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Kidney Week

Abstract: PO0553

Are There Any Further Modalities for Prediction of Subclinical Volume Overload in Advanced Stages of CKD?

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Baki, Aber Halim, Ain Shams University Faculty of Medicine, Cairo, Egypt
  • Mansour, Hazem, Ain Shams University Faculty of Medicine, Cairo, Egypt
Background

Subclinical volume overload is commonly seen in our daily practice which represents a debatable issue. These patients respond favorably to diuretics despite lacking clinical signs of volume overload. Therefore a proper assessment of the volume status in Chronic Kidney Disease (CKD) patients leads to a better control of their medical condition and prevents further deterioration of their clinical situation into the well-known sequelae. Although many tools were used to detect volume overload in such patients as biomarkers, ultrasonography, bio-impedance, echo, and blood viscosity, many non-specific results were due to presence of concomitant comorbidities. The use of Bio Impedance Spectroscopy (BIS) is a recent tool increasingly used due to its appealing features as being non-invasive. BIS is an objective fluid status assessment method, which is shown superior to classical methods such as BP monitoring and weight control in many studies. Combining some of these tools may improve their accuracy and specificity. Inferior vena cava collapsibility index (IVCCI) with Brain Natriuretic Peptide (BNP) can be combined for more specific volume status assessment.

Methods

To assess the usage of combined IVCCI and BNP level in CKD patients to predict subclinical volume overload, 110 patients with CKD (stage 4&5) & not on dialysis and having normal LV systolic function were included with exclusion of the following: 1) Patients with other causes of raised BNP than volume overload (i.e. anemia and heart failure). 2) Patients on diuretics. Complete history, clinical examination and basic laboratory were done for all included patients. IVCCI, BNP serum level were evaluated. By using BIS, we estimated Fluid overload (FO) and extracellular water (ECW). The patients who exhibited a FO/ECW ratio >15% were considered to have volume overload.

Results

Among the 110 cases, we found that 26 patients (23.6%) had subclinical hypervolemia as diagnosed by FO/ECW ratio >15. IVCCI ≤ 38% had higher diagnostic performance than BNP ≥24 pg/ml. Combining both IVCCI ≤38% and BNP ≥24pg/ml increased the specificity and negative predictive value for detection of subclinical hypervolemia.

Conclusion

Combined elevated BNP level and decreased IVCCI could be more precise tools for subclinical volume overload detection in CKD patients.