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Hydration measurement by bioimpedance spectroscopy and blood pressure management in children on hemodialysis

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Abstract

Background

Hypertension is frequent in chronic hemodialyzed patients and usually treated by reducing extracellular fluid. Probing dry weight only based on a clinical evaluation may be hazardous, especially in case of volume independent hypertension.

Methods

We performed a 1-year retrospective study in three pediatric centers to define the relation between blood pressure (BP) and hydration status, assessed by whole-body bioimpedance spectroscopy (BIS). We analyzed 463 concomitant measurements of BP, relative overhydration (rel.OH), and plasma sodium (Napl) in 23 children (mean age 13.9 ± 5.1 years).

Results

Pre-dialytic under-hydration (rel.OH < −7 %) was present in 5.4 % of the sessions, out of which 24 % showed hypertension. Normohydration (rel.OH −7 – +7 %) was observed in 62.4 % of the sessions, 45.3 % of them revealed hypertension. Moderate OH (rel.OH +7 – +15 %) was present in 21 % of the sessions, 47.4 % of them showed normal BP. In 11.2 % of the sessions, severe overhydration (rel.OH > +15 %) was assessed, however, the majority (73 %) showed normal BP. Patient-specific Napl setpoint could not be described. Mean dialysate sodium concentration was higher than mean Napl.

Conclusions

Hypertension is not always related to overhydration. Therefore, BIS should restrict the practice of “probing dry weight” in hypertensive children. Moreover, sodium dialytic balance needs to be considered to improve BP management.

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Acknowledgments

We thank the nurses for continuous support with data management and for performing the measurements. Moreover, we are grateful to Elani Streja for her technical assistance.

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Authors and Affiliations

  1. Nephrology Dialysis Transplantation Children’s Unit, University Hospital Hautepierre, 1, Avenue Molière, 67098, Strasbourg, France

    Ariane Zaloszyc & Michel Fischbach

  2. Pediatric Nephrology University Children’s Hospital, INF 430, 69120, Heidelberg, Germany

    Betti Schaefer, Franz Schaefer & Claus Peter Schmitt

  3. Pediatric Nephrology, Hôpital Necker-Enfants Malades, 75015, Paris, France

    Saoussen Krid, Rémi Salomon & Patrick Niaudet

Authors
  1. Ariane Zaloszyc
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  2. Betti Schaefer
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  4. Saoussen Krid
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  5. Rémi Salomon
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  7. Claus Peter Schmitt
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  8. Michel Fischbach
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Correspondence to Michel Fischbach.

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Zaloszyc, A., Schaefer, B., Schaefer, F. et al. Hydration measurement by bioimpedance spectroscopy and blood pressure management in children on hemodialysis. Pediatr Nephrol 28, 2169–2177 (2013). https://doi.org/10.1007/s00467-013-2540-6

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  • DOI: https://doi.org/10.1007/s00467-013-2540-6

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