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Titolo Volume Indicators and Left Ventricular Mass during Aggressive Volume Management in Patients on Thrice-Weekly Hemodialysis
Autore Alexander S. Goldfarb-Rumyantzev a Madhukar Chelamcharla b Bruce E. Bray c John K. Leypoldt b Iran Lavasani b, d Natalia Nelson b, d Tooran Lavasani b, d Bradley Baird b Alfred K. Cheung b, d, e - a Division of Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass. , b Division of Nephrology and Hypertension, c Division of Cardiology, and d Dialysis Program, University of Utah School of Medicine, and e Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah , USA
Referenza Nephron Clinical Practice 2009; 113: c270-c280
Contenuto Objective: We examined the relationship between various volume indicators, i.e. multifrequency bioelectric impedance analysis (BIA), predialysis serum N-terminus-pro-brain natriuretic peptide (NT - pro - BNP) levels, and inferior vena cava diameter, and left ventricular mass index (LVMI) at baseline and with rigorous volume management on thrice-weekly hemodialysis. Methods: Twenty-two patients on chronic thrice-weekly hemodialysis were followed for 52 weeks. Left ventricular hypertrophy was present in 100% of the cohort at baseline. Results: There were no significant correlations among volume indicators except for a correlation between extracellular-volume-to-body-mass ratio and collapsibility index (r = 0.476; p = 0.039) at 6 months. There were no correlations be tween blood pressure and volume indicators. Baseline (but not follow-up) collapsibility index correlated with LVMI (r = 0.506; p = 0.038). In ?lag-time? analyses, there were no correlations between volume indicators at baseline or 6 months and LVMI at subsequent time points. LVMI decreased from 243.6 8 83.3 g/m 2 at baseline to 210.6 8 62.9 g/m 2 at 6 months (p = 0.104) and further to 203.2 8 49.0 g/m 2 at 12 months (p = 0.035). Conclusions: (1) Left ventricular hypertrophy was prevalent in hemodialysis patients; (2) BIA, inferior vena cava ultrasound and serum NT-pro-BNP levels yield discordant results for fluid volumes; (3) regression of LVMI could occur with rigorous fluid management, even with thrice-weekly dialysis
Data 09.09.2009
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