Department of Nephrology, University Hospital Carl Gustav Carus, Dresden.
Nephrol Dial Transplant. 2010 Feb;25(2):545-51. doi: 10.1093/ndt/gfp517. Epub 2009 Oct 6.
Dry weight assessment (DWA) is essential to efficient therapy of haemodialysis (HD) patients. However, so far objective methods for DWA have not been applicable to daily routine. Thus, exact fluid management in HD remains difficult and is often based on clinical criteria. The aims of this study were (1) to objectively define pre- and post-dialytic ranges of extracellular volume in a large cohort of HD patients (in whom DWA had been defined according to clinical criteria), (2) to compare the hydration status between diabetic and non-diabetic patients, and (3) to assess a patient subgroup that might benefit from correction of target weight.
We measured fluid overload (FO) prior to a mid-week HD session in 370 randomly selected HD patients (50% with diabetes) from five dialysis centres. A new bioimpedance spectroscopy (BIS) device that implies a validated body composition model was applied. This tool allows correct quantification of extracellular FO or - deficiency in comparison to a healthy reference population (normal range -1.1 to 1.1 L according to the 10th and 90th percentile of measurements). In addition, weight and blood pressure were recorded before and after treatment.
Pre-dialytic FO ranged from -0.5 to 4 L and post-dialytic FO from -2.5 to 2 L (10th and 90th percentile of measurements), indicating that on average the hydration status of healthy subjects is considered as the optimal target weight in HD patients. Comparison of FO between diabetic and non-diabetic patients revealed no difference. Based on the consideration that an FO < -1.1 L before and >1.1 L after HD indicates inadequate DWA, we identified 98 (26%) patients who might benefit from correction of target body weight.
BIS is an interesting, objective method to support clinical DWA. Further studies should be performed to investigate beneficial clinical effects of this approach.
干体重评估（DWA）对于血液透析（HD）患者的有效治疗至关重要。然而，到目前为止，DWA 的客观方法还不能适用于日常常规。因此，HD 中的精确液体管理仍然很困难，并且通常基于临床标准。本研究的目的是：（1）在大量 HD 患者（根据临床标准定义了 DWA）中客观地定义透析前和透析后细胞外体积的范围；（2）比较糖尿病患者和非糖尿病患者的水化状态；（3）评估可能受益于目标体重校正的患者亚组。
我们在五个透析中心随机选择了 370 名 HD 患者（50%患有糖尿病），在每周中期 HD 治疗前测量了液体超负荷（FO）。应用了一种新的生物阻抗谱（BIS）设备，该设备应用了经过验证的身体成分模型。与健康参考人群（根据测量的第 10 和第 90 百分位数，正常范围为-1.1 至 1.1 L）相比，该工具可以正确量化细胞外 FO 或缺乏。此外，在治疗前后记录体重和血压。
透析前 FO 范围为-0.5 至 4 L，透析后 FO 范围为-2.5 至 2 L（测量的第 10 和第 90 百分位数），这表明平均而言，健康受试者的水合状态被认为是 HD 患者的最佳目标体重。糖尿病患者和非糖尿病患者之间的 FO 比较没有差异。基于在 HD 之前和之后的 FO < -1.1 L 和> 1.1 L 表明 DWA 不足的考虑，我们确定了 98（26%）名可能受益于目标体重校正的患者。
BIS 是支持临床 DWA 的一种有趣的客观方法。应进行进一步的研究，以调查这种方法的有益临床效果。
