Two studies presented at the WCN 2013, demonstrated new insights into body fluid management with an innovative analysis system that enables fast, accurate and non-invasive fluid status monitoring.
Fresenius Medical Care’s contribution to the scientific program at this year’s World Congress of Nephrology (WCN), focused on optimising patient outcomes in dialysis. Two of more than forty studies presented, demonstrated new insights into body fluid management with the help of Fresenius Medical Care’s Body Composition Monitor (BCM) – an innovative analysis system that enables fast, accurate and non-invasive fluid status monitoring. BCM is currently the only device that has been validated for fluid status monitoring in both healthy subjects and dialysis patients.1,2
Objective measurement of normohydration weight can be achieved with high reproducibility in the routine dialysis setting3
Normohydration weight (NHW) is an important parameter in the clinical determination of target dry weight and should be measured with high reproducibility so that changes may be attributed to altered body composition.3 The BCM allows NHW to be objectively obtained on a monthly basis and this is currently in use as part of a Fluid Management Program that is being rolled out within the Fresenius Medical Care (NephroCare) dialysis network.
In order to assess the reproducibility of NHW with BCM, Chamney and colleagues used 62,067 data sets from 256 clinics (including four consecutive NHW values per patient over approximately 3 months) to determine the standard error of estimate (SEE).3 Results showed that high reproducibility within 0.39 kg can be expected in individual patients in routine clinical practice – and they concluded that this is ideal for clinical application during the process of dry weight assessment.3
Figure 1. NHW reproducibility in all patients in the three month period to October 20123
Table 1. Clinic level NHW reproducibility (SEE in kg) for each month of the FMP3
Fluid management decision support in chronic HD patients4
A prospective interventional study by Moissl and colleagues that aimed to assess whether BCM could improve fluid status and cardiovascular parameters in dialysis patients was also presented.4 Using a time average fluid overload (TAFO) target range of 0.5 L ± 0.75 L, 17 patients enrolled in the study were identified as being over-hydrated at baseline, 26 were normo-hydrated and 12 were dehydrated. Optimisation of fluid status over 3 months with BCM resulted in:4
- Significant improvement in TAFO from 2.8 L to 1.6 L (p<0.002) in the over-hydrated group accompanied by a significant decrease in pre-dialysis systolic blood pressure (BPsys) from 150 to 139 mmHg (p=0.02)
- Significant improvement in TAFO from -1.1 L to -0.5 L (p=0.02) in the dehydrated group, accompanied by a non-significant increase in BPsys from 116 to 127 mmHg (p=0.20)
- At study end, more than 75% of all patients were on target, or closer to target than at study start.
The authors concluded that active fluid management with BCM significantly improves fluid status, blood pressure and other cardiovascular parameters.4
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- Moissl U, Wabel P, Chamney PW et al. Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas 2006;27:921–33.
- Chamney PW, Wabel P Moissl U et al. A whole-body model to distinguish excess fluid from the hydration of major body tissues. Am J Clin Nutr 2007;85:80–9.
- Chamney P, Metzner J, Moissl U et al. Objective measurement of normohydration weight can be achieved with high reproducibility in the routine dialysis setting. Presented at the: World Congress of Nephrology (WCN). Hong Kong, May 31–June 4 2013: Abstract SA490.
- Moissl U, Arias-Guillén M, Fontseré N et al. Fluid management decision support in chronic HD patients. Presented at the: World Congress of Nephrology (WCN). Hong Kong, May 31–June 4 2013: Abstract MO402.