Published online Jul 25, 2022. doi: 10.5527/wjn.v11.i4.127
Peer-review started: June 19, 2021
First decision: July 31, 2021
Revised: September 19, 2021
Accepted: June 21, 2022
Article in press: June 21, 2022
Published online: July 25, 2022
Processing time: 395 Days and 21.4 Hours
Assessment of fluid status in patients with chronic kidney disease (CKD) on haemodialysis (HD) is important to guide treatment. Objective methods of assessment fluid status in this population of patients are needed. In CKD patients on HD, bio-impedance analysis (BIA) is reliable in assessment of fluid status though not available in many clinical situations. Clinical assessments for fluid overload (FO) are more popular in practice, though the individual elements are imprecise and may underestimate FO. There is need to determine the performance of a locally-developed clinical score (CS) in fluid status assessment when evaluated against BIA.
This study was motivated by the need to derive a local method of assessing fluid status in patients on HD and determine how this method compares with the BIA.
The objectives of this study were to assess the hydration status of patients on maintenance HD using BIA and a CS, as well as to evaluate the performance of that CS against BIA in fluid status assessment.
This was a single-centre, hospital-based cross-sectional study which recruited adult patients with CKD who were on maintenance HD. The patients were aged 18 years and above and had been on main
From 100 patients on maintenance HD screened for eligibility, 80 were recruited into this study. Seventy-one (88.75%) patients were fluid overloaded when evaluated using BIA with mean extracellular volume of 3.02 ± 1.79 L as opposed to the forty-seven (58.25%) patients who had FO when evaluated using the CS (P < 0.0001, 95% confidence interval: 0.1758-0.4242). The best cut-off point identified for the CS was four with values > 4 indicating FO and values 4 indicating no FO. At this cut-off point, the CS had 63% and 78% sensitivity and specificity respectively. None of the factors evaluated for association with FO showed statistical significance on the multivariable logistic regression model.
Fluid overload is very prevalent in patients on chronic HD at the Kenyatta National Hospital Clinical score detects less FO when compared with BIA. The sensitivity and specificity for the CS were 63% and 78% respectively. None of the factors evaluated for association with FO showed statistical significance on the multivariable logistic regression model.
Almost 90% of the patients had FO by BIA, and 57.5% had gross FO. BIA diagnosed significantly more patients with FO than the CS. The CS had a sensitivity if 63% and a specificity of 78% at a cut-off of 4.