NDT Advance Access originally published online on May 5, 2008
Nephrology Dialysis Transplantation 2008 23(9):2965-2971; doi:10.1093/ndt/gfn228
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Towards improved cardiovascular management: the necessity of combining blood pressure and fluid overload
1 Fresenius Medical Care D GmbH, Bad Homburg, Germany 2 Fresenius Medical Care DS, Czech Republic 3 Centro Medico National, Miratejo, Portugal 4 Crosshouse Hospital, Kilmarnock, UK 5 Medical University of Lublin, Lublin, Poland 6 Georg Haas Dialysezentrum, Giessen, Germany
Correspondence and offprint requests to: Peter Wabel, Research & Development, Fresenius Medical Care D GmbH, Daimlerstrasse 15, D-61352 Bad Homburg, Germany. E-mail: peter.wabel{at}fmc-ag.com
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Abstract |
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Background. Hypertension and fluid overload (FO) are well-recognized problems in the chronic kidney disease (CKD) population. While the prevalence of hypertension is well documented, little is known about the severity of FO in this population.
Methods. A new bioimpedance spectroscopy device (BCM—Body Composition Monitor) was selected that allows quantitative determination of the deviation in hydration status from normal ranges (
HS). Pre-dialysis systolic blood pressure (BPsys) and HS was analysed in 500 haemodialysis patients from eight dialysis centres. A graphical tool (HRP—hydration reference plot) was devised allowing HS to be combined with measurements of BPsys enabling comparison with a matched healthy population (n = 1244).
Results. Nineteen percent of patients (n = 95) were found to have normal BPsys and HS in the normal range. Approximately one-third of patients (n = 133) exhibited reasonable control of BPsys and fluids (BPsys <150 mmHg and HS <2.5 L). In only 15% of patients (n = 74) was hypertension observed (BPsys >150 mmHg) with a concomitant HS >2.5 L (possible volume-dependent hypertension). In contrast, 13% of patients (n = 69) were hypertensive with HS <1.1 L (possible essential hypertension). In 10% of patients (n = 52), BPsys <140 mmHg was recorded despite HS exceeding 2.5 L.
Conclusion. Our study illustrated the wide variability in BPsys regardless of the degree of HS. The HRP provides an invaluable tool for classifying patients in terms of BPsys and HS and the proximity of these parameters to reference ranges. This represents an important step towards more objective choice of strategies for the optimal treatment of hypertension and FO. Further studies are required to assess the prognostic and therapeutic role of the HRP.
Keywords: bioimpedance spectroscopy; fluid status; fluid overload; haemodialysis; hypertension
Received for publication: 16.10.07
Accepted in revised form: 2. 4.08
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