Is high-volume post-dilution haemodiafiltration associated with risk of fluid volume imbalance? A national multicentre cross-sectional cohort study.
bioimpedance
fluid overload
post-dilution haemodiafiltration
sodium balance
sodium gradient
Journal
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
ISSN: 1460-2385
Titre abrégé: Nephrol Dial Transplant
Pays: England
ID NLM: 8706402
Informations de publication
Date de publication:
01 12 2019
01 12 2019
Historique:
received:
11
04
2019
accepted:
11
06
2019
pubmed:
11
9
2019
medline:
1
5
2020
entrez:
11
9
2019
Statut:
ppublish
Résumé
Fluid overload is frequent among hemodialysis (HD) patients. Dialysis therapy itself may favor sodium imbalance from sodium dialysate prescription. As on-line hemodiafiltration (OL-HDF) requires large amounts of dialysate infusion, this technique can expose to fluid accumulation in case of a positive sodium gradient between dialysate and plasma. To evaluate this risk, we have analyzed and compared the fluid status of patients treated with HD or OL-HDF in French NephroCare centers. This is a cross-sectional and retrospective analysis of prevalent dialysis patients. Data were extracted from the EUCLID5 data base. Patients were split in 2 groups (HD and OL-HDF) and compared as whole group or matched patients for fluid status criteria including predialysis relative fluid overload (RelFO%) status from the BCM®. 2242 patients (age 71 years; female: 39%; vintage: 38 months; Charlson index: 6) were studied. 58% of the cohort were prescribed post-dilution OL-HDF. Comparing the HD and OL-HDF groups, there was no difference between HD and OL-HDF patients regarding the predialysis systolic BP, the interdialytic weight gain, the dialysate-plasma sodium gradient, and the predialysis RelFO%. The stepwise logistic regression did not find dialysis modality (HD or OL-HDF) associated with fluid overload or high predialysis systolic blood pressure. In OL-HDF patients, monthly average convective or weekly infusion volumes per session were not related with the presence of fluid overload. In this cross-sectional study we did not find association between the use of post-dilution OL-HDF and markers of fluid volume excess. Aligned dialysis fluid sodium concentrations to patient predialysis plasma sodium and regular monitoring of fluid volume status by bioimpedance spectroscopy may have been helpful to manage adequately the fluid status in both OL-HDF and HD patients.
Sections du résumé
BACKGROUND
Fluid overload is frequent among hemodialysis (HD) patients. Dialysis therapy itself may favor sodium imbalance from sodium dialysate prescription. As on-line hemodiafiltration (OL-HDF) requires large amounts of dialysate infusion, this technique can expose to fluid accumulation in case of a positive sodium gradient between dialysate and plasma. To evaluate this risk, we have analyzed and compared the fluid status of patients treated with HD or OL-HDF in French NephroCare centers.
METHOD
This is a cross-sectional and retrospective analysis of prevalent dialysis patients. Data were extracted from the EUCLID5 data base. Patients were split in 2 groups (HD and OL-HDF) and compared as whole group or matched patients for fluid status criteria including predialysis relative fluid overload (RelFO%) status from the BCM®.
RESULTS
2242 patients (age 71 years; female: 39%; vintage: 38 months; Charlson index: 6) were studied. 58% of the cohort were prescribed post-dilution OL-HDF. Comparing the HD and OL-HDF groups, there was no difference between HD and OL-HDF patients regarding the predialysis systolic BP, the interdialytic weight gain, the dialysate-plasma sodium gradient, and the predialysis RelFO%. The stepwise logistic regression did not find dialysis modality (HD or OL-HDF) associated with fluid overload or high predialysis systolic blood pressure. In OL-HDF patients, monthly average convective or weekly infusion volumes per session were not related with the presence of fluid overload.
CONCLUSIONS
In this cross-sectional study we did not find association between the use of post-dilution OL-HDF and markers of fluid volume excess. Aligned dialysis fluid sodium concentrations to patient predialysis plasma sodium and regular monitoring of fluid volume status by bioimpedance spectroscopy may have been helpful to manage adequately the fluid status in both OL-HDF and HD patients.
Identifiants
pubmed: 31504813
pii: 5556401
doi: 10.1093/ndt/gfz141
pmc: PMC6887955
doi:
Substances chimiques
Dialysis Solutions
0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
2089-2095Informations de copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA.
Références
Methods Inf Med. 2004;43(1):83-8
pubmed: 15026844
Nephrol Dial Transplant. 2018 Jul 1;33(7):1223-1235
pubmed: 29370428
J Am Soc Nephrol. 2017 Aug;28(8):2491-2497
pubmed: 28473637
Nephrol Dial Transplant. 2013 Jan;28(1):192-202
pubmed: 23229932
Nephrol Dial Transplant. 2011 Apr;26(4):1281-7
pubmed: 21303968
Kidney Int. 2008 Mar;73(6):759-64
pubmed: 18160959
Lancet. 2016 Jul 16;388(10041):285-93
pubmed: 27226131
Nephrol Dial Transplant. 2002 Aug;17(8):1463-9
pubmed: 12147795
J Am Soc Nephrol. 2013 Feb;24(3):487-97
pubmed: 23411788
J Am Soc Nephrol. 2012 Jun;23(6):1087-96
pubmed: 22539829
Kidney Int. 2017 Jun;91(6):1495-1509
pubmed: 28318624
Nephrol Dial Transplant. 2015 May;30(5):849-58
pubmed: 25762355
Nephrol Dial Transplant. 2009 May;24(5):1574-9
pubmed: 19131355
J Nephrol. 2019 Jun;32(3):461-469
pubmed: 30628020
J Am Soc Nephrol. 2010 Oct;21(10):1798-807
pubmed: 20813866
Nephrol Dial Transplant. 2016 Jun;31(6):978-84
pubmed: 26492924
Nephrol Dial Transplant. 2009 Mar;24(3):956-62
pubmed: 19004849
J Nephrol. 2013 Nov-Dec;26 Suppl 20:S23-33
pubmed: 24293195