Volume overload in hemodialysis: diagnosis, cardiovascular consequences, and management

Area of Science:

• Nephrology
• Cardiology
• Medical Imaging

Background:

• Volume overload in haemodialysis (HD) patients is associated with hypertension, cardiac dysfunction, and increased mortality.
• Current methods for diagnosing volume excess and estimating dry weight in HD patients rely on clinical criteria with poor accuracy.
• Accurate and objective methods for evaluating dry weight and diagnosing subclinical volume overload are needed.

Purpose of the Study:

• To review current knowledge on the diagnosis, prognosis, and treatment of volume overload in haemodialysis patients.
• To highlight the limitations of traditional diagnostic methods and the potential of newer objective techniques.
• To discuss strategies for optimizing fluid management in volume-expanded HD patients.

Main Methods:

• Review of existing literature on volume overload in haemodialysis.
• Evaluation of diagnostic methods including clinical assessment, bioimpedance spectroscopy, and lung ultrasound.
• Analysis of treatment strategies focusing on gradual fluid removal.

Main Results:

• Bioimpedance spectroscopy offers reliable quantification of body fluid distribution.
• Lung ultrasound provides accurate estimates of extravascular lung water, reflecting central circulation status.
• Gradual fluid removal over an extended period is crucial for cardiovascular tolerance in HD patients.

Conclusions:

• Objective methods like bioimpedance spectroscopy and lung ultrasound show promise for improving the diagnosis and management of volume overload in HD patients.
• Further clinical trials are needed to validate the utility of various methods in practice.
• Optimized fluid management is essential for improving cardiovascular tolerance and patient outcomes in haemodialysis.