Hussein Usama, Cimini Monica, Handelman Garry J, Raimann Jochen G, Liu Li, Abbas Samer R, Kotanko Peter, Levin Nathan W, Finkelstein Fredric O, Zhu Fansan
Renal Research Institute, New Haven, Connecticut.
Renal Research Institute, New York, New York.
J Appl Physiol (1985). 2022 Jul 1;133(1):205-213. doi: 10.1152/japplphysiol.00645.2021. Epub 2022 Jun 2.
Diagnosis of fluid overload (FO) in early stage is essential to manage fluid balance of patients with chronic kidney disease (CKD) and to prevent cardiovascular disease (CVD). However, the identification of fluid status in patients with CKD is largely dependent on the physician's clinical acumen. The ratio of fluid overload to extracellular volume (FO/ECV) has been used as a reference to assess fluid status. The primary aim of this study was to compare FO/ECV with other bioimpedance methods and clinical assessments in patients with CKD. Whole body ECV, intracellular volume (ICV), total body water (TBW), and calf normalized resistivity (CNR) were measured (Hydra 4200). Thresholds of FO utilizing CNR and ECV/TBW were derived by receiver operator characteristic (ROC) analysis based on data from pooled patients with CKD and healthy subjects (HSs). Clinical assessments of FO in patients with CKD were performed by nephrologists. Patients with CKD (stage 3 and stage 4) ( = 50) and HSs ( = 189) were studied. The thresholds of FO were ≤14.3 (10 Ωm/kg) for females and ≤13.1 (10 Ωm/kg) for males using CNR and ≥0.445 in females and ≥0.434 in males using ECV/TBW. FO was diagnosed in 78%, 62%, and 52% of patients with CKD by CNR, FO/ECV, and ECV/TBW, respectively, whereas only 24% of patients with CKD were diagnosed to be FO by clinical assessment. The proportion of FO in patients with nondialysis CKD was largely underestimated by clinical assessment compared with FO/ECV, CNR, and ECV/TBW. CNR and FO/ECV methods were more sensitive than ECV/TBW in identifying fluid overload in these patients with CKD. We found that fluid overload (FO) in patients with nondialysis CKD was largely underestimated by clinical assessment compared with bioimpedance methods, which was majorly due to lack of appropriate techniques to assess FO. In addition, although degree of FO by bioimpedance markers positively correlated with the age in healthy subjects (HSs), no difference was observed in the three hydration markers between groups of 50 ≤ age <70 yr and age ≥70 yr in the patients with CKD.
早期诊断液体超负荷（FO）对于管理慢性肾脏病（CKD）患者的液体平衡以及预防心血管疾病（CVD）至关重要。然而，CKD患者液体状态的识别很大程度上依赖于医生的临床敏锐度。液体超负荷与细胞外液量之比（FO/ECV）已被用作评估液体状态的参考指标。本研究的主要目的是比较CKD患者的FO/ECV与其他生物电阻抗方法及临床评估结果。测量了全身ECV、细胞内液量（ICV）、总体水（TBW）和小腿归一化电阻（CNR）（Hydra 4200）。基于合并的CKD患者和健康受试者（HSs）的数据，通过受试者工作特征（ROC）分析得出利用CNR和ECV/TBW诊断FO的阈值。由肾病科医生对CKD患者进行FO的临床评估。研究了50例CKD（3期和4期）患者及189例HSs。利用CNR诊断女性FO的阈值为≤14.3（10 Ωm/kg），男性为≤13.1（10 Ωm/kg）；利用ECV/TBW诊断女性FO的阈值为≥0.445，男性为≥0.434。分别通过CNR、FO/ECV和ECV/TBW诊断出78%、62%和52%的CKD患者存在FO，而通过临床评估仅诊断出24%的CKD患者存在FO。与FO/ECV、CNR和ECV/TBW相比，临床评估对非透析CKD患者中FO的比例有很大程度的低估。在识别这些CKD患者的液体超负荷方面，CNR和FO/ECV方法比ECV/TBW更敏感。我们发现，与生物电阻抗方法相比，临床评估对非透析CKD患者的液体超负荷（FO）有很大程度的低估，这主要是由于缺乏评估FO的合适技术。此外，尽管生物电阻抗标记物所显示的FO程度在健康受试者（HSs）中与年龄呈正相关，但在CKD患者中，年龄在50≤年龄<70岁组和年龄≥70岁组之间，三种水合标记物未观察到差异。
