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Kidney Week

Abstract: TH-PO187

Change in Extracellular Fluid Volume (ECV) Calculated with a Plasma Uric-Acid Kinetic Model May Reflect True ECV Better Than That with Body Weight in Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ito, Takahito, Kataguilli Medical Center, Shibata, Japan
  • Shinzato, Takahiro, Daiko Medical Engineering Research Institute, Nagoya-shi,, Japan
  • Shibata, Kazuhiko, Yokohama Minami Clinic, Yokohama, Japan
  • Nakai, Shigeru, Fujita Health University School of Health Scieneces, Toyoake, Aichi, Japan
  • Aoki, Takeshi, Nagoya Municipal Industrial Research Institute, Iwakura-shi, Aichi-ken, Japan
Background

In Kidney Week 2018 (SA-PO-867 and 868), we reported a novel method to calculate extra-cellular fluid volume (ECV) of hemodialysis (HD) patients, which is based on a kinetic model of plasma uric acid (UA) concentration. In this study, we compared annual change of clinically adjusted dry weight (DW) with that of ECV calculated by our method.

Methods

Among 79 Japanese HD outpatients who were enrolled in the previous study, 53 patients maintaining stable blood flow and ultrafiltration rates on the days of blood sampling both at April 2018 and at April 2019 were included in this analysis (64.8 ± 10.5 y, male 69.8%). They had no cardiac event at least for two years. DW of each patient had been adjusted throughout the period by a nephrologist-in-charge using cardio-thorax ratio and blood pressure. ECV values at post-HD were calculated by our method and were standardized by the body surface area (BSA). Demographic and biochemical data used below were obtained at April 2018. An annual increment is designated as Δ.

Results

DW and ECV/BSA values decreased during the period (-0.51 ± 1.71 kg and -0.42 ± 1.22 L/m2, paired Wilcoxon P=0.0377 and 0.0078, respectively). Both were not associated with age, sex, total protein, albumin, creatinine, corrected-calcium, phosphate, urea nitrogen, hemoglobin, nPCR, and diabetic history. ΔECV/BSA was not associated with ΔDW at all (R=0.141, P=0.3133) (Fig). ΔECV/BSA correlated positively with dialysis vintage (R=0.307, P=0.0251) and negatively with Δalbumin (R=-0.402, P=0.0029), but ΔDW did not. ΔECV/BSA showed better correlation with plasma atrial natriuretic peptide concentration measured in 2018 (R= -0.420, P= 0.0018) than ΔDW (R=-0.356, P=0.0088) (Fig).

Conclusion

ΔECV, which is calculated with our plasma UA kinetic model, was consistent with clinical data better than ΔDW. Our results suggest that ΔECV/BSA rather than ΔDW reflects true change of ECV in HD patients.

Although ΔECV/BSA (A) and ΔDW (B) from April 2018 to April 2019 negatively correlated with plasma ANP concentration measured at April 2018, both did not correlate with each other (C).

Funding

  • Clinical Revenue Support