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- Stenberg, Jenny, 1976-, et al.
(författare)
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Brain natriuretic peptide reflects individual variation in hydration status in hemodialysis patients
- 2019
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Ingår i: Hemodialysis International. - : Wiley. - 1492-7535 .- 1542-4758. ; 23:3, s. 402-413
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Fluid management in hemodialysis patients is a controversial topic. Brain natriuretic peptide (BNP) is secreted from the heart in response to volume overload, and may be a marker of overhydration in hemodialysis patients. Our aim was to investigate the correlation between BNP and overhydration in a cohort of hemodialysis patients, and to find out whether BNP and overhydration correlate in repeated measurements within individuals with elevated BNP.METHODS: The study was prospective, observational, and had a cross-sectional part and a longitudinal follow-up. The distribution of BNP was investigated in a cohort of 64 hemodialysis patients. Blood samples and bioimpedance spectroscopy measurements were performed before midweek dialysis. Subsequently, 11 study participants with elevated BNP concentrations (>500 pg/mL) were assessed in another nine dialysis sessions each. These individuals also had their cardiac function and heart rate variability (HRV) examined.FINDINGS: BNP was above 500 pg/mL in 38% of the participants, and correlated positively with overhydration (rs = 0.381), inflammation and malnutrition, but not with systolic blood pressure. In comparison to participants with BNP below 500 pg/mL, participants with elevated BNP were older, had lower muscle strength, lower bodyweight and lower levels of hemoglobin and albumin. Echocardiography revealed cardiac anomalies in all 11 participants in the longitudinal follow-up, and HRV, as measured by SDNN, was pathologically low. In repeated measurements, the between-individuals variation of BNP in relation to overhydration was greater (SD = 0.581) than the within-person variation (SD = 0.285).DISCUSSION: BNP correlates positively to overhydration, malnutrition, and inflammation. In a subgroup of patients with elevated BNP, who are mainly elderly and frail, BNP reflects individual variation in hydration status, and hence seems to be a modifiable marker of overhydration. These data suggest that BNP is best applied for measuring changes in hydration status within an individual over time.
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| 2. |
- Stenberg, Jenny, 1976-, et al.
(författare)
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Systematic fluid assessment in haemodialysis care: : Development and validation of adecision aid
- 2019
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Konferensbidrag (refereegranskat)abstract
- BackgroundOverhydration is a mortality risk factor in haemodialysis patients, and about a third of patients have poorly controlled fluid balance. Bioimpedance is a technique that can detect excess body water. However it is important to recognize that bioimpedance adds information to what is already a complex decision-making process, rather than providing a simple target applicable to all patients. Clinical guidelines incorporating the information from bioimpedance in determination of dry weight are lacking.ObjectivesTo develop and validate a decision aid, which standardizes the process of recording, scoring and responding to changes in routinely measured physiological parameters, and provides a basis for a unified and systematic approach to the assessment of volume status in haemodialysis care.MethodsWe are developing a scoring system, which we have named Subjective Volume Status Score (SVSS). Experts in theuse of bioimpedance have been included to address face-validity. In order to test the reliability of SVSS, nurses from a number of British and Swedish haemodialysis units will be recruited to use SVSS in individual assessments of four typical patient cases. Their assessments will be analyzed with inter-rater agreement analysis.ResultsSVSS consists of:A scoring system, built upon six physiological parameters, for detection and assessment of clinical symptoms of impaired hydration statusThresholds and triggers, a simple track-and-trigger system guiding the caregiver in deciding when and how to respondA decision aid, which helps to incorporate the information from bioimpedance when setting the dry weight, and aims to facilitate communication in the team, by providing a common language.Conclusion/Application to practiceOur guiding principle is that if SVSS is going to work in diverse haemodialysis care settings, then it must be simple to implement and must use physiological parameters that are already being routinely measured in the haemodialysis care.
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