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Optimal fluid control can normalize cardiovascular risk markers and limit left ventricular hypertrophy in thrice weekly dialysis patients
Author(s) -
Velasco Nestor,
Chamney Paul,
Wabel Peter,
Moissl Ulrich,
Imtiaz Toufeeq,
Spalding Elaine,
McGregor Mark,
Innes Andrew,
MacKay Ian,
Patel Rajan,
Jardine Alan
Publication year - 2012
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/j.1542-4758.2012.00689.x
Subject(s) - medicine , left ventricular hypertrophy , cardiology , ambulatory blood pressure , brain natriuretic peptide , troponin complex , troponin t , blood pressure , pressure overload , hemodialysis , population , muscle hypertrophy , troponin , heart failure , cardiac hypertrophy , myocardial infarction , environmental health
Increased hemodialysis frequency can make fluid overload easier to treat, although most patients are still treated thrice weekly. Chronic fluid overload is associated with left ventricular hypertrophy and elevated serum cardiac biomarkers, recognized as mortality risk factors. Serum cardiac troponin T ( cTnT ), N ‐terminal prohormone brain natriuretic peptide ( NT ‐pro BNP ), left ventricular mass index by cardiac magnetic imaging, and ambulatory blood pressure was measured in 30 thrice weekly hemodiafiltration patients. Time‐averaged fluid overload ( TAFO ) was quantified by bioimpedance spectroscopy. In the study group, left ventricular hypertrophy was found to be 26% by cardiac magnetic resonance. Ambulatory blood pressure was 130 mmHg (112–151) requiring a low equivalent dose of medication of 0.25 units (0–1). Significantly, lower levels of left ventricular mass index ( P < 0.05) were associated in those patients with TAFO <1 L or NT ‐pro BNP <1200 pg/ mL or cTnT <0.1 ug/ L . In the subgroups, 16 patients had normal cTnT (<0.03 ug/ L ), 16 patients had NT ‐pro BNP <400 pg/ mL , and 20 patients had TAFO <1 L . Nine patients had both cTnT <0.03 ug/ L and NT ‐pro BNP <400 pg/ mL . Normally hydrated thrice‐weekly hemodiafiltration patients can have cardiac biomarker and TAFO levels indistinguishable from the normal healthy population. Obtaining TAFO by bioimpedance monitoring can offer a practical alternative to serum cardiac biomarkers.