Presentation on theme: "PRESERVARE PER PROLUNGARE CONTROLLO DEL BILANCIO DEI FLUIDI CON BCM"— Presentation transcript:
1PRESERVARE PER PROLUNGARE CONTROLLO DEL BILANCIO DEI FLUIDI CON BCM Dott. Gianpaolo Amici, U.O. Nefrologia e Dialisi, Ospedale di Treviso
2USRDS 2009 Adjusted mortality rates USRDS 2009 Change in hospitalization ratesUSRDS 2004 Risk of death (cause and modality)
3Ipervolemia, ipertensione e patologia cardiovascolare in DP Lameire N, et al. Cardiovascular diseases in peritoneal dialysis patients: the size of the problem. Kidney Int Suppl Nov;56:S28-36.Lameire N, Van Biesen W. Importance of blood pressure and volume control in peritoneal dialysis patients. Perit Dial Int Mar-Apr;21(2):Khandelwal M, et al. Volume expansion and sodium balance in peritoneal dialysis patients. Part I: Recent concepts in pathogenesis. Adv Perit Dial. 2003;19:36-43.Khandelwal M, et al. Volume expansion and sodium balance in peritoneal dialysis patients. Part II: Newer insights in management. Adv Perit Dial. 2003;19:44-52.Wang AY. Cardiovascular risk factors in peritoneal dialysis patients revisited. Perit Dial Int Jun;27 Suppl 2:S223-7.Wang AY. The John F. Maher Award Recipient Lecture The "heart" of peritoneal dialysis:residual renal function. Perit Dial Int Mar-Apr;27(2):Van Biesen W, et al. Residual renal function and volume status in peritoneal dialysis patients: a conflict of interest? J Nephrol May-Jun;21(3):Brunkhorst R. Hypervolemia, arterial hypertension and cardiovascular disease: a largely neglected problem in peritoneal dialysis. Clin Nephrol. 2008; Apr;69(4):233-8.Carvalho MJ, Rodrigues A. Importance of residual renal function and peritoneal dialysis in anuric patients. Contrib Nephrol. 2009;163:Piraino B. Cardiovascular complications in peritoneal dialysis patients. Contrib Nephrol. 2009;163:102-9.
4Wang MC, et al. BLOOD PRESSURE AND LEFT VENTRICULAR HYPERTROPHY IN PATIENTS ON DIFFERENT PERITONEAL DIALYSIS REGIMENS Perit Dial Int 2001; 21: 36–42“In this study, ambulatory nighttime systolic BP load >30% had an independent association with LVH. Office and home BP measurements were correlated with ABPM in PD patients. The result that CCPD patients had a higher LVMI than CAPD patients may be due to a relative volume overload during the daytime in CCPD patients”.
5Nutritional Assessment Using Body Composition Monitoring in Peritoneal Dialysis Patients. Variables Determining Body Mass, Fat Tissue and Lean Tissue Index. Covic A (Van Biesen W), et al.ObjectiveApart from adequate management of the fluid status in peritoneal dialysis (PD) patients the nutritional aspect of the therapy is equally important for the patient’s morbidity and mortality. In this cross-sectional study body composition data was obtained with the Body Composition Monitor (BCM, Fresenius Medical Care) to identify relevant variables for optimized nutritional outcomes.MethodsWe screened 973 PD patients from 28 centers in 6 European countries. 639 patients met the inclusion/exclusion criteria. Body composition, blood pressure (BP), dialysis modality and prescription, pre-existing diseases, comorbidities, and antihypertensive medication were documented and analyzed.ResultsMean body mass index (26.3±5.1 kg/mq) and fat tissue index (12.6±6.0 kg/mq) were slightly above the normal range whereas mean lean tissue index (13.4±3.4 kg/mq, LTI) was within normal range at a mean weight of 72.2±15.4kg and height of 166±9.6 cm. Patients on glucose PD solutions alone had a statistically significantly better outcome than those on polyglucose or amino acid solutions in regard of nutritional parameters like lean tissue index.ConclusionsThe study provides essential information on nutritional status in a large representative cohort of European PD patients. BCM measurement enables clinicians to obtain objective data on patient’s body composition regarding fat tissue, lean tissue, and fluid status in routine clinical practice to optimize PD therapy and patient outcomes.
6Devolder I, et al. BODY COMPOSITION, HYDRATION, AND RELATED PARAMETERS IN HEMODIALYSIS VERSUS PERITONEAL DIALYSIS PATIENTS. Perit Dial Int 2010; 30: 208–214“Although much clinical attention is paid to volume status, 24% of patients still have clinically relevant volume overload. Implementation of a reliable and clinically applicable tool to assess volume status is therefore necessary. It is possible to obtain comparable volume status in PD and HD patients”.
7BCM-Body Composition Monitor Principio di base delle frequenze multiple ~measurementU(t)Apply ACZero frequency(Cell behaves as an insulator)CellMedium frequency(50 kHz)(Cell behaves as a partial insulator)High frequency(Cell behaves as an ordinary conductor)ECW
8Range di misurazione: la curva dell‘impedenza Information about body compositionReaktanceBIA BISgbaMeas. range BISPhysiologic impedance curve of patientBIA(50 kHz)1MHz5kHzRRinfResistanceSolo con Bioimpedance spectroscopy (BIS) è possibile valutare la curva fisiologica dell‘impedenza.
9Come sono le curve di impedenza nei pazienti? healthy subjectmalnourished patientfluid overloaded patientThe impedance curves of patients are very different from healthy subjects.To assess the body composition in healthies the complete curve must be measured.
11Il modello a 3 compartimenti Base del modello di composizione corporea del BCM ….Excessfluid≈ 100%waterProteins& mineralsLeantissue70%waterLipids &mineralsAdiposetissue20 %waterMoissl UM, et al. Physiol Meas 2006; 27:Chamney PW, et al. Am J Clin Nutr 2007; 85: 80-9.
12BCM – aspetto delle schermate … quantifiesindividual overhydration (L)… determinesurea distribution volume (L)… measuresnon-invasively, fast and easy… providesa basis for nutritional assessment
13Grafico analisi di un singolo paziente nel tempo con software BCM
15PA e idratazione con BCM in dialisi Towards improved cardiovascular management: the necessity of combining blood pressure and fluid overloadP. Wabel, et al. NDT, prevalent HD patients from 8 European centers (Germany, Poland, UK, Portugal, Cz)
16Letteratura sul BCMMoissl UM, et al. Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas Sep;27(9): Chamney PW, et al. A whole-body model to distinguish excess fluid from the hydration of major body tissues. Am J Clin Nutr Jan;85(1):80-9. Wizemann V, et al. Whole-body spectroscopy (BCM) in the assessment of normovolemia in hemodialysis patients. Contrib Nephrol. 2008;161: Wabel P, et al. Towards improved cardiovascular management: the necessity of combining blood pressure and fluid overload. Nephrol Dial Transplant Sep;23(9): Wizemann V, et al. The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant May;24(5): Wabel P, et al. Importance of whole-body bioimpedance spectroscopy for the management of fluid balance. Blood Purif. 2009;27(1): Crepaldi C, et al. Application of body composition monitoring to peritoneal dialysis patients. Contrib Nephrol. 2009;163:1-6. Machek P, et al. Guided optimization of fluid status in haemodialysis patients. Nephrol Dial Transplant Feb;25(2): Devolder I, et al. Body composition hydration and related parameters in hemodialysis versus peritoneal dialysis patients. Perit Dial Int 2010; 30: 208—14.