Journal de néphrologie et thérapeutique

Chest Ultrasound, Body Composition Monitoring and Brain Natriuretic Peptide for Assessment of Hydration Status in Hemodialysis Patients. (Single Center Experience)

Abstract

Mohamed Rashwan*,Mohamed Said Abdelsalam,Mohammed Mahdi Althaf,Shahid Jalil,Lutfi Alkorbi,Ihab A Ibrahim,Osman Ibraihim Alfurayh

Objective: Normal hydration state without experiencing symptoms indicative of over or under hydration at or after the end of hemodialysis treatment or what we call "dry weight” DW is a challenge for most nephrologists. Different methods has been tried to achieve this goal. We performed this study to investigate and compare three different objective tools (2 medical devices and 1 laboratory value) body composition measurement (BCM), chest ultrasound and brain natriuretic peptide (BNP) to narrow the gap toward proper estimation of DW in Hemodialysis patients. Methods: 49 stable chronic hemodialysis patients underwent assessment pre and post hemodialysis using all the available modalities mentioned above. Results: BCM assessment showed pre dialysis 27 patients (55%) were classified as overhydrated, 18 patients (37%) as normohydrated and 4 patients (8%) patients as hypohydrated. Lung comets score before hemodialysis were 21.4 ± 17 and after hemodialysis were 9.1 ± 6.9. 19 patients (39%) had lung comets score <14, 21 (43%) between 14-30 and 9 (18%) >30. There was no difference in age, gender, SBP, and DBP between the three groups. Circulating BNP levels showed significant decrease (33%) from a mean of 10443 ± 17232 pg/ml predialysis to 6956 ± 13885 pg/ml post-dialysis (p=0.00). Conclusions: Chest ultrasound, BCM, and BNP measurements as indicators for volume status assessment showed significant reduction in overhydration after dialysis, which is related more to changes in volume status rather than to its absolute values before and after hemodialysis however the was no correlation between the three modalities as assessment tool for volume status.