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Association between OH/ECW and echocardiographic parameters in CKD5 patients not undergoing dialysis
Byoung-Geun Han1, Shin Han Song1, Jin Sae Yoo1
1Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won, S. Korea.
Insights
Bioimpedance spectroscopy (BIS) can help detect fluid overload in chronic kidney disease (CKD) patients. Early detection of fluid overload using BIS and lab tests may reduce diastolic dysfunction risk.
Area of Science:
- Nephrology
- Cardiology
- Biomedical Engineering
Background:
- Echocardiography is crucial for diagnosing cardiac issues in chronic kidney disease (CKD) patients but has limitations.
- Assessing volume status is vital for managing CKD patients and preventing cardiovascular disease.
- Bioimpedance spectroscopy (BIS) is emerging as a bedside tool for quantifying hydration status.
Purpose of the Study:
- To investigate the association between fluid overload (OH/ECW) measured by BIS and echocardiographic parameters in CKD patients.
- To explore the relationship between NT-proBNP, echocardiographic data, and fluid overload.
Main Methods:
- 127 CKD patients undergoing initial dialysis planning were enrolled.
- Echocardiography and BIS were performed on all participants.
- Statistical analysis examined associations between BIS-derived OH/ECW, echocardiographic findings, and NT-proBNP levels.
Main Results:
- Relative fluid overload (OH/ECW) positively correlated with left atrial dimension, left atrial volume index (LAVI), and E/e´ ratio.
- NT-proBNP showed significant associations with all echocardiographic parameters evaluated.
- Multivariate analysis identified E/e´ ratio, NT-proBNP, and albumin as significant predictors of OH/ECW.
Conclusions:
- BIS-measured OH/ECW is linked to echocardiographic indicators of diastolic dysfunction.
- Integrating BIS (OH/ECW) and laboratory tests (NT-proBNP, albumin) may aid in preliminary screening for diastolic dysfunction risk.
- Timely detection and management of fluid overload in CKD patients could mitigate diastolic dysfunction; further research is warranted.
Background:
Echocardiography is the most valuable tool for assessing cardiac abnormalities of chronic kidney disease (CKD) patients even though it has its limitations, including high equipment cost and the need for specialized personnel. Assessment of volume status is important not only for volume management, but also for prevention of cardiovascular disease of the CKD patients. Recently, bioimpedance is gaining acceptance as a way to quantitatively assess patient hydration status at bedside.
Methods:
127 patients who were admitted for planning their first dialysis treatment were enrolled. The echocardiography and bioimpedance spectroscopy (BIS) were performed. The association between echocardiographic data and clinical values such as NT-proBNP and OH/ECW was examined.
Results:
OH/ECW, which indicates relative fluid overload, was positively associated with LA dimension (r = 0.25, P = 0.007), LAVI (r = 0.32, P < 0.001), and E/e´ ratio (r = 0.38, P < 0.001). While OH/ECW was not significantly associated with echocardiographic values such as LVEDD, LVEDV, LVMI, and LVEF, NT-proBNP were significantly associated with all echocardiographic parameters. Multivariate logistic regression analysis showed E/e´ ratio (odds ratio, 1.14 [95% confidence interval (CI), 1.01 to 1.29]; P = 0.031), NT-proBNP (odds ratio, 4.78 [95% CI, 1.51 to 15.11]; P = 0.008), and albumin (odds ratio, 0.22 [95% CI, 0.08 to 0.66]; P = 0.007) were significantly associated with OH/ECW.
Conclusions:
Since OH/ECW measured by BIS is associated with echocardiographic parameters related to diastolic dysfunction, preliminary screening through laboratory findings, including serum albumin in conjunction with OH/ECW and NT-proBNP, may find patient with risk of diastolic dysfunction. Our study suggests that a timely detection of fluid overload in patients with CKD as well as their proper treatment may help reduce diastolic dysfunction. Further research may be needed to validate the consistency of this association across other stages of CKD.
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