Yıl: 2017 Cilt: 26 Sayı: 2 Sayfa Aralığı: 183 - 189 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients

Öz:
AMAÇ: Hemodiyalizde hipervolemi ve malnütrisyon çoğu kez gözden kaçan risk faktörleridir. Çalışmamızda amaç, biyoempedans sektroskopi (BİS) ile gösterilen hipervolemi ve malnütrisyonun uzun dönem sağkalım üzerine etkisini araştırmaktır (Clinical Trials. gov Identifier:NCT01468363).GEREÇ ve yÖNTEMLER: Çalışmaya 431 prevalan HD hastası alınarak 32,2±14,4 ay takip edilmiştir. Hastalara BIS ölçümü yapılmış, ilaç kullanımları, bazal ve çalışma sonundaki rutin tetkikleri değerlendirilmiştir. Çalışma süresince hastane yatışları, seanslar sırasında yaşanan komplikasyonlar değerlendirilmiştir.BULGULAR: Yaş ortalaması 59,4±14,6 yıl olan toplam 431 (%53,6'sı erkek) hastadan 125'i çalışma sonunda exitus olmuştur. Diyabet oranı %47, eritropoietin %67, diüretik kullanımı %40, prediyaliz sistolik kan basıncı 133,4±25,8 diyastolik kan basıncı 79,2±12,4 mm Hg dir.Biyoempedans verilerine göre göreceli hidrasyon durumu OH/ECW değerlendirildiğinde, kümülatif sağkalım, hipervolemik olanlarda daha düşük olarak bulundu.SONUÇ: Hemodiyaliz hastalarında hipervolemi ve malnütrisyon uzun dönem mortalite göstergesidir, erken tanı ve zamanında müdahale çok önemlidir. Klinik bulgular tanıda yeterli olmayabilir laboratuvar verileri ve BİS yöntemi hipervolemi ve malnütrisyon tanısında kullanılabilir.
Anahtar Kelime:

Konular: Cerrahi

Hemodiyaliz Hastalarında Biyoempedansla Değerlendirilen Volüm ve Beslenme Belirteçleri ile Mortalite İlişkisi

Öz:
OBJECTIVE: Hypervolemia and malnutrition are often undiagnosed risk factors for hemodialysis (HD). Our aim was to investigate the long-term effects of hypervolemia and malnutrition evaluated by bioimpedance spectroscopy (BIS) on survival. (Clinical Trials. Gov Identifier: NCT01468363). MATERIAL and METHODS: A total of 431 Prevalent HD patients were followed for 32.2±14.4 months. The patients underwent BIS measurement, a medical history was obtained, and routine tests were analyzed at the baseline and at the end of the study. Hospitalizations and complications of HD were recorded. RESULTS: The mean age was 59.4±14.6 (10-92) years with a total of 431 (53.6% males) patients of which 125 died. The percentage of diabetics was 47%, erythropoietin use 67%, and diuretic use 40%. Predialysis systolic blood pressure (BP) was 133.4±25.8 and diastolic BP 79.2±12.4 mm Hg. The rate of diabetes, and the number of hospitalizations and blood transfusions were higher in the patients who died. Diastolic BP as a clinical hypervolemia finding, BIS hypervolemia indicator of over hydration (OH), and extracellular water (ECW) were all increased, and fat tissue index as a malnutrition finding was decreased in patients who died. There were significant rates of anemia and hypoalbuminemia in this group as well. The cumulative survival was lower in hypervolemic patients as assessed by relative hydration status OH/ECW. CONCLUSION: Hypervolemia and malnutrition are the long-term mortality indicators in hemodialysis. Early diagnosis and treatment is important. Clinical findings may not be sufficient and laboratory and BIS methods can be used for diagnosis.
Anahtar Kelime:

Konular: Cerrahi
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • Jaeger JQ, Mehta RL: Assessment of dry weight in hemodialysis: An overview. J Am Soc Nephrol 1999;10:392-403
  • Charra B: Fluid balance, dry weight, and blood pressure in dialysis. Hemodial Int 2007;11:21-31
  • Agarwal R: Hypertension and survival in chronic hemodialysis patients past lessons and future opportunities. Kidney Int 2005;67:1- 13
  • Hur E, Gungor O, Asci G, Sezis M, Kayikcioglu M, Kahvecioglu S, Usta M, Duman S, Toz H, Oks E: Bioimpedance spectroscopy for the detection of hypervolemia in hemodialysis patients. Turk Neph Dial Transpl 2011;20:235-240
  • Hur E, Gungor O, Musayev O, Usta M, Toz H, Asci G, Ozkahya M, Duman S, Ok E: Bioimpedance spectroscopy for the detection of hypervolemia in peritoneal dialysis patients. Adv Perit Dial 2011;27:65-70
  • Moissl UM, Wabel P, Chamney PW, Bosaeus I, Levin NW, Bosy-Westphal A, Korth O, Müller MJ, Ellegård L, Malmros V, Kaitwatcharachai C, Kuhlmann MK, Zhu F, Fuller NJ: Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas 2006;27:921-933
  • Wabel P, Chamney P, Moissl U, Jirka T: Importance of whole-body bioimpedance spectroscopy for the management of fluid balance. Blood Purif 2009;27:75-80
  • Chamney PW, Wabel P, Moissl UM, Müller MJ, Bosy-Westphal A, Korth O, Fuller NJ: A whole-body model to distinguish excess fluid from the hydration of major body tissues. Am J Clin Nutr 2007;85:80-89
  • Wang J, Pierson RN: Disparate hydration of adipose and lean tissue require a new model for body water distribution in man. J Nutr 1976;106:1687-1693
  • Soylemezoglu O, Duzova A, Yalçinkaya F, Arinsoy T, Süleymanlar G: Chronic renal disease in children aged 5-18 years: A population- based survey in Turkey, the CREDIT-C study. Nephrol Dial Transplant 2012;27 Suppl 3:iii146-51.
  • Tsai YC, Chiu YW, Tsai JC, Kuo HT, Hung CC, Hwang SJ, Chen TH, Kuo MC, Chen HC: Association of fluid overload with cardiovascular morbidity and all-cause mortality in stages 4 and 5 CKD. Clin J Am Soc Nephrol 2015;10:39-46
  • Parrinello G, Torres D, Paterna S, di Pasquale P, Licata G: The pathophysiology of acute heart failure: The key role of fluid accumulation. Am Heart J 2008;156:e19
  • Akcicek F, Dilber S, Ozgen G, Ok E, Akalin E, Atabay G, Basci A, Guclu A, Dorhout Mees EJ: Spontaneous perirenal hematoma due to periarteritis nodosa. Nephron 1994;68:396
  • Çoker A, Ok E, Tokat Y, Hoşcoşkun C, Kaplan H, Yararbaş Ö: Evaluation of patients transplanted in countries other than Turkey. Transplant Proc 1994;26:2455-2456
  • Charra B, Chazot C: Volume control, blood pressure and cardiovascular function. Lessons from hemodialysis treatment. Nephron Physiol 2003;93:94-101
  • Ozkahya M, Ok E, Cirit M, Aydin S, Akçiçek F, Başçi A, Dorhout Mees EJ: Regression of left ventricular hypertrophy in haemodialysis patients by ultrafiltration and reduced salt intake without antihypertensive drugs. Nephrol Dial Transplant 1998;13:1489-1493
  • Hur E, Usta M, Toz H, Asci G, Wabel P, Kahvecioglu S, Kayikcioglu M, Demirci MS, Ozkahya M, Duman S, Ok E: Effect of fluid management guided by bioimpedance spectroscopy on cardiovascular parameters in hemodialysis patients: A randomized controlled trial. Am J Kidney Dis 2013;61:957-965
  • Hur E, Yildiz G, Budak Kose S, Kokturk F, Musayev O, Gungor O, Magden K, Yildirim I, Duman S, Ok E: Bioimpedance and echocardiography used interchangeably in volume comparison of dialysis patients. Hippokratia 2012;16:329-334
  • Sipahi S, Hur E, Demirtas S, Kocayigit I, Bozkurt D, Tamer A, Gunduz H, Duman S: Body composition monitor measurement technique for the detection of volume status in peritoneal dialysis patients: The effect of abdominal fullness. Int Urol Nephrol 2011;43:1195-1199
  • Hur E, Ozisik M, Ural C, Kose SB, Yildirim I, Yildiz G, Magden K, Akcicek F, Basci A, Suleymanlar G, Ates K, Duman S: Body position may effect the volume status measured by bioimpedance. Volume and nutritional status evaluated by bioimpedance affected by body positions. Turk Neph Dial Transpl 2014;23:26-32
  • Wizemann V, Wabel P, Chamney P, Zaluska W, Moissl U, Rode C, Malecka-Masalska T, Marcelli D: The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant 2009;24:1574-1579
  • Ofsthun N, Labrecque J, Lacson E, Keen M, Lazarus JM: The effects of higher hemoglobin levels on mortality and hospitalization in hemodialysis patients. Kidney Int 2003;63:1908-1914
  • Ma JZ, Ebben J, Xia H, Collins AJ: Hematocrit level and associated mortality in hemodialysis patients. J Am Soc Nephrol 1999;10:610- 619
  • Kim YJ, Jeon HJ, Kim YH, Jeon J, Ham YR, Chung S, Choi DE, Na KR, Lee KW: Overhydration measured by bioimpedance analysis and the survival of patients on maintenance hemodialysis: A single- center study. Kidney Res Clin Pract 2015;34:212-218
  • Hung SC, Kuo KL, Peng CH, Wu CH, Lien YC, Wang YC, Tarng DC: Volume overload correlates with cardiovascular risk factors in patients with chronic kidney disease. Kidney Int 2014;85:703-709
  • Menon V, Gul A, Sarnak MJ: Cardiovascular risk factors in chronic kidney disease. Kidney Int 2005;68:1413-1418
  • Kaysen GA: The microinflammatory state in uremia: Causes and potential consequences. J Am Soc Nephrol 2001;12:1549-1557
  • Kaysen GA, Stevenson FT, Depner TA: Determinants of albumin concentration in hemodialysis patients. Am J Kidney Dis 1997;29:658-668
  • Stenvinkel P, Heimbürger O, Paultre F, Diczfalusy U, Wang T, Berglund L, Jogestrand T: Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 1999;55:1899-1911
  • Joki N, Hase H, Tanaka Y, Takahashi Y, Saijyo T, Ishikawa H, Inishi Y, Imamura Y, Hara H, Tsunoda T, Nakamura M: Relationship between serum albumin level before initiating haemodialysis and angiographic severity of coronary atherosclerosis in end-stage renal disease patients. Nephrol Dial Transplant 2006;21:1633-1639
  • Bammens B, Evenepoel P, Keuleers H, Verbeke K, Vanrenterghem Y: Free serum concentrations of the proteinbound retention solute p-cresol predict mortality in hemodialysis patients. Kidney Int 2006;69:1081-1087
  • Dumler F: Hypoalbuminemia is a marker of overhydration in chronic maintenance patients on dialysis. ASAIO J 2003;49:282- 286
  • Kraemer M, Rode C, Wizemann V: Detection limit of methods to assess fluid status changes in dialysis patients. Kidney Int 2006;69:1609-1620
  • Matthie JR: Bioimpedance measurements of human body composition: Critical analysis and outlook. Expert Rev Med Devices 2008;5:239-261
  • Jaffrin MY, Morel H: Body fluid volumes measurements by impedance: A review of bioimpedance spectroscopy (BIS) and bioimpedance analysis (BIA) methods. Med Eng Phys 2008;30:1257-1269
  • Wizemann V, Rode C, Wabel P: Whole-body spectroscopy (BCM) in the assessment of normovolemia in hemodialysis patients. Contrib Nephrol 2008;161:115-118
  • Passauer J, Petrov H, Schleser A, Leicht J, Pucalka K: Evaluation of clinical dry weight assessment in haemodialysis patients using bioimpedance spectroscopy: A cross-sectional study. Nephrol Dial Transplant 2010;25:545-551
  • Machek P, Jirka T, Moissl U, Chamney P, Wabel P: Guided optimization of fluid status in haemodialysis patients. Nephrol Dial Transplant 2010;25:538-544
  • Moissl U, Arias-Guillén M, Wabel P, Fontseré N, Carrera M, Campistol JM, Maduell F: Bioimpedance-guided fluid management in hemodialysis patients. Clin J Am Soc Nephrol 2013;8:1575-1582
  • Ferrario M, Moissl U, Garzotto F, Cruz DN, Clementi A, Brendolan A, Tetta C, Gatti E, Signorini MG, Cerutti S, Ronco C: Effects of fluid overload on heart rate variability in chronic kidney disease patients on hemodialysis. BMC Nephrol 2014;15:26
  • Onofriescu M, Siriopol D, Voroneanu L, Hogas S, Nistor I, Apetrii M, Florea L, Veisa G, Mititiuc I, Kanbay M, Sascau R, Covic A: Overhydration, cardiac function and survival in hemodialysis patients. PLoS One 2015;10:e0135691.
APA hur e, KÖSE BUDAK Ş, MAGDEN K, YILDIZ G, SOYALTIN U, toka b, TURAN N, ÇELİKÖRS S, ALTUNDAL B, TUNÇ A, YILMAZ A, SİVRİ A, Sezer S, DUMAN S (2017). The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients. , 183 - 189.
Chicago hur ender,KÖSE BUDAK Şennur,MAGDEN KEMAL,YILDIZ Gürsel,SOYALTIN UTKU ERDEM,toka bilal,TURAN Naki,ÇELİKÖRS Saadet,ALTUNDAL Bünyamin,TUNÇ Ali,YILMAZ Adil,SİVRİ Ahmet,Sezer Siren,DUMAN SONER The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients. (2017): 183 - 189.
MLA hur ender,KÖSE BUDAK Şennur,MAGDEN KEMAL,YILDIZ Gürsel,SOYALTIN UTKU ERDEM,toka bilal,TURAN Naki,ÇELİKÖRS Saadet,ALTUNDAL Bünyamin,TUNÇ Ali,YILMAZ Adil,SİVRİ Ahmet,Sezer Siren,DUMAN SONER The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients. , 2017, ss.183 - 189.
AMA hur e,KÖSE BUDAK Ş,MAGDEN K,YILDIZ G,SOYALTIN U,toka b,TURAN N,ÇELİKÖRS S,ALTUNDAL B,TUNÇ A,YILMAZ A,SİVRİ A,Sezer S,DUMAN S The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients. . 2017; 183 - 189.
Vancouver hur e,KÖSE BUDAK Ş,MAGDEN K,YILDIZ G,SOYALTIN U,toka b,TURAN N,ÇELİKÖRS S,ALTUNDAL B,TUNÇ A,YILMAZ A,SİVRİ A,Sezer S,DUMAN S The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients. . 2017; 183 - 189.
IEEE hur e,KÖSE BUDAK Ş,MAGDEN K,YILDIZ G,SOYALTIN U,toka b,TURAN N,ÇELİKÖRS S,ALTUNDAL B,TUNÇ A,YILMAZ A,SİVRİ A,Sezer S,DUMAN S "The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients." , ss.183 - 189, 2017.
ISNAD hur, ender vd. "The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients". (2017), 183-189.
APA hur e, KÖSE BUDAK Ş, MAGDEN K, YILDIZ G, SOYALTIN U, toka b, TURAN N, ÇELİKÖRS S, ALTUNDAL B, TUNÇ A, YILMAZ A, SİVRİ A, Sezer S, DUMAN S (2017). The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi, 26(2), 183 - 189.
Chicago hur ender,KÖSE BUDAK Şennur,MAGDEN KEMAL,YILDIZ Gürsel,SOYALTIN UTKU ERDEM,toka bilal,TURAN Naki,ÇELİKÖRS Saadet,ALTUNDAL Bünyamin,TUNÇ Ali,YILMAZ Adil,SİVRİ Ahmet,Sezer Siren,DUMAN SONER The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 26, no.2 (2017): 183 - 189.
MLA hur ender,KÖSE BUDAK Şennur,MAGDEN KEMAL,YILDIZ Gürsel,SOYALTIN UTKU ERDEM,toka bilal,TURAN Naki,ÇELİKÖRS Saadet,ALTUNDAL Bünyamin,TUNÇ Ali,YILMAZ Adil,SİVRİ Ahmet,Sezer Siren,DUMAN SONER The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi, vol.26, no.2, 2017, ss.183 - 189.
AMA hur e,KÖSE BUDAK Ş,MAGDEN K,YILDIZ G,SOYALTIN U,toka b,TURAN N,ÇELİKÖRS S,ALTUNDAL B,TUNÇ A,YILMAZ A,SİVRİ A,Sezer S,DUMAN S The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi. 2017; 26(2): 183 - 189.
Vancouver hur e,KÖSE BUDAK Ş,MAGDEN K,YILDIZ G,SOYALTIN U,toka b,TURAN N,ÇELİKÖRS S,ALTUNDAL B,TUNÇ A,YILMAZ A,SİVRİ A,Sezer S,DUMAN S The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi. 2017; 26(2): 183 - 189.
IEEE hur e,KÖSE BUDAK Ş,MAGDEN K,YILDIZ G,SOYALTIN U,toka b,TURAN N,ÇELİKÖRS S,ALTUNDAL B,TUNÇ A,YILMAZ A,SİVRİ A,Sezer S,DUMAN S "The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients." Türk Nefroloji Diyaliz ve Transplantasyon Dergisi, 26, ss.183 - 189, 2017.
ISNAD hur, ender vd. "The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients". Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 26/2 (2017), 183-189.