Tangvoraphonkchai, Kamonwan;
Davenport, Andrew;
(2016)
Pre-dialysis and post-dialysis hydration status and N-terminal pro-brain natriuretic peptide and survival in haemodialysis patients.
The International Journal of Artificial Organs
, 39
(6)
pp. 282-287.
10.5301/ijao.5000514.
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Abstract
PURPOSE: Many dialysis centres have no formal program for assessing and adjusting post-haemodialysis (HD) target weight. Apart from clinical assessment, there are bioimpedance devices and natriuretic peptides that could potentially aid clinical management. We wished to determine whether pre- or post-HD bioimpedance assessment of extracellular water (ECW) or N terminal probrain natriuretic peptide (NT-proBNP) affected patient outcomes. METHODS: Multi-frequency bioimpedance assessments (MFBIA) were made before and after the midweek dialysis session, along with a post-dialysis NT-proBNP measurement. RESULTS: Data from 362 patients, median age of 63 (50-76) years, 59.7% male, 41.2% Caucasoid, with a median dialysis vintage of 31.4 (13.5-61.7) months were available for review. During a median follow-up of 49.6 (21.9-50.2) months there were 110 (30.4%) deaths. Patients who died had significantly increased ECW, as % over-hydrated both pre-HD 6.6 (5.8-7.6)% vs. survivors 5.1 (4-6.6)%, and post-HD 5.1 (4-6.6)% vs. 0.5 (-1-2.2.0, p<0.001, respectively. They also had higher NT-proBNP 325 (122-791) vs. 102 (48-342) pmol/l, p = 0.002. Using an adjusted Cox model, pre-HD ECW overhydration remained an independent factor associated with mortality (overhydration %: hazard ratio 1.15, 95% limits 1.03-1.28, p = 0.013), with a receiver operator curve (ROC) value of 0.7. CONCLUSIONS: ECW excess is associated with increased mortality for HD patients, with ECW excess pre-dialysis being the strongest association, although these patients also had increased ECW post dialysis. Future trials are required to determine whether achieving euvolaemia as determined by bioimpedance improves patient survival.
| Type: | Article |
|---|---|
| Title: | Pre-dialysis and post-dialysis hydration status and N-terminal pro-brain natriuretic peptide and survival in haemodialysis patients |
| Location: | Italy |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.5301/ijao.5000514 |
| Publisher version: | http://dx.doi.org/10.5301/ijao.5000514 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Bioimpedance; haemodialysis; over hydration; extracellular water; intracellular water; brain natriuretic peptide |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1514383 |
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