Introduction:
The concept of dry weight in patients of CKD stage 5D has been changed to target body weight and it is defined as a weight which is achieved after removal of excess body fluid and below which fluid removal would cause hypotension and muscle cramp. This target body weight can be achieved by optimum ultrafiltrate removal during hemodialysis. Optimization of UF can be done by the presence of lung B lines or by measuring total body water by bioimpedance analysis.
Methods:
30 patients were taken from tertiary care hospital who are CKD stage 5 and on maintenance hemodialysis . Out of 10 patients had urine output more than 1 liter and rest are anuric.
These patients were divided in two equal groups. One group( 15 patients) got first 4 weeks of HD where UF removal was determined by number of B lines and next 4 weeks it was determined by BIA(percentage of total body water). In other group( other 15 patients) First 4 weeks was by BIA and next 4 weeks by lung ultrasound.
Results were based on better achievement of Target body weight ( without any muscle cramp or intradialytic hypotension or features of volume overload ) and achievement of optimum Lung B lines( <5) , IVC collapsibility index(>50%) and optimum Total body water ( 58-62% of body weight)
Inclusion criteria :- All male CKD 5D aged more than 18 years with duration of dialysis more than 3 months getting HD on 3 times per week.
Exclusion criteria EF <40%, anemia( Hb <7), .
Objectives:
To compare the performance of bioimpedance analysis and real time ultrasound with respect to volume assessment parameters in CKD stage 5 patients who are in maintenance hemodialysis
Results:
Out of 30 patients , 17(56%) patients achieved better target body weight by lung ultrasound with B-lines of 4-8, IVC collapsibility index between 50% to 55% and total body water of 58 to 66% of body weight. Out of these 17 patients , only 3 patients had urine output more than 1 liter.
Other 10(33%) patients had achieved better Target Body weight by bioimpedance analysis on the basis of total body water. Out of these10 people 4 had urine output more than 1 liter. In these patients Total body water was in the range of 57 to 62 % , B lines are 7 to 12 and IVC collapsibility was 45 to 50%.
Rest 3(10%) patients did not achieve better Target Body weight by means of either Lung ultrasound or Bioimpedance analysis. In all three patients urine output was more than 1 liter but their lung ultrasound showed 5 to 8 B lines and TBW was also above the target range. In all these 30 patients , reduction of BP was better correlated with number of B lines with correlation coefficient of 0.76 whether TBW reduction was less correlated with reduction of BP with coefficient of 0.56.
Conclusions:
1.At the end of the study, we can not conclude that lung ultrasound is better method in removing ultrafiltrate over bioimpedance analysis but for this study lung ultrasound could determine better target body weight in more number of patients on maintenance hemodialysis over bioimpedance analysis .and clinical hydration status like presence of edema also determined UF removal in very small number of patients. ( 10%) .
2. Reduction of Bp is more correlated( coefficient- 0.76) with reduction of B lines than reduction of total body water ( coefficient -0.56)
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.