Antoine Mouche1, Cyrielle Parmentier2, Fatma Fendri2, Claire Herbez-Rea2,3, Anne Couderc4, Laurène Dehoux4, Marina Avramescu4, Theresa Kwon5, Julien Hogan5, Jean-Daniel Delbet2, Tim Ulinski2,3. 1. Pediatric Nephrology Unit, Armand Trousseau Hospital, AP-HP.Sorbonne Université, DMU Origyne, 75012, Paris, France. antoine.mouche@aphp.fr. 2. Pediatric Nephrology Unit, Armand Trousseau Hospital, AP-HP.Sorbonne Université, DMU Origyne, 75012, Paris, France. 3. DMU Origyne, Sorbonne Université, Paris, France. 4. Pediatric Nephrology Unit, Necker Enfants Malades, AP-HP, Paris, France. 5. Pediatric Nephrology Unit, Robert Debré Hospital, AP-HP, Paris, France.
Abstract
BACKGROUND: Dry weight (DW) adjustment in children on hemodialysis (HD) can be challenging. It relies on clinical evaluation and additional supports. Our aim was to study the benefits of cardiac biomarker assessment, in addition to the more commonly used technique, bioimpedance spectroscopy (BIS), and clinical signs for DW prescription in pediatric HD patients. METHOD: Observational study including 41 children on HD in three pediatric HD centers in the Paris region. During one session, BIS was performed before the session and serum levels of BNP and NT-proBNP were analyzed before and after the session. RESULTS: Median pre-dialysis level of BNP was 87 ng/L [24-192] and NT-proBNP 968 ng/L [442-4828]. Cardiac biomarker levels showed positive correlation with the BIS hydration status evaluation (p = 0.004). The most appropriate cutoff for pre-dialysis BNP to detect significant overhydration (OH) was 165 ng/L (sensitivity 0.67, specificity 0.84). Based on the BIS evaluation, only 32% of patients with high blood pressure (BP) had OH, whereas in the normal BP group, 33% had significant OH. CONCLUSIONS: DW prescription for children on HD should not only rely on clinical evaluation, particularly BP, but should also include additional helpful parameters. BIS is well-validated in children, but it has limitations in non-cooperative patients, and its cost can limit its use in some settings. Cardiac biomarkers, especially BNP, were well-correlated to hydration status evaluated by BIS, and thus could add valuable information for individual patient management and DW assessment. A higher resolution version of the Graphical abstract is available as Supplementary information.
BACKGROUND: Dry weight (DW) adjustment in children on hemodialysis (HD) can be challenging. It relies on clinical evaluation and additional supports. Our aim was to study the benefits of cardiac biomarker assessment, in addition to the more commonly used technique, bioimpedance spectroscopy (BIS), and clinical signs for DW prescription in pediatric HD patients. METHOD: Observational study including 41 children on HD in three pediatric HD centers in the Paris region. During one session, BIS was performed before the session and serum levels of BNP and NT-proBNP were analyzed before and after the session. RESULTS: Median pre-dialysis level of BNP was 87 ng/L [24-192] and NT-proBNP 968 ng/L [442-4828]. Cardiac biomarker levels showed positive correlation with the BIS hydration status evaluation (p = 0.004). The most appropriate cutoff for pre-dialysis BNP to detect significant overhydration (OH) was 165 ng/L (sensitivity 0.67, specificity 0.84). Based on the BIS evaluation, only 32% of patients with high blood pressure (BP) had OH, whereas in the normal BP group, 33% had significant OH. CONCLUSIONS: DW prescription for children on HD should not only rely on clinical evaluation, particularly BP, but should also include additional helpful parameters. BIS is well-validated in children, but it has limitations in non-cooperative patients, and its cost can limit its use in some settings. Cardiac biomarkers, especially BNP, were well-correlated to hydration status evaluated by BIS, and thus could add valuable information for individual patient management and DW assessment. A higher resolution version of the Graphical abstract is available as Supplementary information.
Authors: Frank M van der Sande; Esther R van de Wal-Visscher; Stefano Stuard; Ulrich Moissl; Jeroen P Kooman Journal: Blood Purif Date: 2019-12-18 Impact factor: 2.614
Authors: Y Ishizaka; Y Yamamoto; T Fukunaga; N Yokota; O Kida; K Kitamura; K Kangawa; N Minamino; H Matsuo; T Eto Journal: Am J Kidney Dis Date: 1994-09 Impact factor: 8.860