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The adjustment of post-dialysis dry weight based on non-invasive measurements in children
1Division of Nephrology, Ege University, Faculty of Medicine, Izmir, Turkey.
Insights
Inferior vena cava (IVC) diameter and atrial natriuretic peptide (ANP) levels can help estimate dry weight (DW) in children undergoing haemodialysis. Echography of the IVC shows promise as a non-invasive tool for assessing hydration status.
Area of Science:
- Nephrology
- Pediatrics
- Cardiology
Background:
- Clinical assessment of hydration status in children on haemodialysis is challenging.
- Accurate estimation of post-dialysis dry weight (DW) is crucial for effective treatment.
- Developing reliable methods to determine DW is a significant clinical need.
Purpose of the Study:
- To evaluate the utility of inferior vena cava (IVC) diameter, plasma atrial natriuretic peptide (ANP), and plasma renin activity (PRA) in determining DW in children with chronic haemodialysis.
- To assess changes in these parameters before and after ultrafiltration (UF) therapy.
Main Methods:
- Studied 12 overhydrated haemodialysis patients and 12 age-matched healthy children.
- Measured clinical, echocardiographic, IVC diameter and collapsibility indices, plasma ANP, and PRA before and after UF therapy.
- Utilized analysis of variance and Dunnett's test for statistical comparisons.
Main Results:
- Following UF, patients showed increased IVC collapsibility (42.3% to 53.6%) and decreased IVC index (1.08 to 0.81 cm/m2).
- Pre-UF IVC indices in patients differed significantly from controls (56.9% and 0.70 cm/m2).
- Plasma ANP levels decreased significantly post-UF (171 to 129 pg/ml), while PRA changes were not significant.
Conclusions:
- Overhydration in haemodialysis children is associated with increased IVC diameter, elevated plasma ANP, and reduced IVC collapsibility.
- Echocardiographic assessment of the IVC appears to be a promising non-invasive method for estimating DW in this population.
- Further research is needed to establish normative IVC values for both haemodialysis and healthy children.
Background:
The clinical criteria to assess hydration status are not always reliable. Hence, the development of techniques to estimate more accurately post-dialysis dry weight (DW) remains a major challenge. The present study evaluates the value of the inferior vena cava (IVC) diameter, plasma concentration of atrial natriuretic peptide (ANP), and plasma renin activity (PRA) in determining the DW in chronic haemodialysis children.
Methods:
Twelve overhydrated haemodialysis patients (4 girls, 8 boys) with a mean age of 12.8 were admitted to the study. Clinical, electrocardiographic, telecardiographic and echocardiographic findings, IVC and collapsibility indices and plasma concentrations of ANP and PRA were investigated before and after ultrafiltration (UF) therapy. Twelve age-matched normal children were studied as controls. Analysis of variance and Dunnett's test were applied for comparisons between patients and controls.
Results:
Following UF therapy the patients' mean IVC collapsibility index was increased from 42.3 to 53.6% and IVC index was decreased from 1.08 to 0.81 cm/m2, both statistically significant. The pre-UF therapy collapsibility and IVC indices of the patient group were significantly different from those of the control group (56.9% and 0.70 cm/m2 respectively). The patients' mean plasma concentrations of ANP were 171 +/- 47.4 pg/ml before UF, 129 +/- 51.3 pg/ml after UF and 102 +/- 38.7 pg/ml in the control group. The ANP levels of the patients showed a significant decrease following the UF therapy. PRA was measured as 0.82 ng/ml/h before UF and 1.08 ng/ml/h after UF, but the increase was not statistically significant.
Conclusions:
Our findings revealed increased diameter of the IVC and plasma ANP concentrations and decreased collapsibility due to overhydration. Echography of IVC may be a promising non-invasive tool to estimate the DW in haemodialysis children. Further studies providing normative values for the IVC indices in both haemodialysis and normal children are required.