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Kim MJ, Jeon JW, Kim HR, Park H, Han S, Hwang Y, Park H, Park K, Lee EJ, Ham YR, Na KR, Lee KW, Choi DE. Ratio of Extracellular to Intracellular Water Is Associated with Permanent Catheter Patency Survival in Patients Receiving Maintenance Hemodialysis. Diagnostics (Basel) 2023; 13:2545. [PMID: 37568908 PMCID: PMC10417513 DOI: 10.3390/diagnostics13152545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
Patients undergoing dialysis through a permanent catheter often experience infection or malfunction. However, few studies have clarified the predictors of permanent catheter patency survival in patients undergoing hemodialysis. We assessed the relationship between the parameters of body composition monitoring (BCM), determined before the initiation of dialysis, and the patency survival of the permanent catheters inserted in 179 patients who commenced hemodialysis between 14 January 2020 and 31 August 2021. The relationships between permanent catheter patency at 6 weeks and BCM parameters, laboratory tests, age, sex, comorbidities, and medications at baseline were studied using Kaplan-Meier survival curves. Permanent catheter patency was observed to be superior at high extracellular-to-intracellular (ECW/ICW) ratio (p < 0.005). After adjustment for covariates, the ECW/ICW ratio remained an independent factor associated with permanent catheter patency survival. When patients with non-patent catheters were subdivided into infection and malfunction groups, and the associations of BCM parameters were evaluated in those groups, the ECW/ICW ratio was not significantly associated with permanent catheter patency survival in the infection group (p = 0.327); instead, a significant association was found for the lean tissue index (p < 0.001). In the malfunction group, the ECW/ICW ratio remained significantly associated with permanent catheter patency survival (p < 0.001).
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Affiliation(s)
- Moo-Jun Kim
- Department of Nephrology, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea; (M.-J.K.); (J.-W.J.); (H.-R.K.)
| | - Jae-Wan Jeon
- Department of Nephrology, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea; (M.-J.K.); (J.-W.J.); (H.-R.K.)
| | - Hae-Ri Kim
- Department of Nephrology, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea; (M.-J.K.); (J.-W.J.); (H.-R.K.)
| | - Hyerim Park
- Department of Medical Science, Chungnam National University, Daejeon 35015, Republic of Korea;
| | - Suyeon Han
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (S.H.); (Y.H.); (H.P.); (K.P.); (E.-J.L.); (Y.-R.H.); (K.-W.L.)
| | - Yunkyeong Hwang
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (S.H.); (Y.H.); (H.P.); (K.P.); (E.-J.L.); (Y.-R.H.); (K.-W.L.)
| | - Heewon Park
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (S.H.); (Y.H.); (H.P.); (K.P.); (E.-J.L.); (Y.-R.H.); (K.-W.L.)
| | - Kyungho Park
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (S.H.); (Y.H.); (H.P.); (K.P.); (E.-J.L.); (Y.-R.H.); (K.-W.L.)
| | - Eu-Jin Lee
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (S.H.); (Y.H.); (H.P.); (K.P.); (E.-J.L.); (Y.-R.H.); (K.-W.L.)
| | - Young-Rok Ham
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (S.H.); (Y.H.); (H.P.); (K.P.); (E.-J.L.); (Y.-R.H.); (K.-W.L.)
| | - Ki-Ryang Na
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (S.H.); (Y.H.); (H.P.); (K.P.); (E.-J.L.); (Y.-R.H.); (K.-W.L.)
| | - Kang-Wook Lee
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (S.H.); (Y.H.); (H.P.); (K.P.); (E.-J.L.); (Y.-R.H.); (K.-W.L.)
| | - Dae-Eun Choi
- Department of Medical Science, Chungnam National University, Daejeon 35015, Republic of Korea;
- Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (S.H.); (Y.H.); (H.P.); (K.P.); (E.-J.L.); (Y.-R.H.); (K.-W.L.)
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Zschätzsch S, Stauss-Grabo M, Gauly A, Braun J. Integrating Monitoring of Volume Status and Blood Volume-Controlled Ultrafiltration into Extracorporeal Kidney Replacement Therapy. Int J Nephrol Renovasc Dis 2021; 14:349-358. [PMID: 34511978 PMCID: PMC8416185 DOI: 10.2147/ijnrd.s319911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/13/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Volume management in hemodialysis (HD) requires the ability to assess volume status objectively and determine treatment strategies that achieve euvolemia without compromising hemodynamic stability. The aim of this study was to compare dialysis with and without blood volume-controlled ultrafiltration (UF) in combination with body composition monitoring, and to evaluate indicators for adequate dialysis (Kt/V), ultrafiltration volume, fluid status, and the occurrence of intradialytic morbid events (IME). Patients and Methods Patients undergoing hemodialysis or on-line hemodiafiltration with support of a blood volume monitor (BVM) - a feedback control device integrated into the 5008 and 6008 HD systems - were enrolled. Patients received treatment for four weeks using the 6008 CAREsystem and the BVM (6008+). Data on dialysis dose (Kt/V), UF volume and predialysis fluid status were documented. This data was also documented retrospectively for four weeks with (5008+) and without (5008-) the use of the BVM with the 5008 system. Comparisons were analyzed using linear mixed models. Results Twenty-four patients were enrolled. Kt/V was unaffected by blood volume-controlled UF (5008- vs 5008+: p=0.230) and was equally achieved with both HD systems (5008+ vs 6008+: p=0.922). The UF volume and fluid status achieved were comparable, independent of the use of UF control with BVM (5008- vs 5008+; UF volume: p=0.166; fluid overload: p=0.390) or the HD system (5008+ vs 6008+: UF volume: p=0.003; fluid overload: p=0.838), except for UF volume being higher in the 6008+ phase. IMEs occurred in less than 3% of treatments, with no difference between study phases. Conclusion This study demonstrates that a clinical approach to kidney replacement therapy that tracks volume status and manages intradialytic fluid removal by blood volume-controlled UF delivers adequate dialysis without compromising fluid removal. It maintains volume status and ensures low incidence of IMEs.
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Affiliation(s)
- Sebastian Zschätzsch
- Center for Kidney and Blood Pressure Diseases, Georg-Haas-Dialysis Center, Giessen, Germany
| | | | - Adelheid Gauly
- Fresenius Medical Care, Global Medical Office, Bad Homburg, Germany
| | - Jennifer Braun
- Fresenius Medical Care, Global Medical Office, Bad Homburg, Germany
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