Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won, S. Korea.
Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Kang-won, S. Korea.
PLoS One. 2018 Apr 9;13(4):e0195202. doi: 10.1371/journal.pone.0195202. eCollection 2018.
Echocardiography is the most valuable tool for assessing cardiac abnormalities of chronic kidney disease (CKD) patients even though it has its limitations, including high equipment cost and the need for specialized personnel. Assessment of volume status is important not only for volume management, but also for prevention of cardiovascular disease of the CKD patients. Recently, bioimpedance is gaining acceptance as a way to quantitatively assess patient hydration status at bedside.
127 patients who were admitted for planning their first dialysis treatment were enrolled. The echocardiography and bioimpedance spectroscopy (BIS) were performed. The association between echocardiographic data and clinical values such as NT-proBNP and OH/ECW was examined.
OH/ECW, which indicates relative fluid overload, was positively associated with LA dimension (r = 0.25, P = 0.007), LAVI (r = 0.32, P < 0.001), and E/e´ ratio (r = 0.38, P < 0.001). While OH/ECW was not significantly associated with echocardiographic values such as LVEDD, LVEDV, LVMI, and LVEF, NT-proBNP were significantly associated with all echocardiographic parameters. Multivariate logistic regression analysis showed E/e´ ratio (odds ratio, 1.14 [95% confidence interval (CI), 1.01 to 1.29]; P = 0.031), NT-proBNP (odds ratio, 4.78 [95% CI, 1.51 to 15.11]; P = 0.008), and albumin (odds ratio, 0.22 [95% CI, 0.08 to 0.66]; P = 0.007) were significantly associated with OH/ECW.
Since OH/ECW measured by BIS is associated with echocardiographic parameters related to diastolic dysfunction, preliminary screening through laboratory findings, including serum albumin in conjunction with OH/ECW and NT-proBNP, may find patient with risk of diastolic dysfunction. Our study suggests that a timely detection of fluid overload in patients with CKD as well as their proper treatment may help reduce diastolic dysfunction. Further research may be needed to validate the consistency of this association across other stages of CKD.
即使超声心动图存在设备成本高和需要专业人员等局限性，它仍是评估慢性肾脏病（CKD）患者心脏异常的最有价值的工具。评估容量状态不仅对容量管理很重要，而且对预防 CKD 患者的心血管疾病也很重要。最近，生物阻抗法作为一种床边定量评估患者水化状态的方法正在被接受。
共纳入 127 名因计划首次透析治疗而入院的患者。进行了超声心动图和生物阻抗谱（BIS）检查。检查了超声心动图数据与 NT-proBNP 和 OH/ECW 等临床值之间的关系。
OH/ECW （提示相对液体过载）与左心房内径（r = 0.25，P = 0.007）、左心房容积指数（r = 0.32，P < 0.001）和 E/e´ 比值（r = 0.38，P < 0.001）呈正相关。虽然 OH/ECW 与 LVEDD、LVEDV、LVMI 和 LVEF 等超声心动图值无显著相关性，但 NT-proBNP 与所有超声心动图参数均显著相关。多变量逻辑回归分析显示 E/e´ 比值（比值比，1.14 [95%置信区间（CI），1.01 至 1.29]；P = 0.031）、NT-proBNP（比值比，4.78 [95%CI，1.51 至 15.11]；P = 0.008）和白蛋白（比值比，0.22 [95%CI，0.08 至 0.66]；P = 0.007）与 OH/ECW 显著相关。
由于 BIS 测量的 OH/ECW 与舒张功能障碍相关的超声心动图参数相关，因此通过实验室检查（包括血清白蛋白）联合 OH/ECW 和 NT-proBNP 进行初步筛查，可能会发现舒张功能障碍风险的患者。我们的研究表明，及时发现 CKD 患者的液体过载并进行适当的治疗可能有助于减少舒张功能障碍。可能需要进一步的研究来验证这种关联在 CKD 的其他阶段的一致性。
