Methods Study design: single-blinded cross-over clinical trial Study population: ESRD patients receiving chronic dialysis at the Hadassah Medical Center hemodialysis units. Hypothesis We assume that adjustment of dry weight in ESRD patients receiving hemodialysis using sonographic IVCD measurements will improve quality of life. Objective Examination of the quality of life consequences of dry weight estimation in ESRD patients receiving dialysis with sonographic IVCD measurement. As this is the only reported randomized intervention, conducted with Asian participants, we sought to conduct a similar study in an independent hemodialysis population. They found lesser clinical mishaps and improved quality of life in the intervention group, an effect which was more pronounced in patients found to be hypovolemic. Chang et al reported the only randomized controlled trial to examine quality of life and clinical outcomes of hemodialysis patients in whom IVCD was measured compared to patients in whom dry weight estimation was based solely on physical examination. Cheriex et al have determined that IVCD correlates with right atrial filling, and suggested that IVCD above 11.5 mm/m2 indicates hypervolemia, and values less than 8 mm/m2 indicate hypovolemia. One of the methods proposed as objective estimators of hydration status is sonographic measurement of the inferior vena cava diameter (IVCD). Both over- and underestimation diminish quality of life. Underestimation results in chronic dehydration, hypotension, dizziness, muscle spasms, gastrointestinal disturbances, tinnitus and shock. Overestimation leads to hypertension, edema and pulmonary congestion, cardiac hypertrophy and failure. This method is inaccurate, and many patients suffer from the consequences of over- or under-estimation of their dry weight. Today, clinical estimation of dry weight is based on physical examination. Dry weight is defined as the post-dialysis weight under which a patient suffers (more often than not) from symptoms of hypotension. Fluid removal is dependent upon estimation of dry weight. Introduction Patients with end-stage renal disease (ESRD) cannot regulate their fluid balance, and are dependent on dialysis for fluid removal. Hemodialysis Complication End Stage Renal Diseaseĭiagnostic Test: sonographic measurement of inferior vena cava diameter A crossover design is intended to examine the effect of IVCD measurement on quality of life and rate of hemodynamic adversities as compared with traditional estimation of dry weight. In this study, we aim to assess the applicability and clinical utility of this method in our dialysis units. In a single-center, blinded and controlled trial it has been shown to improve clinical outcomes in patients receiving hemodialysis. It is available, inexpensive and efficient, yet operator-dependent. Sonographic measurement of the inferior vena cava diameter (IVCD) is a method under investigation for assessing hydration status. Several techniques have been proposed to asses hydration status in dialysis patient, among them measurement of bioimpedance and biochemical markers. Current methods are imprecise, and thus many patients are hype- or hypovolemic, and suffer respective consequences such as hypertension, pulmonary congestion, cardiac hypertrophy, chronic dehydration, hypotension and shock. Why Should I Register and Submit Results?ĭetermination of dry weight in patients with end-stage renal disease treated with hemodialysis is an unmet challenge in clinical nephrology.
0 Comments
Leave a Reply. |