Assessing accuracy of estimated dry weight in dialysis patients post transplantation: the kidney knows best
Tóm tắt
Estimated dry weight is used to guide fluid removal during outpatient hemodialysis sessions. Errors in estimated dry weight can result in intradialytic hypotension and interdialytic fluid overload. The goal of this study was to assess the accuracy of estimated dry weight by comparing it to the 2-week post-transplant weight in two cohorts of hemodialysis patients.
This observational, multi-center, retrospective cohort study included maintenance hemodialysis patients who underwent kidney transplantation at two medical centers in Massachusetts. The relationship between estimated dry weight pre-transplant and weight at week 2 post-transplant in patients with good allograft function (serum creatinine ≤ 1.5 mg/dL) was analyzed. Estimated dry weight was considered accurate if it was within ± 2% of the week 2 post-transplant weight. Fifty seven patients with good allograft function were identified: mean age 54 ± 14 years, 32 (58%) from deceased donors, 22 (38.6%) females. 38 were Caucasian (66.7%), 11 Hispanic (19.3%), 3 black (5.3%), and 5 others (8.8%). 2-week mean post transplantation serum creatinine was 1.2 ± 0.2 mg/dL. Mean (SD) estimated dry weight was 71.4 ± 15.9. Before transplantation, only 14 (24.6%) patients were within ± 2% of the 2-week post-transplant weight; 23 (40.3%) were above and 20 (35.1%) were below. Our point of view, based on the assumption that the weight of patients with good allograft function at 2 weeks post-transplant approaches their accurate dry weight, is that a majority of maintenance hemodialysis patients (75.4%) are hypervolemic or hypovolemic prior to renal transplantation. This highlights the importance of finding novel tools to achieve euvolemia in patients undertaking dialysis. Timely feedback regarding achieved weight 2 weeks post-transplant to treating nephrologists and dialysis centers may be a starting point for assessing accuracy of dry weight.
Tài liệu tham khảo
Sinha AD, Agarwal R (2017) Setting the dry weight and its cardiovascular implications. Semin Dial 30(6):481–488. https://doi.org/10.1111/sdi.12624
Charra B, Laurent G, Chazot C, Calemard E, Terrat JC, Vanel T, Jean G, Ruffet M (1996) Clinical assessment of dry weight. Nephrol Dial Transpl 11(2):S16–S19. https://doi.org/10.1093/ndt/11.supp2.16
Rocco MV, Lockridge RS Jr, Beck GJ, Eggers PW, Gassman JJ, Greene T, Larive B, Christopher T, Chan, Chertow GM, Copland M, Hoy CD, Lindsay RM, Levin NW, Ornt DB, Pierratos A, Pipkin MF, Rajagopalan S, Stokes JB, Unruh ML, Star RA, Kliger AS (2011) The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial. Kidney Int 80:1080–1091. https://doi.org/10.1038/ki.2011.213
Chazot C, Charra B, Laurent G, Didier C, Van CV, Terrat JC, Calemard E, Vanel T, Ruffet M (1995) Interdialysis blood pressure control by long haemodialysis sessions. Nephrol Dial Transpl 10:831–837. https://doi.org/10.1093/oxfordjournals.ndt.a027292
Weiner DE, Brunelli SM, Hunt A, Schiller B, Glassock R, Maddux FW, Johnson D, Parker T, Nissenson A (2014) Improving clinical outcomes among hemodialysis patients: a proposal for a “volume first” approach from the chief medical officers of US dialysis providers. Am J Kidney Dis 64(5):685–695. https://doi.org/10.1053/j.ajkd.2014.07.003
Reddan DN, Szczech LA, Hasselblad V, Lowrie EG, Lindsay RM, Himmelfarb J, Toto RD, Stivelman J, Winchester JF, Zillman LA, Califf RM, Owen WF Jr (2005) Intradialytic blood volume monitoring in ambulatory hemodialysis patients a randomized trial. J Am Soc Nephrol 16(7):2162–2169. https://doi.org/10.1681/asn.2004121053
Machek P, Jirka T, Moissl U, Chamney P, Wabel P (2010) Guided optimization of fluid status in haemodialysis patients. Nephrol Dial Transpl 25(2):538–544. https://doi.org/10.1093/ndt/gfp487
Antlanger M, Josten P, Kammer M, Exner I, Lorenz-Turnheim K, Eigner M, Paul G, Klauser-Braun R, Sunder-Plassmann G, Säemann MD, Hecking M (2017) Blood volume-monitored regulation of ultrafiltration to decrease the dry weight in fluid-overloaded hemodialysis patients: a randomized controlled trial. BMC Nephrol 18(1):238. https://doi.org/10.1186/s12882-017-0639-x
Patel HV, Annigeri RA, Kowdle PC, Rao BS, Seshadri R, Balasubramanian S, Vadamalai V (2019) Bioimpedance spectroscopy-guided ultrafiltration normalizes hydration and reduces intradialytic adverse events in hemodialysis patients. Indian J Nephrol 29(1):1–7. https://doi.org/10.4103/ijn.IJN_150_18
Leung KCW, Quinn RR, Ravani P, Duff H, MacRae JM (2017) Randomized crossover trial of blood volume monitoring-guided ultrafiltration biofeedback to reduce intradialytic hypotensive episodes with hemodialysis. Clin J Am Soc Nephrol 12(11):1831–1840. https://doi.org/10.2215/CJN.01030117
Choi KH, Yang SC, Joo DJ, Kim MS, Kim YS, Kim SI, Han WK (2012) Clinical assessment of renal function stabilization after living donor nephrectomy. Transpl Proc 44:2906–2909. https://doi.org/10.1016/j.transproceed.2012.05.086
Shami AR, Karembelka A, Yabes J, Yao Y, Miskulin D, Gassman J, Ploth D, Negrea L, Paine S, Rahman M, Kwong RY, Zager P, Jhamb M (2018) Association of intradialytic hypertension with left ventricular mass in hypertensive hemodialysis patients enrolled in the blood pressure in Dialysis (BID) study. Blood Press Res 43(3):882–892. https://doi.org/10.1159/000490336
Manisha J, Weisbord SD, Steel JL, Unruh M (2008) Fatigue in patients receiving maintenance dialysis: a review of definitions, measures, and contributing factors. Am J Kidney Dis 52(2):353–365. https://doi.org/10.1053/j.ajkd.2008.05.005
Rivera-González CS, Pérez-Grovas H, Madero M, Mora-Bravo F, Saavedra N, López-Rodriguez J, Lerma C (2013) Identification of impeding factors for dry weight achievement in end-stage renal disease after appropriate kidney graft function. Artif Organs 38(2):113–120. https://doi.org/10.1111/aor.12133
Agarwal R, Alborzi P, Satyan S, Light RP (2009) Dry-weight reduction in hypertensive hemodialysis patients (DRIP): a randomized, controlled trial. Hypertension 53(3): 500–507. https://doi.org/10.1161/HYPERTENSIONAHA.108.125674
Schneditz D, Kron J, Hecking M (2018) Anything goes? High time for smart blood volume monitors. ASAIO 64(6):697–700. https://doi.org/10.1097/MAT.0000000000000885
Kron S, Schneditz D, Czerny J, Leimbach T, Budde K, Kron J (2018) Adjustment of target weight based on absolute blood volume reduces the frequency of intradialytic morbid events. Hemodial Int 22(2):254–260. https://doi.org/10.1111/hdi.12582
Germain MJ, Joubert J, O’Grady D, Nathanson BN, Chait Y, Levin NW (2018) Comparison of stroke volume measurements during hemodialysis using bioimpedance cardiography and echocardiography. Hemodial Int 22:201–208. https://doi.org/10.1111/hdi.12589
Levin NW, de Abreu MHFG, Borges LE, de Abreu MHFG, Borges LE, Filho HAT, Sarwar R, Gupta S, Hafeez T, Lev S, Williams C (2018) Hemodynamic response to fluid removal during hemodialysis: categorization of causes of intradialytic hypotension. Nephrol Dial Transpl 33(9):1643–1649. https://doi.org/10.1093/ndt/gfy048