Hemodiyaliz hastalarında hipervoleminin gösterilmesinde biyoimpedans spektroskopinin yeri
Küçük Resim Yok
Tarih
2011
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ: Hemodiyaliz (HD) hastalarında volüm durumunun değerlendirilmesi için güvenilir, pratik, ucuz bir yönteme gereksinim vardır. Bu çalışmada, HD hastalarında hipervolemiyi saptamada biyoimpedans spektroskopinin (BİS) etkinliği araştırıldı. GEREÇ ve YÖNTEMLER: İki merkezden 172 HD hastası çalışmaya alındı. Ekokardiyografi, 48 saatlik ayaktan kan basıncı ölçümü, BİS temeline dayalı (50 frekans) dayalı (Body Composition Monitor) olarak vücut kompozisyon analizi yapıldı. Litre olarak aşırı sıvı yükü (OH), hücre dışı su (ESS) ve OH/ESS oranı volüm göstergeleri olarak kullanıldı. BULGULAR: Hastaların yaş ortalaması 52±13 yıl, HD süresi 60±43 ay, %41'i kadın, %17'si diyabetikti. Ortalama sol ventrikül kitle indeksi (LVKi) 159±42 gr/m2 bulundu ve hastaların %77'sinde sol ventrikül hipertrofisi (SVH) vardı. Ortalama OH ve OH/ESS oranı sırasıyla 2,1±1,6 L ve %11±8 idi. OH/ESS oranının; gündüz sistolik kan basıncı (KB) (r:0,383, p<0,0001), gece sistolik KB (r:0,380, p<0,0001), 48-saatlik nabız basıncı (r:0,413, p<0,0001), sol atrium indeksi (SAi) (r:0,301, p<0,0001), SVKi (r:0,378, p<0,0001) ve ejeksiyon fraksiyonu (EF) (r:-0,239, p:0,002) ile ilişkisi vardı. OH/ESS oranı %5'in altında olanların kardiyovasküler risk profili daha iyiydi. Doğrusal regresyon analizinde OH/ESS oranı SAi (t:3,00, p:0,003), SVKi (t:2,77, p:0,006) ve EF (t:-2,34, p:0,02) için bağımsız bir risk etkeniydi. SONUÇ: Hemodiyaliz hastalarının volüm durumunun belirlenmesinde BİS güvenilir bir yöntemdir. BİS ile ölçülen OH/ESS sol atrium çapı, sol ventrikül kitlesi ve ejeksiyon fraksiyonunun ana belirleyicisidir. %5'in altındaki OH/ESS değeri kabul edilebilir kan basıncı kontrolü ve daha iyi kardiyak durumla birliktedir.
INTRODUCTION: A practical, inexpensive and reliable method is needed for assessment of volume status in hemodialysis (HD) patients. In this study the efficiency of bioimpedance spectroscopy (BIS) for detection of hypervolemia was investigated. MATERIAL and METHODS: A total of 172 prevalent HD patients were enrolled from 2 centers. Echocardiography, 48-hours ambulatory blood pressure (BP) measurement, and body composition analysis using the BIS technique (50 frequencies) (Body Composition Monitor) were performed. Overhydration (OH) and extracellular water (ECW) in liters, and the OH/ECW ratio were used as volume indices. RESULTS: The mean age was 52±13 years and HD duration 60±43 months. Of the cases, 41% were female, 17% were diabetic. The mean left ventricular mass index (LVMi) was 159±42 gr/m2 and 77% of the patients had left ventricular hypertrophy (LVH). The mean OH and OH/ECW ratio were 2.1±1.6 L and 11±8%, respectively. OH/ECW ratio was correlated with day-time systolic BP (r:0.383, p<0.0001), night-time systolic BP (r:0.380, p<0.0001), pulse pressure-48h (r:0.413, p<0.0001), left atrium index (LAi) (r:0.301, p<0.0001), LVMi (r:0.378, p<0.0001) and ejection fraction (EF) (r:-0.239, p:0.002). Patients with OH/ECW ratio lower than 5% had favorable cardiovascular risk profile. On linear regression analysis, the OH/ECW ratio was an independent risk factor for LAi (t:3.00, p:0.003), LVMi (t:2.77, p:0.006) and EF (t:-2.34, p:0.02). CONCLUSION: Bioimpedance spectroscopy is a reliable method to evaluate volume status in HD patients. OH/ECW measured by BIS is a major determinant of left atrial diameter, left ventricular mass and ejection fraction. An OH/ECW value less than 5% is associated with acceptable blood pressure control and better cardiac condition.
INTRODUCTION: A practical, inexpensive and reliable method is needed for assessment of volume status in hemodialysis (HD) patients. In this study the efficiency of bioimpedance spectroscopy (BIS) for detection of hypervolemia was investigated. MATERIAL and METHODS: A total of 172 prevalent HD patients were enrolled from 2 centers. Echocardiography, 48-hours ambulatory blood pressure (BP) measurement, and body composition analysis using the BIS technique (50 frequencies) (Body Composition Monitor) were performed. Overhydration (OH) and extracellular water (ECW) in liters, and the OH/ECW ratio were used as volume indices. RESULTS: The mean age was 52±13 years and HD duration 60±43 months. Of the cases, 41% were female, 17% were diabetic. The mean left ventricular mass index (LVMi) was 159±42 gr/m2 and 77% of the patients had left ventricular hypertrophy (LVH). The mean OH and OH/ECW ratio were 2.1±1.6 L and 11±8%, respectively. OH/ECW ratio was correlated with day-time systolic BP (r:0.383, p<0.0001), night-time systolic BP (r:0.380, p<0.0001), pulse pressure-48h (r:0.413, p<0.0001), left atrium index (LAi) (r:0.301, p<0.0001), LVMi (r:0.378, p<0.0001) and ejection fraction (EF) (r:-0.239, p:0.002). Patients with OH/ECW ratio lower than 5% had favorable cardiovascular risk profile. On linear regression analysis, the OH/ECW ratio was an independent risk factor for LAi (t:3.00, p:0.003), LVMi (t:2.77, p:0.006) and EF (t:-2.34, p:0.02). CONCLUSION: Bioimpedance spectroscopy is a reliable method to evaluate volume status in HD patients. OH/ECW measured by BIS is a major determinant of left atrial diameter, left ventricular mass and ejection fraction. An OH/ECW value less than 5% is associated with acceptable blood pressure control and better cardiac condition.
Açıklama
Anahtar Kelimeler
Cerrahi
Kaynak
Türk Nefroloji Diyaliz ve Transplantasyon Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
20
Sayı
3
