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- Title
Assessment of volume status of pediatric hemodialysis patients.
- Authors
Fadel, Fatina I.; Salah, Doaa M.; Mawla, Mohamed A. Abdel; Galal, Eman; Sayed, Shaimaa
- Abstract
Background: Accurate volume status assessment and dry weight achievement are the most challenging goals for a nephrologist. We aimed to evaluate the role of ultrasonographic parameters including lung ultrasound and inferior vena cava (IVC) measurements as practical methods of volume status assessment in children on hemodialysis by comparing them with established techniques, such as clinical evaluation and bioimpedance spectroscopy. Methods: A prospective cross-sectional study compared pre- and post-dialysis volume status using bioimpedance spectroscopy (BIS) parameters and clinical data with ultrasonographic lung B-lines and IVC parameters in children on regular hemodialysis. Results: A total 60 children (mean age 9.4 ± 2.8 years) were enrolled. Twenty patients (33.3%) were clinically overloaded to varying degrees (17 patients had mild to moderate signs of fluid overload and 3 patients had moderate to severe signs of fluid overload). All other patients (66.7%) were clinically euvolemic. Sonographic parameters were significantly lower post-dialysis than pre-dialysis, including lung B-line count and IVC diameter. IVC collapsibility index mean was significantly higher post-dialysis than pre-dialysis. There was a significant correlation between the lung B-line count, IVC parameters, and BIS-measured overhydration both before and after hemodialysis. Nine patients had ≥ 8 B-lines post-dialysis, only three of them were hypertensive. Conclusions: Clinical criteria alone are not specific for determining accurate fluid status in pediatric hemodialysis patients. Lung B-line score, IVC parameters, and BIS may be complementary to each other and to clinical data. Lung B-lines outperform IVC measurements and BIS in subclinical volume overload detection in pediatric hemodialysis patients.
- Subjects
VENA cava inferior; CROSS-sectional method; HYPERVOLEMIA; HYPERTENSION; HEMODIALYSIS; BLOOD volume determination; LUNGS; BIOELECTRIC impedance; HEMODYNAMICS; DESCRIPTIVE statistics; PEDIATRICS; LONGITUDINAL method; PRE-tests &; post-tests; SPECTRUM analysis; BLOOD flow measurement; WATER-electrolyte balance (Physiology); COMPARATIVE studies; CHILDREN
- Publication
Pediatric Nephrology, 2024, Vol 39, Issue 10, p3057
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-024-06409-2