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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Association between E/e´ ratio and fluid overload in patients with predialysis chronic kidney disease
Jae-Seok Kim1, Jae-Won Yang1, Jin Sae Yoo1
1Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won, Korea.
Insights
Markers of fluid overload, NT-proBNP and bioimpedance spectroscopy (BIS), can predict diastolic dysfunction in chronic kidney disease (CKD) patients. Early monitoring and fluid management may improve cardiovascular outcomes.
Area of Science:
- Nephrology
- Cardiology
- Biomedical Engineering
Background:
- Chronic fluid overload is prevalent in chronic kidney disease (CKD) patients, often leading to diastolic dysfunction and heart failure.
- Assessing fluid status is crucial for managing cardiovascular risks in CKD.
Purpose of the Study:
- To investigate the predictive value of NT-proBNP and bioimpedance spectroscopy (BIS) for echocardiographic findings of diastolic dysfunction.
- To identify fluid status markers for early detection of diastolic dysfunction in non-dialysis CKD stage 5 patients.
Main Methods:
- Eighty-four non-dialysis CKD stage 5 patients underwent BIS, echocardiography, and serum NT-proBNP measurement at a single visit.
- Diastolic dysfunction was defined by an E/e´ ratio greater than 15, reflecting elevated mean left ventricular diastolic pressure.
Main Results:
- 45.24% of patients exhibited diastolic dysfunction (E/e´ > 15).
- Patients with diastolic dysfunction had significantly higher NT-proBNP levels (14,650 pg/mL vs. 4,271 pg/mL) and greater overhydration (5.1 L vs. 2.4 L) compared to those without.
- Predictive cut-off values were identified as 2,797 pg/mL for NT-proBNP and 2.45 L for overhydration.
Conclusions:
- Regular monitoring of fluid status using BIS and NT-proBNP can identify CKD patients at risk of developing diastolic dysfunction.
- Interventions to manage fluid overload may mitigate the risk of diastolic dysfunction and enhance cardiovascular outcomes in CKD patients.
Background:
Chronic fluid overload is common in patients with chronic kidney disease (CKD) and can with time lead to diastolic dysfunction and heart failure. We investigated whether markers of fluid status, such as NT-proBNP and bioimpedance spectroscopy (BIS), can predict echocardiographic findings of diastolic dysfunction in non-dialysis CKD5 patients.
Methods:
BIS, echocardiography, and measurement of serum NT-proBNP were performed in patients with non-dialysis CKD stage 5 at a single study visit. E/e´ ratio reflect mean LV diastolic pressure and a ratio greater than 15 was used as a definition of diastolic dysfunction.
Results:
Eighty-four patients were analyzed. Forty-six patients (54.76%) had E/e´ ratio ≤15 and 38 patients (45.24%) had E/e´ > 15 (diastolic dysfunction). Patients with E/e´>15 had significantly higher serum NT-proBNP (14,650 pg/mL) than patients with to E/e´≤15 (4,271 pg/mL) and had more overhydration (OH), 5.1 liters compared to 2.4 liters. The cut-off values predicting diastolic dysfunction were found to be 2,797 pg/mL for NT-proBNP and 2.45 liters for OH.
Conclusions:
Regular monitoring of fluid status by BIS and NT-proBNP can be used to find patient with risk of developing diastolic dysfunction. Treatments to correct fluid overload may reduce the risk of developing diastolic dysfunction and improve cardiovascular outcome in patients with CKD.
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