Modern Tools for Optimizing Fluid Management in Dialysis Patients: a Comprehensive Review

Overview

Journal BMC Nephrol

Publisher Biomed Central

Specialty Nephrology

Date 2024 Dec 19

PMID 39696062

Authors

Sharad Patel

Sandhya Ashokkumar

Adam Green

Affiliations

Soon will be listed here.

Abstract

Maintaining optimal fluid balance is crucial for patients with end-stage renal disease on dialysis, as both fluid overload and excess removal can lead to poor outcomes. Traditional approaches such as physical exam and chest X-ray have limitations when assessing volume status. This review carefully examines the tools that provide more precise options, including lung ultrasound, echocardiography, Venous Excess Ultrasound (VEXUS), bioimpedance analysis (BIA), and passive leg raise (PLR). We discuss the principles, supporting evidence, and practical uses of these techniques differentiating between static and dynamic methods to evaluate ultrafiltration tolerance. By integrating these modern techniques with clinical judgment, nephrologists can optimize fluid management in dialysis patients. While these tools show promise, further research is needed to establish standardized protocols and evaluate their impact on patient-centered outcomes.

References

Foley R, Parfrey P, Sarnak M . Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998; 32(5 Suppl 3):S112-9. DOI: 10.1053/ajkd.1998.v32.pm9820470. View

Mallamaci F, Benedetto F, Tripepi R, Rastelli S, Castellino P, Tripepi G . Detection of pulmonary congestion by chest ultrasound in dialysis patients. JACC Cardiovasc Imaging. 2010; 3(6):586-94. DOI: 10.1016/j.jcmg.2010.02.005. View

Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein D, Mathis G, Kirkpatrick A . International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012; 38(4):577-91. DOI: 10.1007/s00134-012-2513-4. View

Onofriescu M, Hogas S, Voroneanu L, Apetrii M, Nistor I, Kanbay M . Bioimpedance-guided fluid management in maintenance hemodialysis: a pilot randomized controlled trial. Am J Kidney Dis. 2014; 64(1):111-8. DOI: 10.1053/j.ajkd.2014.01.420. View

Hur E, Usta M, Toz H, Asci G, Wabel P, Kahvecioglu S . Effect of fluid management guided by bioimpedance spectroscopy on cardiovascular parameters in hemodialysis patients: a randomized controlled trial. Am J Kidney Dis. 2013; 61(6):957-65. DOI: 10.1053/j.ajkd.2012.12.017. View

Torino C, Gargani L, Sicari R, Letachowicz K, Ekart R, Fliser D . The Agreement between Auscultation and Lung Ultrasound in Hemodialysis Patients: The LUST Study. Clin J Am Soc Nephrol. 2016; 11(11):2005-2011. PMC: 5108194. DOI: 10.2215/CJN.03890416. View

Monnet X, Cipriani F, Camous L, Sentenac P, Dres M, Krastinova E . The passive leg raising test to guide fluid removal in critically ill patients. Ann Intensive Care. 2016; 6(1):46. PMC: 4875574. DOI: 10.1186/s13613-016-0149-1. View

Kotanko P, Levin N, Zhu F . Current state of bioimpedance technologies in dialysis. Nephrol Dial Transplant. 2008; 23(3):808-12. DOI: 10.1093/ndt/gfm889. View

Brennan J, Ronan A, Goonewardena S, Blair J, Hammes M, Shah D . Handcarried ultrasound measurement of the inferior vena cava for assessment of intravascular volume status in the outpatient hemodialysis clinic. Clin J Am Soc Nephrol. 2007; 1(4):749-53. DOI: 10.2215/CJN.00310106. View

10.

Agarwal R . Hypervolemia is associated with increased mortality among hemodialysis patients. Hypertension. 2010; 56(3):512-7. PMC: 2929660. DOI: 10.1161/HYPERTENSIONAHA.110.154815. View

11.

Picano E, Pellikka P . Ultrasound of extravascular lung water: a new standard for pulmonary congestion. Eur Heart J. 2016; 37(27):2097-104. PMC: 4946750. DOI: 10.1093/eurheartj/ehw164. View

12.

Ommen S, Nishimura R, Appleton C, Miller F, Oh J, Redfield M . Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation. 2000; 102(15):1788-94. DOI: 10.1161/01.cir.102.15.1788. View

13.

Lang R, Badano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L . Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1):1-39.e14. DOI: 10.1016/j.echo.2014.10.003. View

14.

Burton J, Jefferies H, Selby N, McIntyre C . Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol. 2009; 4(5):914-20. PMC: 2676185. DOI: 10.2215/CJN.03900808. View

15.

Dou Y, Cheng X, Liu L, Bai X, Wu L, Guo W . Development and validation of a new dry weight estimation method using single frequency bioimpedance in hemodialysis patients. Blood Purif. 2011; 32(4):278-85. DOI: 10.1159/000330337. View

16.

Kraemer M, Rode C, Wizemann V . Detection limit of methods to assess fluid status changes in dialysis patients. Kidney Int. 2006; 69(9):1609-20. DOI: 10.1038/sj.ki.5000286. View

17.

Zoccali C, Moissl U, Chazot C, Mallamaci F, Tripepi G, Arkossy O . Chronic Fluid Overload and Mortality in ESRD. J Am Soc Nephrol. 2017; 28(8):2491-2497. PMC: 5533242. DOI: 10.1681/ASN.2016121341. View

18.

Covic A, Onofriescu M . Time to improve fluid management in hemodialysis: should we abandon clinical assessment and routinely use bioimpedance?. Clin J Am Soc Nephrol. 2013; 8(9):1474-5. PMC: 3805073. DOI: 10.2215/CJN.06930613. View

19.

Gargani L, Volpicelli G . How I do it: lung ultrasound. Cardiovasc Ultrasound. 2014; 12:25. PMC: 4098927. DOI: 10.1186/1476-7120-12-25. View

20.

Zoccali C, Torino C, Tripepi R, Tripepi G, DArrigo G, Postorino M . Pulmonary congestion predicts cardiac events and mortality in ESRD. J Am Soc Nephrol. 2013; 24(4):639-46. PMC: 3609141. DOI: 10.1681/ASN.2012100990. View