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Methods of fluid assessment in patients undergoing hemodialysis and pertoneal dialysis (Master thesis)

Χαντάντ, Νασρά/ Haddad, Nasra

Chronic Kidney Disease (CKD)is characterized by a gradual decline in kidney function due to loss of functional nephrons. The kidneys are responsible for regulating fluid equilibrium , acid base balance , and various electrolytes, as well as toxic substances removal and hormone pr oduction. In advanced CKD stages, both kidneys are irreversibly damaged and electrolyte disturbances, fluid and toxic substances accumulation are observed ; consequently, patients in end stage kidney disease (ESKD) typically undergo renal replacement therap y either with hemodialysis ( HD ) or peritoneal dialysis PD ). Fluid overload in patients with ESKD is directly related to arterial hypertension, heart failure (CV) and left ventricular hypertrophy and contributes to increase d overall morbidity and mortalit y in this population There are several methods used to assess the hydr ation stat us and achieve euvolemia . E u volemia is defined as water equilibrium between intracellular and extracellular space. In patients under HD , the following methods are more commonly used: clinical examination (including measurement of blood pressure, assessment of peripheral edemas , dilatation of the jugular vein and lung auscultation), chest X ray, measurement of central venous pressure in patients carrying a central venous catheter, ultrasound examination (lung ultrasound, assessment of pericardial fluid and diameter of the inferior vena cava), bioimpedance, type B natriuretic peptide, relative plasma volume, hydrodensitometry and invasive techniques (pulmonary artery cathet erization, transesophageal aortic flow, etc.). On the other hand, in patients under peritoneal dialysis, the most common methods used are clinical examination, chest X ray, bioimpedance, ultrasound examination and type b natriuretic peptide. This article s ummarizes the various methods for estimating hydr ation status in patients undergoing hemodialysis and peritoneal dialysis.