SP464BIOIMPEDANCE SPECTROSCOPY VOLUME STATUS MONITORING AND HYPERTENSION IN HEMODIALYSIS PATIENTS: A PROSPECTIVE RANDOMIZIED STUDY

Abstract

Introduction and Aims: Hypertension in chronic hemodialysis (HD) patients ( pts) is volume dependent on up to 80% of cases. Volume assessment by bioimpedance spectroscopy (BIS) could be more accurate and better target for the treatment then just clinically assessed dry weight (DW). The studies have shown that the relative over hydration (ROH) of HD pts above 15% of their total body extracellular water (ECW), poses increased mortality risk in this population. The concept of the Active Fluid Management (AFM) has been developed and proposed for better control of ECW and less CV complications. This randomized, prospective, blinded, single‐center study was aimed to evaluate the impact of active fluid management (AFM) assessed by BIS on hypertension control in HD pts during nine‐month period. Methods: Study included 59 BIS naive HD pts. BIS was performed by Body Composition Monitor (BCM). In the 1. (active) group according with AFM concept, this measurement has been done every time when their average weekly over hydration (AWOH) exceeded 15% of their normal extracellular volume (ECW) and their DW was time adjusted according to the finding along with clinical judgment. In the 2. (control) group, BIS has been performed monthly and its results did not influence the clinical assessment of their DW. We registered the average blood pressure of 6 successive dialysis measurements before and after dialysis sessions, as well as the number of antihypertensive (AHT) drugs, their equivalent dose (ED) units and N‐terminal brain natriuretic peptide (NTpro‐BNP) at the start and after 9 months. Results: The study included 31 pts (20 males) in the 1. group and 28 pts (18 males) in the 2. group. Patients from both groups were of similar age and HD vintage. The most frequent underling kidney disease was Hypertensive nephropathy in both groups. The pre‐HD mean arterial blood pressure (MAP) was significantly lower in the 1. group at the end of the study, as well as the number of (AHT) drugs and their ED units (Table 1). At the start of the study AWOH < 15% has 54,8% of 1. group and 64.3% in the 2. group. After 9 months, this target achieved 91.3% pts in 1. group, but only 35.7% in 2. group. The AWOH >15% at the end of the study correlated with worsening of NT‐proBNP for > 1400 pg/ml (ROC curve, area 0.758; p= 0.005; CI 95% 0.582 ‐ 0.933) (Figure 1). Conclusions: Active fluid management by bioimpedance spectroscopy proved to be an easy and very helpful tool for control of hypertension in HD patients. (Table Presented).