Challenging fluid overload and aiming for optimum fluid balance
Why Fluid Management matters
An impaired fluid status is a common condition amongst dialysis patients, and both fluid overload and fluid depletion are associated with increased mortality.1
Achieving optimal fluid status is therefore of high importance in clinical practice.
Dialysis patients may experience the probing of their individual dry weight as unpleasant, as this often provokes uncomfortable intradialytic symptoms.2
Impaired fluid status is linked to poor patient outcomes
Inadequate fluid status is harmful from these perspectives, as it is linked to poor short- and long-term patient outcomes.
The initial probing for dry weight, and thereby removing excess fluid during a dialysis session, may lead to episodes of intradialytic hypotension, cramps and dizziness.3
As quantified by data from almost 40,000 patients, over the long term, chronic fluid overload significantly increases the risk of death at all blood pressure levels.4
Chronic fluid overload and mortality in End-Stage Renal Disease (ESRD)
“Given the strong association between chronic FO* and mortality, which far exceeds that of low and high predialysis BP**, our [Zocchali et al., 2017] study suggests that treatment policies guided by fluid status monitoring might be preferable to policies guided solely by predialysis BP measurement.”4
The original publication (graphic modified from Zoccali et al., 2017, page 2494) shows the one-year cumulative mortality risk in different categories of fluid status and pre-dialysis systolic blood pressure. Fluid-overloaded patients had a significantly higher risk of death compared with non-overloaded patients across all BP strata (all p <0.001).4
* FO – fluid overload, ** BP – blood pressure
BCM — Body Composition Monitor
Body weight and BMI (Body Mass Index) do not differentiate between muscle, fat and water. In addition, body composition is often described in terms of fat free mass (FFM) and fat mass (Fat) only, not considering overhydration.5,6
The BCM - Body Composition Monitor is a device on the market to distinguish the muscle mass from fluid overload. This is of special interest for detecting malnutrition in chronic kidney disease patients.5
It was especially designed to support Fluid Management in ESRD patients and also offers benefits for the assessment of the nutritional status.6,7
The BCM - Body Composition Monitor seperates excess fluid (overhydration) from the lean and adipose tissue components of the body on the basis of a unipue body composition model.
Fluid Management solutions
The BCM – Body Composition Monitor separates excess fluid (over-hydration) from the lean and adipose tissue components of the body on the basis of a body composition model.
BVM – Blood Volume Monitor
The BVM offers an automatic adjustment of the ultrafiltration rate according to the measured relative blood volume change based on precise ultrasonic measuring technology.
The Blood Volume Monitor helps to prevent intradialytic hypotensive episodes.8
The BVM permits the online acquisition of:
- Relative changes in the blood volume (RBV)
- Hematocrit value (Hct)
- Hemoglobin value (Hb)
1 Dekker et al., Impact of fluid status and inflammation and their interaction on survival: a study in an international hemodialysis patient cohort. Kidney International (2017) 91(5): 1214-1223.
2 Agarwal et al., Dry-Weight: A Concept Revisited in an Effort to Avoid Medication-Directed Approaches for Blood Pressure Control in Hemodialysis Patients. Clin J Am Soc Nephrol (2010); 5: 1255-1260.
3 Charra, Fluid balance, dry weight, and blood pressure in dialysis. Hemodialysis International (2007), 11(1), 21-31.
4 Zoccali et al., Chronic Fluid Overload and Mortality in ESRD, J Am Soc Nephro (2017); 28(8):2496.
5 Marcelli et al., Body Composition and Survival in Dialysis Patients: Results from an International Cohort Study, Clin J Am Soc Nephrol (2015); 10(7):1192-1200.)
6 Chamney et al., A whole-body model to distinguish excess fluid from the hydration of major body tissues. Am J Clin Nutr (2007); 85: 80-89
7 Arias-Guillén M., Bioimpedance Spectroscopy as a Practical Tool for the Early Detection and Prevention of Protein-Energy Wasting in Hemodialysis Patients. J Ren Nutr. 2018 Sep;28(5):324-332.
8 Gabrielli et al., Improved intradialytic stability during haemodialysis with blood volume-controlled ultrafiltration. J Nephrol. 2009 Mar-Apr;22(2):232-40.