hemodialysis therapy

2012 ◽  
Vol 16 (3) ◽  
pp. 363-376 ◽  
Author(s):  
Mengjing Wang ◽  
Haiming Li ◽  
Huimin Liao ◽  
Yongfu Yu ◽  
Li You ◽  
...  
Keyword(s):  
Observational Study ◽  
Phosphate Removal ◽  
Removal Model ◽  
Conventional Hemodialysis

OS 19-09 Bioelectrical impedance phase angle as intradialytic hypotension predictor

2016 ◽  
Vol 34 (Supplement 1) ◽  
pp. e231
Author(s):  
Vaidas Vicka ◽  
Laurynas Rimsevicius ◽  
Alvita Gincaite ◽  
Diana Sukackiene ◽  
Marius Miglinas
Keyword(s):  
Phase Angle ◽  
Bioelectrical Impedance ◽  
Intradialytic Hypotension

scholarly journals Comparison of Body Composition Assessment Methods in Patients with Human Immunodeficiency Virus-Associated Wasting Receiving Growth Hormone

2006 ◽  
Vol 91 (8) ◽  
pp. 2952-2959 ◽  
Author(s):  
John G. Esposito ◽  
Scott G. Thomas ◽  
Lori Kingdon ◽  
Shereen Ezzat
Keyword(s):  
Body Composition ◽  
Bioelectrical Impedance ◽  
Community Dwelling ◽  
Fat Free Mass ◽  
Daily Injection ◽  
Crossover Fashion ◽  
Treatment Change ◽  
Body Composition Assessment ◽  
Before And After ◽  
Rhgh Treatment

Abstract Context: Bioelectrical impedance spectroscopy (BIS) and skinfold anthropometry (SKF) have been used to monitor body composition among patients with HIV wasting; however, validation of these techniques during recombinant human GH (rhGH) treatment has not been performed. Objective: Our objective was to evaluate the degree of agreement between criterion measurements of dual-energy x-ray absorptiometry (DXA) and those of BIS and SKF in patients with HIV wasting treated with rhGH. Design and Setting: We conducted a randomized, double-blinded, placebo-controlled, two-period crossover trial at the University of Toronto and Mount Sinai Hospital (Toronto, Canada). Patients: A referred sample of 27 community-dwelling men with HIV-associated weight loss (≥10% over preceding 12 months) despite optimal antiretroviral therapy participated in the study. Intervention: Intervention was one daily injection of rhGH (6 mg) or placebo self-administered for 3 months in a crossover fashion with a 3-month washout. Main Outcome Measures: Fat-free mass (FFM) and fat mass (FM) were measured by BIS, SKF, and DXA before and after rhGH and placebo treatment. Results: FFMBIS was not significantly different from FFMDXA after rhGH treatment (P = 0.10). Mean differences (bias ± sd) according to Bland-Altman analysis were smaller for SKF than for BIS (P < 0.05) at all time points, yet treatment-induced change in FM was better detected with BIS than with SKF. BIS estimates of FFM and FM showed better agreement with those of DXA after rhGH treatment (1.6 ± 4.6 kg and −2.1 ± 3.9 kg) compared with baseline (3.8 ± 3.5 kg and −4.1 ± 3.6 kg) and placebo (2.7 ± 4.4 kg and −3.1 ± 4.6) (P < 0.05). BIS overestimated and SKF underestimated the treatment-induced changes in FFM and FM. Conclusions: SKF was more accurate than BIS when measuring body composition in patients with HIV wasting before and after rhGH treatment; nonetheless, the accuracy of BIS increased after treatment. Change in FM because of treatment was not accurately assessed with SKF.

scholarly journals Characteristics of Intracellular and Extracellular Fluid Ratio for the Varying Body Impedances in Fixed Total Body Fluid

2017 ◽  
Author(s):  
JungHun Choi
Keyword(s):  
Human Body ◽  
High Frequency ◽  
Body Fluid ◽  
Extracellular Fluid ◽  
Bioelectrical Impedance ◽  
The Body ◽  
Horizontal Axis ◽  
Fluid Status ◽  
Total Body ◽  
Frequency Current

A bioelectrical impedance analysis is a proven method to measure body composition in clinical situations. It uses the relation between the body fluid and the impedances in a variety of frequencies. A body model can be simplified as a parallel combination of a capacitor and two resistors which represent a cell membrane, Intracellular Fluid (ICF), and Extracellular Fluid (ECF). Low frequency current passes through ECF and high frequency current also passes through ICF in a body. A Cole-Cole plot is a graphical interpretation of the path of impedances and each axis represents resistance and reactance with variable frequencies. A high value of resistance in a horizontal axis is a resistance value of ECF and a low value of resistance at a high frequency presents ICF. Interpolation technique is needed to find out the exact cross-point between impedance values and the horizontal axis. The two estimated impedance values are used to derive Total Body Water (TBW), ICF, ECF, Fat Free Mass (FFM), and Fat Mass (FM) from various published equations [1]. Minimizing the possible error of fluid volume assessment and accurate prediction of fluid status in a human body is essential for appropriate therapy. Different techniques of fluid status assessment in a human body can be applicable, such as physical examination, orthostatic vital signs, blood volume measurement, acoustic cardiograph, chest radiography, and thoracic ultrasonography [2]. In this study, a bioelectrical impedance spectroscopy device and simple body models were used to collect data such as TBW, ICF, ECF, FM, and FFM. The ratio between ICF and ECF was investigated for the same values of TBW, FM, and FFM by varying impedance values.

scholarly journals High ultrafiltration rate induced intradialytic hypotension is a predictor for cardiac remodeling: a 5-year cohort study

Renal Failure ◽  
2020 ◽  
Vol 43 (1) ◽  
pp. 40-48
Author(s):  
Jinbo Yu ◽  
Xiaohong Chen ◽  
Yang Li ◽  
Yaqiong Wang ◽  
Zhonghua Liu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiac Remodeling ◽  
Intradialytic Hypotension ◽  
Ultrafiltration Rate
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