Document Detail

Towards improved cardiovascular management: the necessity of combining blood pressure and fluid overload.
MedLine Citation:
PMID:  18458032     Owner:  NLM     Status:  MEDLINE    
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 (DeltaHS). Pre-dialysis systolic blood pressure (BPsys) and DeltaHS was analysed in 500 haemodialysis patients from eight dialysis centres. A graphical tool (HRP-hydration reference plot) was devised allowing DeltaHS 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 DeltaHS in the normal range. Approximately one-third of patients (n = 133) exhibited reasonable control of BPsys and fluids (BPsys <150 mmHg and DeltaHS <2.5 L). In only 15% of patients (n = 74) was hypertension observed (BPsys >150 mmHg) with a concomitant DeltaHS >2.5 L (possible volume-dependent hypertension). In contrast, 13% of patients (n = 69) were hypertensive with DeltaHS <1.1 L (possible essential hypertension). In 10% of patients (n = 52), BPsys <140 mmHg was recorded despite DeltaHS exceeding 2.5 L. CONCLUSION: Our study illustrated the wide variability in BPsys regardless of the degree of DeltaHS. The HRP provides an invaluable tool for classifying patients in terms of BPsys and DeltaHS 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.
Peter Wabel; Ulrich Moissl; Paul Chamney; Tomas Jirka; Petr Machek; Pedro Ponce; Petr Taborsky; Ciro Tetta; Nestor Velasco; Jiri Vlasak; Wojciech Zaluska; Volker Wizemann
Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2008-05-05
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  23     ISSN:  1460-2385     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-08-19     Completed Date:  2009-02-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  2965-71     Citation Subset:  IM    
Research & Development, Fresenius Medical Care D GmbH, Daimlerstrasse 15, D-61352 Bad Homburg, Germany.
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MeSH Terms
Cardiovascular Diseases / prevention & control*
Fluid Therapy
Hypertension / epidemiology,  prevention & control*
Kidney Failure, Chronic / epidemiology,  therapy
Middle Aged
Renal Dialysis* / methods

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