Suksai Nottawan, Yongsiri Somchai, Witoon Raweewan, Chueansuwan Rachaneeporn, Juttuporn Anothai
Division of Gastroenterology, Department of Medicine, Burapha University, Chonburi, Thailand.
Division of Nephrology, Department of Medicine, Burapha University, Chonburi, Thailand.
Hepatol Forum. 2025 Feb 18;6(2):57-61. doi: 10.14744/hf.2024.2024.0044. eCollection 2025.
The impact of fluid status changes on liver stiffness measurements (LSM) using transient elastography (TE) in dialysis patients remains unclear. This study aimed to evaluate LSM variations during hemodialysis (HD) and analyze contributing factors.
A cross-sectional study was conducted on dialysis patients at a tertiary care hospital. TE and bioelectrical impedance analysis were performed at four time points: before dialysis, immediately after, the first day after, and the second day after dialysis. LSM values were compared across these time points.
Seventy patients were enrolled, with two cases showing consistently extremely elevated LSM values exceeding 20 kPa, considered outliers. The mean LSM values were 7.6±7.0 kPa before dialysis, 6.12±2.94 kPa immediately after, 6.64±5.27 kPa on the first day, and 6.94±5.12 kPa on the second day after dialysis. The mean pre-HD LSM was significantly higher than immediately after and on the first day after dialysis, with mean differences of 1.54 kPa (95% CI 0.22-2.86, p=0.02) and 1.02 kPa (95% CI 0.15-1.9, p=0.02), respectively. The ultrafiltration volume positively correlated with the LSM difference pre- and post-HD (r=0.315, p=0.008). Patients with residual fluid overload had significantly higher post-HD LSM compared to euvolemic patients (p=0.003).
LSM values significantly decreased after dialysis and remained lower for up to 24 hours. Transient elastography should preferably be performed within 24 hours post-dialysis when the patient is in a euvolemic state.
透析患者中，液体状态变化对使用瞬时弹性成像（TE）测量肝脏硬度值（LSM）的影响尚不清楚。本研究旨在评估血液透析（HD）期间LSM的变化并分析相关影响因素。
在一家三级护理医院对透析患者进行了一项横断面研究。在四个时间点进行TE和生物电阻抗分析：透析前、透析后即刻、透析后第一天和透析后第二天。比较这些时间点的LSM值。
共纳入70例患者，其中2例患者的LSM值持续极高，超过20 kPa，被视为异常值。透析前LSM的平均值为7.6±7.0 kPa，透析后即刻为6.12±2.94 kPa，透析后第一天为6.64±5.27 kPa，透析后第二天为6.94±5.12 kPa。透析前LSM的平均值显著高于透析后即刻和透析后第一天，平均差值分别为1.54 kPa（95%CI 0.22 - 2.86，p = 0.02）和1.02 kPa（95%CI 0.15 - 1.9，p = 0.02）。超滤量与透析前后LSM差值呈正相关（r = 0.315，p = 0.008）。与血容量正常的患者相比，仍有液体超负荷的患者透析后LSM显著更高（p = 0.003）。
透析后LSM值显著降低，且在长达24小时内保持较低水平。当患者处于血容量正常状态时，最好在透析后24小时内进行瞬时弹性成像检查。
