The association of overhydration with megafistulas in hemodialysis patients
Objectives: Diffuse enlargements of arteriovenous dialysis fistulas customarily attributed to either excessive arterial inflow or central outflow stenosis. The relationship between volume status and clinically enlarged (arteriovenous) fistula (CEF) formation in end-stage renal disease (ESRD) patient...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2019-01-01
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| Series: | Renal Failure |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/0886022X.2019.1614954 |
| _version_ | 1818915477059010560 |
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| author | Mihály Tapolyai Mária Faludi Klára Berta Melinda Forró Lajos Zsom Ákos G. Pethő László Rosivall Tibor Fülöp |
| author_facet | Mihály Tapolyai Mária Faludi Klára Berta Melinda Forró Lajos Zsom Ákos G. Pethő László Rosivall Tibor Fülöp |
| author_sort | Mihály Tapolyai |
| collection | DOAJ |
| description | Objectives: Diffuse enlargements of arteriovenous dialysis fistulas customarily attributed to either excessive arterial inflow or central outflow stenosis. The relationship between volume status and clinically enlarged (arteriovenous) fistula (CEF) formation in end-stage renal disease (ESRD) patients is not well understood. Methods: We assessed the pre-dialysis bioimpedance spectroscopy-measured percentage of overhydration (OH%) in 13 prevalent dialysis patients with CEF development and negative angiography and compared the results with those of 52 control dialysis patients (CONTR). All patients were prevalent ESRD patients receiving thrice-weekly maintenance hemodiafiltration at an academic outpatient dialysis unit. Results: 10/13 CEF patients had OH% ≥15% as compared to 20/52 control patients (Chi square p: .02). The degree of OH% was 20.2 ± 7.4% among the CEF vs. 14.4 ± 7.1% in the control group (Student’s t-test p: .01), representing 4.2 ± 3.2 vs. 2.8 ± 1.6 L of excess fluid pre-dialysis (p: .03). Patients with CEF development took an average of 1.7 ± 1.4 vs. 0.8 ± 0.8 (p: .002) antihypertensive medications compared to the CONTR patients, yet their blood pressure was higher: 156/91 vs. 141/78 mmHg (systolic/diastolic p: .03<.0001). We found no difference in fistula vintage, body mass index, age, diabetes status, or diuretic use. The odds ratio of having a CEF in patients with ≥15% OH status was 5.3 (95% CI: 1.3–21.7; p: .01), the Number Needed to Harm with overhydration was 4. Conclusions: There is an association between bioimpedance spectroscopy-measured overhydrated clinical state and the presence of CEF; either as an increased volume capacitance or as a potential cause. |
| first_indexed | 2024-12-20T00:02:54Z |
| format | Article |
| id | doaj.art-53deebe3b8544595a0fc7c90e50bf521 |
| institution | Directory Open Access Journal |
| issn | 0886-022X 1525-6049 |
| language | English |
| last_indexed | 2024-12-20T00:02:54Z |
| publishDate | 2019-01-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Renal Failure |
| spelling | doaj.art-53deebe3b8544595a0fc7c90e50bf5212022-12-21T20:00:45ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492019-01-0141144044510.1080/0886022X.2019.16149541614954The association of overhydration with megafistulas in hemodialysis patientsMihály Tapolyai0Mária Faludi1Klára Berta2Melinda Forró3Lajos Zsom4Ákos G. Pethő5László Rosivall6Tibor Fülöp7Semmelweis UniversitySemmelweis UniversitySemmelweis UniversityFresenius Medical Care HungaryFresenius Medical Care HungarySemmelweis UniversitySemmelweis UniversityRalph H. Johnson VA Medical CenterObjectives: Diffuse enlargements of arteriovenous dialysis fistulas customarily attributed to either excessive arterial inflow or central outflow stenosis. The relationship between volume status and clinically enlarged (arteriovenous) fistula (CEF) formation in end-stage renal disease (ESRD) patients is not well understood. Methods: We assessed the pre-dialysis bioimpedance spectroscopy-measured percentage of overhydration (OH%) in 13 prevalent dialysis patients with CEF development and negative angiography and compared the results with those of 52 control dialysis patients (CONTR). All patients were prevalent ESRD patients receiving thrice-weekly maintenance hemodiafiltration at an academic outpatient dialysis unit. Results: 10/13 CEF patients had OH% ≥15% as compared to 20/52 control patients (Chi square p: .02). The degree of OH% was 20.2 ± 7.4% among the CEF vs. 14.4 ± 7.1% in the control group (Student’s t-test p: .01), representing 4.2 ± 3.2 vs. 2.8 ± 1.6 L of excess fluid pre-dialysis (p: .03). Patients with CEF development took an average of 1.7 ± 1.4 vs. 0.8 ± 0.8 (p: .002) antihypertensive medications compared to the CONTR patients, yet their blood pressure was higher: 156/91 vs. 141/78 mmHg (systolic/diastolic p: .03<.0001). We found no difference in fistula vintage, body mass index, age, diabetes status, or diuretic use. The odds ratio of having a CEF in patients with ≥15% OH status was 5.3 (95% CI: 1.3–21.7; p: .01), the Number Needed to Harm with overhydration was 4. Conclusions: There is an association between bioimpedance spectroscopy-measured overhydrated clinical state and the presence of CEF; either as an increased volume capacitance or as a potential cause.http://dx.doi.org/10.1080/0886022X.2019.1614954bioimpedance spectroscopyblood pressurebody compositionend-stage renal diseasemegafistulavolume overload |
| spellingShingle | Mihály Tapolyai Mária Faludi Klára Berta Melinda Forró Lajos Zsom Ákos G. Pethő László Rosivall Tibor Fülöp The association of overhydration with megafistulas in hemodialysis patients Renal Failure bioimpedance spectroscopy blood pressure body composition end-stage renal disease megafistula volume overload |
| title | The association of overhydration with megafistulas in hemodialysis patients |
| title_full | The association of overhydration with megafistulas in hemodialysis patients |
| title_fullStr | The association of overhydration with megafistulas in hemodialysis patients |
| title_full_unstemmed | The association of overhydration with megafistulas in hemodialysis patients |
| title_short | The association of overhydration with megafistulas in hemodialysis patients |
| title_sort | association of overhydration with megafistulas in hemodialysis patients |
| topic | bioimpedance spectroscopy blood pressure body composition end-stage renal disease megafistula volume overload |
| url | http://dx.doi.org/10.1080/0886022X.2019.1614954 |
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