Journal Article

The assessment of fluid status in haemodialysis patients: usefulness of the Doppler echocardiographic parameters

Chih-Cheng Wu, Yao-Ping Lin, Wen-Chung Yu, Wen-Shin Lee, Tsei-Lieh Hsu, Philip Yu-An Ding and Chen-Huan Chen

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 19, issue 3, pages 644-651
Published in print March 2004 | ISSN: 0931-0509
Published online March 2004 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfg621
The assessment of fluid status in haemodialysis patients: usefulness of the Doppler echocardiographic parameters

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Background. In end-stage renal disease (ESRD) patients undergoing regular haemodialysis (HD), the maintenance of fluid status within an optimal range is critical. We therefore examined the role of Doppler echocardiographic parameters in the assessment of fluid status in these patients.

Methods. Three study groups were enrolled: 40 healthy volunteers (NTNR), 40 HD patients who were normotensive without receiving antihypertensive agents (NTHD) and 38 HD patients who had remained hypertensive (HTHD) despite antihypertensive treatment. Measurements of Doppler echocardiographic parameters from pulmonary vein (PV) and mitral inflow (Mi) were performed on a non-dialysis day. Extracellular water as a percentage of body weight (ECW%) and pre-dialysis mean blood pressure (BDMBP) were references for fluid status. The best Doppler parameter for fluid status assessment identified from the study groups was then tested in another validation groups (38 NTHD and 38 HTHD).

Results. Among all of the PV and Mi parameters, the S/D ratio (peak systolic velocity divided by peak diastolic velocity) was correlated with fluid status parameters best (with ECW%, r = –0.49, P<0.001; with BDMBP, r = –0.51, P<0.001). The correlations were independent of age, sex and Mi parameters. The receiver operating characteristics curve analysis demonstrated that an S/D ratio >1.33 had a sensitivity of 90% and a specificity of 77% in identifying NTHD patients. When the same criterion was applied to the validation groups, the positive predictive value was 64% and the negative predictive value was 86%.

Conclusion. The Doppler-derived S/D ratio is a potentially useful marker for the assessment of fluid status in HD patients.

Keywords: dry weight; echocardiography; fluid status; haemodialysis

Journal Article.  4806 words.  Illustrated.

Subjects: Nephrology

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