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KURU AĞIRLIK TAKİBİ İÇİN BİYOİMPEDANS ANALİZİ ve VENA KAVA İNFERİOR SONOGRAFİSİNİN KULLANILMASI

THE USE OF INFERIOR VENA CAVA SONOGRAPHY AND BIOELECTRIC IMPEDANCE ANALYSIS FOR THE FOLLOW UP OF DRY WEIGHT

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2003

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Dry.weight (DW), could be defined as the postHD weight where the patient is in a state of normohydration. We evaluated the clinical relevance of bioelectric impedance analysis (BIA) and inferior vena cava (IVC) sonography for the assessment of DWand we investigated the relationship between DW and hypertension. We studied 19 chronic HD patients (12M/7F; median age: 46, R [20-74]) in two consecutive studies. In study I, a formal examination was performed on all patients including a chest x-ray. BIA indexes (resistance; Rz, reactance; Xc, phase angle; PA) were measured three times (preHD, postHD, 150 mn after HD) by using a single frequency (50 kHz) current. IVC diameter was determined 120-150 mn after HD. In study II, 9 (4M/5F) hypertensive patients from first study were investigated. Their DW was reduced over a period of 4-8 week, by %3 if clinical hydration status was normal (n=6) and by %5 if clinically overt overhydration was present (n=3). After the reduction of dry weight these patients were reevaluated with BIA and IVC sonography. For obtaining normal references of BIA indexes, we performed BIA in 79 (35M/44F) healthy adults. In study I; the fluid removal during HD resulted in significant reduction in body weight (BW) and rise in all BIA indexes. The changes in BW and BIA indexes were significantly (p<0.05) correlated (Pearson's r values: Rz/h: "0.685; Xc/h: -0.694; PA: -0.478, p=0.001 for all three variables). BIA measurements were significantly lower in clinically overhydrated patients than clinically normohydrated patients. IVC measurements were not different between the two groups. In study II, after DW reduction, both pre and postHD mean arterial pressure readings were significantly reduced. All BIA indexes increased significantly, and preHD measurements became similar with the control group. However IVC measurements didn t differ significantly from the first measurements. BIA seems more useful than VCI measurements especially for the follow up of the dry weight. BIA analysis could provide an objective method for the follow up of dry weight changes over the time
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Abstract (Original Language): 
Kuru ağırlık hastanın, diyaliz sonrası ulaşılmaya çalışılan, normohidrate olduğu ağırlık olarak tanımlanabilir. Kuru ağırlık tayininde yardımcı olabileceği kabul edilen, biyoelektrik impedans analizi (BİA) ve vena kava inferior (VKİ) çapı ölçümünün klinik yararını araştırdık. Araştırmada 19 kronik hemodiyaliz (HD) hastasını (12E/ 7K, medyan yaş 46, A[20-74J) birbirini takip eden iki aşamada inceledik. Aşama Ide tüm hastalar fizik muayene ve telekardiyografi ile değerlendirildi. BİA indeksleri (rezistans; Rz, reaktans; Xc, faz açısı; FA) sabit (50 kHz) frekanslı akım kullanılarak prediyaliz, postdiyaliz ve diyalizden 150 dk sonra olmak üzere toplam 3 kez ölçüldü. VKİ çapları ise postdiyaliz 120-150. dk'lar arasında ölçüldü. Aşama ü'de ilk aşamada değerlendirilen hastalardan hipertansif olan 9 (4E/5K) hasta incelendi. Hastaların kuru ağırlıkları 4-8 hafta içinde, klinik olarak normohidrate iseler %3 (n=6), klinik olarak sürhidratasyon bulguları varsa %5 (n=3) oranında azaltıldı. Bu dönem sonunda hastalar tekrar BİA ve VKİ çapı ile değerlendirildiler. Ayrıca BİA indeksleri için kontrol grubu olarak 79 (35E/ 44K) sağlıklı bireyin ölçümleri yapıldı. Aşama I'de HD ile sıvı çekilmesi ağırlıkta azalmaya ve BİA indekslerinde artmaya neden oldu. Ağırlıktaki değişim ile BİA indekslerinde olan değişim anlamlı olarak ilişkiliydi (Pearson r değerleri: Rz/b: -0.68; Xc/b: -0.69; PÂ: -0.48; her üç değişken için de p=0.001). Klinik olarak sürhidrate olan hastaların BİA değerleri normohidratelere göre anlamlı olarak düşüktü. İki grup arasında VKİ çapı yönünden fark saptanamadı. Aşama H'de kuru ağırlığın azaltılması; pre ve post diyaliz ortalama arter basınçlarında düşmeye, BİA indekslerinde ise anlamlı artmaya neden oldu. Prediyaliz BİA indeksleri kontrol grubu ile benzer seviyelere yükseldi. VKİ çaplarında ise anlamı değişiklik olmadı. BİA, VKİ çapının ölçümüne göre özellikle kuru ağırlık takibi için daha yararlı bir yöntem olarak bulunmuştur. Vücut kuru ağırlığındaki değişimler BİA ile takip edildiğinde objektif olarak yorumlanabilir
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  • 4
209-215
  • Turkish

REFERENCES

References: 

1. Jaeger JQ, Metha RL Assessment of dry weight in hemodialysis: an overview. J Am Soc Nephrol 1999;10:392-403.
2. Franz M, Pohanka E, Tribl B et al Living on chronic hemodialysis between dryness and fluid overload. Kidney Int 511997; (suppl 59): 39-42.
3. Cheriex EC, Leunissen KML, Janssen JHA et al: Echography of inferior vena cava is a simple and reliable tool for estimation of 'dry weight' in hemodialysis patients. Nephrol Dial Transplant 1989;4:563-568.
4. Lauster F, Gerzer R, Weil J et al Assessment of dry body-weight in hemodialysis patients by the biochemical marker cGMP. Nephrol Dial Transplant 1990;5:356-361.
5. De Vries JPPM, Kouw PM, Van Der Meer NJM et al Non-invasive monitoring of blood volume during hemodialysis: its relation with post-dialytic dry weight. Kidney Int 1993: 44; 851-854.
6. Piccoli A, for the italian hemodialysis-bioelectrical impedance analysis (hd-bia) study group. Identification of operational clues to dry weight prescription in hemodialysis using bioimpedance
vector analysis. Kidney Int 1998: 53; 1036-1043.
7. Pupim LB, Kent P, ikizler TA: Bioelectrical impedance analysis in dialysis patients. Miner
Electrolyte Metab 1999; 25: 400-406.
8. Liedtke RJ. Fundamentals of bioelectrical impedance analysis. RJL Systems publications. 1998. http://www.rjlsystems.com/research/bia-fundamentals.html
9. Liedtke RJ. Principles of bioelectrical impedance analysis. RJL Systems publications, 1997. http:// www.rjlsystems.com/research/bia-principles.htrnl.
10. Katzarski KS, Nisell J, Randmaa I et al: A critical evaluation of ultrasound measurement of inferior vena cava diameter in assessing dry weight in normotensive and hypertensive hemodialysis
patients. Am J Kid Dis 1997; 30: 459-465.
11. Sahn DJ, DeMaria A, Kisslo J: Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation
1978; 58: 1072-1083.
12. Katzaeski K, Charra B, Laurent G et al.: Multifrequency bioimpedance in assessment of dry weight in haemodialysis. Nephrol Dial Transplant
1996; 11 (suppl 2): 20-23.
13. Maggiore Q, Nigrelli S, Ciccarelli C et al.: Nutritional and prognostic correlates of bioimpedance indexes in hemodialysis patients.
Kidney Int 1996;50:2103-2108.
14. Mandelbaum A, Ritz E: Vena cava diameter measurement for estimation of dry weight in hemodialysis patients. Nephrol Dial Transplant
1996; ll(suppl2):24-27.

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