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Optimal fluid control can normalize cardiovascular risk markers and limit left ventricular hypertrophy in thrice

Nestor Velasco1, Paul Chamney, Peter Wabel

  • 1John Stevenson Lynch Renal Unit, NHS Ayrshire & Arran, Kilmarnock, UK.

Hemodialysis International. International Symposium on Home Hemodialysis
|April 21, 2012
PubMed

Insights

Maintaining normal fluid levels in thrice-weekly hemodiafiltration patients is key. Time-averaged fluid overload (TAFO) and cardiac biomarkers can be normal, suggesting bioimpedance monitoring as a practical alternative.

Area of Science:

  • Nephrology
  • Cardiology
  • Biomedical Engineering

Background:

  • Chronic fluid overload in hemodialysis patients is linked to left ventricular hypertrophy and elevated cardiac biomarkers, increasing mortality risk.
  • While increased dialysis frequency aids fluid management, many patients remain on thrice-weekly treatments.
  • Left ventricular hypertrophy (LVH) is a significant concern in chronic kidney disease patients undergoing hemodialysis.

Purpose of the Study:

  • To investigate the relationship between time-averaged fluid overload (TAFO), cardiac biomarkers (cTnT, NT-proBNP), and left ventricular mass index (LVMI) in thrice-weekly hemodiafiltration patients.
  • To assess if normally hydrated patients on thrice-weekly hemodiafiltration have cardiac biomarker and TAFO levels comparable to the general population.
  • To explore bioimpedance spectroscopy as a practical alternative to serum cardiac biomarkers for monitoring fluid status.

Main Methods:

  • Studied 30 patients undergoing thrice-weekly hemodiafiltration.
  • Measured serum cardiac troponin T (cTnT), N-terminal prohormone brain natriuretic peptide (NT-proBNP), left ventricular mass index (LVMI) via cardiac MRI, and ambulatory blood pressure.
  • Quantified time-averaged fluid overload (TAFO) using bioimpedance spectroscopy.

Main Results:

  • Twenty-six percent of patients exhibited left ventricular hypertrophy.
  • Lower LVMI was significantly associated with TAFO <1 L, NT-proBNP <1200 pg/mL, or cTnT <0.1 ug/L (P < 0.05).
  • A significant number of patients achieved normal levels for TAFO, cTnT, and NT-proBNP, suggesting normal hydration is achievable and associated with better cardiac parameters.

Conclusions:

  • Normally hydrated thrice-weekly hemodiafiltration patients can exhibit cardiac biomarker and TAFO levels similar to healthy individuals.
  • Bioimpedance monitoring of TAFO offers a practical and potentially valuable alternative to traditional serum cardiac biomarkers for assessing fluid status and cardiac risk.
  • Effective fluid management is crucial for mitigating cardiac complications in hemodialysis patients.

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