FP619FLUID STATUS ASSESSMENT IN CHRONIC HEMODIALYSIS PATIENTS AND COMPARISON OF NEWER TECHNIQUES

Abstract

Introduction and Aims: Hydration status control is an important constituent of an adequate and efficient hemodialysis (HD) treatment, while there are not precise clinical indices, to early recognize small changes in fluid status of patients undergoing chronic haemodialysis therapy. Recently, newer methods have been developed to evaluate hyperhydration before and after HD, while the ultrasound (US) lung comet score (ULCs), offered a suitable new technique. The aim of this study was to evaluate and compare the accuracy of newer available techniques for the estimation of the hydration status of patients undergoing haemodialysis; the Inferior Vena Cava diameter (VCD), the Bioelectrical Impedance Analysis (BIA), the Continuous blood volume monitoring (CRIT‐LINE) and Ultrasound Lung Comet score (ULCs). Methods: A total of 53 patients (age 63.4 ± 14.4 years, dialysis duration 6.9 ± 8.3 years) undergoing chronic haemodialysis thrice weekly were included in the study. The evaluation of hydration status methods was applied thrice weekly before and after HD. For the assessment of the inferior vena cava diameter (IVCD) M‐mode method with Vivid 3 ultrasound unit was applied while a 2D display technique with Vivid 3 ultrasound unit was applied for the Ultrasound Lung Comet score (ULCs). Over hydration was estimated by BIA method with BCM‐Body Composition Monitor (Fresenius Medical Care (FMC) Deutschland GmbH) and Continuous blood volume monitoring with the CRIT‐LINE III System (FMC). Comparison of methods was performed with ROC curve analysis, also with comparison of Areas Under the Curve using the nonparametric Friedman test (a two‐way analysis on ranks) followed by Dunn's post‐hoc test for multiple comparisons. Results: According to the results of IVCD (as the gold standard method), the measurements were divided in hyper‐hydrated: 39 (25.52%), hypo‐hydrated: 41 (25.78%) and normal hydration status: 79 (49.68%). The AUC of ULCs was significantly higher than the AUC of BIA (0.813 vs 0.707, p = 0.032) and CRIT‐LINE (0.813 vs 0.609, p = 0.001) for hyperhydration. However, both BIA and CRIT‐LINE had higher sensitivity than ULCs, but much lower specificity. Additionally for the hypohydration status the AUC of ULCs was significantly higher than the AUC of BIA (0.831 vs 0.758, p = 0.035) and CRIT‐LINE (0.831 vs 0.504, p < 0.001) and had higher sensitivity and specificity than BIA and CRIT‐LINE. Furthermore Post hoc multiple comparison tests revealed that the AUC of VCD was not significantly different from the AUC of ULC. However, in all other cases the AUCs were found significantly different. In the case of hyperhydration the sensitivity and specificity of ULCs, BIA, CRIT‐LINE were 76.9 and 74.2, 89.7 and 45.0, 82.1 and 39.2, respectively. Thus, no difference could be demonstrated between IVCD and ULCs in evaluating the fluid status of HD patients, while comparing BIA to CRIT‐LINE, BIA appeared to be more dependable method. Conclusions: These findings indicate that ULCs is a valuable and easily performed newer technique for the accurate evaluation of dry weight and fluid status in ESRD patients undergoing chronic HD, that might help to recognize an asymptomatic lung congestion in these patients.