Volume Indicators and Left Ventricular Mass during Aggressive Volume Management in Patients on Thrice-Weekly Hemodialysis

摘要

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 correlatibn between extracellular-volume-to-body-mass ratio and collapsibility index (r = 0.476; p = 0.039) at 6 months. There were no correlations between 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 +-83.3 g/m~2 at baseline to 210.6 +- 62.9g/m~2 at 6 months (p = 0.104) and further to 203.2 +- 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, evenWith thrice-Weekly dialysis.