Echocardiographic impact of hydration status in dialysis patients

array:21 ["pii" => "X2013251412000499" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2011.Nov.10867" "estado" => "S300" "fechaPublicacion" => "2012-01-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2012;32:94-102" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6814 "formatos" => array:3 [ "EPUB" => 320 "HTML" => 5614 "PDF" => 880 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699512000491" "issn" => "02116995" "doi" => "10.3265/Nefrologia.pre2011.Nov.10867" "estado" => "S300" "fechaPublicacion" => "2012-01-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2012;32:94-102" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 9069 "formatos" => array:3 [ "EPUB" => 295 "HTML" => 8034 "PDF" => 740 ] ] "es" => array:12 [ "idiomaDefecto" => true "titulo" => "Repercusión ecocardiográfica del estado de hidratación en los pacientes en diálisis" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "94" "paginaFinal" => "102" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Echocardiographic impact of hydration status in dialysis patients" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10867_108_17726_es_10867_t1.jpg" "Alto" => 423 "Ancho" => 600 "Tamanyo" => 172887 ] ] "descripcion" => array:1 [ "es" => "Características de los pacientes en hemodiálisis y diálisis peritoneal" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Isabel Juan García, Isabel Juan-García, María Jesús Puchades, María J. 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Puchades, Rafael Sanjuan, Rafael Sanjuán, Isidro Torregrosa, Miguel Angel Solis, Miguel Á. Solís, Marisa Blasco, Miguel González, Antonio Martinez, Alfonso Miguel, Antonio Martínez" "autores" => array:16 [ 0 => array:4 [ "nombre" => "Isabel" "apellidos" => "Juan García" "email" => array:1 [ 0 => "ijuangar@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] 1 => array:4 [ "nombre" => "Isabel" "apellidos" => "Juan-García" "email" => array:1 [ 0 => "ijuangar@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 2 => array:3 [ "nombre" => "María Jesús" "apellidos" => "Puchades" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "María J." 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"apellidos" => "Solís" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 9 => array:3 [ "nombre" => "Marisa" "apellidos" => "Blasco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "affc" ] ] ] 10 => array:3 [ "nombre" => "Miguel" "apellidos" => "González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 11 => array:3 [ "nombre" => "Antonio" "apellidos" => "Martinez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] 12 => array:3 [ "nombre" => "Marisa" "apellidos" => "Blasco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "affd" ] ] ] 13 => array:3 [ "nombre" => "Alfonso" "apellidos" => "Miguel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] 14 => array:3 [ "nombre" => "Antonio" "apellidos" => "Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 15 => array:3 [ "nombre" => "Alfonso" "apellidos" => "Miguel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "NEFROLOGÍA, Hospital Clínico Universitario de Valencia, VALENCIA, VALENCIA, ESPAÑA, " "etiqueta" => "a" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Clínico Universitario de Valencia, " "etiqueta" => "b" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "MEDICINA INTENSIVA, Hospital Clínico Universitario de Valencia, VALENCIA, VALENCIA, ESPAÑA, " "etiqueta" => "c" "identificador" => "affc" ] 3 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Clínico Universitario de Valencia, " "etiqueta" => "d" "identificador" => "affd" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Repercusión ecocardiográfica del estado de hidratación en los pacientes en diálisis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10867_16025_25587_en_t1_10867i2.jpg" "Alto" => 1464 "Ancho" => 2126 "Tamanyo" => 857195 ] ] "descripcion" => array:1 [ "en" => "Characteristics of patients on peritoneal haemodialysis and dialysis" ] ] ] "textoCompleto" => "INTRODUCTIONCardiovascular disease is the main cause of death in patients with chronic kidney disease (CKD).1 This is usually due to the presence of traditional risk factors, such as diabetes mellitus, hypertension (AHT), dyslipidaemia and advanced age,2 and to the actual kidney disease (overhydration, uraemic cardiomyopathy and vascular damage, i.e. atherosclerosis, vascular calcification and arterial stiffness).The main manifestations of cardiovascular disease in these patients are arterial vascular disease and cardiomyopathy.3 The high prevalence of cardiomyopathy is due to AHT and atherosclerosis, which create excess pressure and lead to the development of concentric left ventricular hypertrophy (LVH). Anaemia, fluid overload and arteriovenous fistulae create volume overload, which leads to left ventricular dilation with eccentric LVH.4,5,6There are various methods for assessing hydration status. Assessment of the inferior vena cava and biochemical parameters, such as B-type natriuretic peptide, are useful methods for assessing intravascular hydration status,7 while bioimpedance spectroscopy (BIS) assesses body and extracellular hydration states.8 The latter technique is simple, inexpensive, reproducible, non-invasive and easy to apply, and is based on the human body's resistance to alternating electrical currents. It assesses not only hydration status but also intracellular and extracellular water, the extracellular and intracellular ratio, the total water volume, as well as nutritional parameters.The aim of this study was to stratify patients on dialysis according to hydration status, and to assess possible echocardiographic abnormalities in the various groups according to dialysis technique. METHOD Patients We performed a cross-sectional observational study on 117 clinically stable patients on the dialysis programme of the University Clinical Hospital of Valencia between 2008 and 2010. The study included 65 patients (41 males) from the Haemodialysis Unit and 52 patients (28 males) from the Peritoneal Dialysis Unit. Those patients who had arrhythmia, severe valvular heart disease, amputation of any limb, pacemakers or metal prostheses that would interfere with bioimpedance were excluded. All patients signed the informed consent and the hospital ethics committee approved the study protocol. Measurements Examinations of patients on haemodialysis (HD) were performed during the middle of the week, while patients on peritoneal dialysis were examined before the first replacement of the morning with an empty peritoneum.To assess hydration status, we used multifrequency bioimpedance with the Fresenius BCM-Body Composition Monitor, which measures 50 different frequencies from 5kHz to 1MHz. This technique has been validated by dilution techniques that are considered the gold standard,9 dual X-ray absorptiometry and plethysmography,10 among others.11,12 For the measurement, we used two pairs of electrodes: one at a distal position, an injector and a sensor, placed dorsally on the hand (third metacarpophalangeal and carpal joints, respectively) and another on the foot (third metatarsophalangeal and tibiotarsal joints). The reference was the right hemisoma; in HD, the reference was the hemisoma free of vascular accesses. Prior to the procedure, patients were accurately measured and weighed. Examination was performed in the HD group before and after the session. In both HD and peritoneal dialysis (PD), the patient was placed in supine decubitus for 15-20 minutes before the examination in order to help distribute excess fluid and avoid the presence of oedema that could distort results. After the HD session, we also waited the same amount of time to allow balancing among the various compartments (intravascular-extravascular-cellular).Among the various parameters obtained by BIS, we chose the extracellular water-total body water ratio (ECW/TBW) to assess hydration status and the overhydration-extracellular water ratio (OH/ECW) for the mortality risk.Patients were classified by hydration status by means of ECW/TBW normalised for age and gender using the method described by Lindley et al, i.e. the difference between the theoretical ratio under normal conditions and that obtained by bioimpedance. If the difference is >2.5%, the patient is hyperhydrated (HHD), if between >2.5% and <2.5% the patient is normohydrated (NHD), and dehydrated if <2.5%.13The OH/ECW is a ratio that currently is defined as a significant and independent predictor of mortality in patients on dialysis when it is greater than 15%.14We defined AHT in those patients who had blood pressure (BP) readings >140/80mm Hg and/or were taking antihypertensive drugs.On the examination day, a blood test was performed to determine haemoglobin (mg/dl), calcium (mg/l), phosphorus (mg/l), parathormone (pg/ml), total proteins (g/dl) and albumin (g/dl) in each patient.We performed transthoracic echocardiography with a multifrequency transducer and a tissue Doppler program (Aloka) before the HD session, and after emptying the peritoneal cavity in PD. Readings and measurements were made following the recommendations of the American Society of Echocardiography (ASE).11,15 Left ventricular mass (LVM) was calculated using the modified ASE formula,16,17 which is the most widely used method since it has shown values closely associated with autopsy findings: LVM=0.8x [1.04x (LVTDD + TDTS + TDTPW) 3+ (LVTDD)3] +0.6 (LVTDD: LV telediastolic diameter; TDTS: telediastolic thickness of the septum; TDTPW: telediastolic thickness of the posterior wall). LVM was indexed by body surface (ILVM). Based on the studies of Devereux et al, the cut-off point for the diagnosis of LVH using the ILVM was ≥125g/m2, with no difference by gender (Figure 1).16To classify the type of LVH, we calculated the relative thickness (RT) with the formula: RT=2xPW/LVTDD; we considered a normal RT when <0.45.16The assessment of the left atrium was performed by measuring the left atrium volume by the indexed Simpson's disc summation method, where the volume of the left atrium is the individual summation of all discs in the series. We used this method for its speed and for correlating well with any method for determining left atrial volume.18,19Data were processed using the SPSS 15 program. Results are expressed as mean, standard deviation for data with normal distribution; and as median, interquartile range (IQR) and confidence interval (CI) for data that did not have normal distribution. We performed the comparison of means with the Mann-Whitney and Student’s-t test according to the distribution of the variables. Linear regression was performed with Pearson's p. To compare means between the two groups, we performed ANOVA for one factor with Bonferroni and Dunnett's C post-hoc tests, according to the homogeneity of variances. Values of P<.05 were considered statistically significant. We performed a multivariate analysis, using eccentric LVH as the dependent variable and the other study variables as independent variables. RESULTS We examined 117 patients, 65 patients in the HD group and 52 in the PD group. The relevant demographic and clinical characteristics and cardiovascular risk factors are shown in Table 1. It is noteworthy that patients who were on HD had been longer on the technique and had lower residual renal function (RRF) than patients on PD. As for laboratory tests, it is noteworthy that patients on HD had higher readings of total proteins and albumin in blood.The presence of AHT was greater in PD patients, although HD had poorer control of readings. The use of antihypertensive drugs and their combination was greater in patients on PD patients (59.6% vs 30.8%). The most frequently used drugs in both groups were calcium antagonists and angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor antagonists (ARAII). Diuretics were used more frequently in PD.We initially examined the relationship in each dialysis group between the hydration status and BP, by means of normalised ECW/TBW ratios. Patients on HD before and after performing the session presented hydration states and BP readings that are shown in Figure 2 and Figure 3. The distribution of patients on PD is shown in Figure 4.In the HD group, 37.5% presented systolic blood pressure (SBP) readings >140mm Hg, with 25% being HHD and 12.5% NHD. Some 62.5% were normotensive, with 42.1% being HHD and 18.8% NHD. In the PD group, 24.9% had SBP >140mm Hg, 11.5% were HHD and 11.5% were NHD. Some 74.9% were normotensive, with 34.6% being HHD and 32.6% NHD. We observed a decline in the number of HHD patients in the HD group after the session (67.1% pre-HD compared to 26.1% post-HD), as well as a decline in blood pressure readings (SBP>140mm Hg - 37.5% to 32.6%).If we consider the presence of hypertension (>140/80mm Hg or drug treatment) and the hydration status in each dialysis group, we observe AHT in 45.45% of the HD group, of which 30.3% were HHD. After the HD session, we observed a decrease in AHT patients (post-HD 43.4%) and a decrease in the number of HHD patients (68.1% vs 27.3%). In PD patients, 69.2% had HTA, of which 28.8% were HHD. Therefore, if we consider the readings for BP and drug treatment, we find greater AHT in PD patients and greater HHD states in PD patients than in readings after HD.The presence of HHD according to ECW/TBW was more frequent in HD than in PD before the dialysis session (67.1% pre-HD compared to 46.1% PD), but after the HD session a better control of the hydration status is achieved (post-HD 26.1%).When analysing each dialysis group according to hydration status, the subgroup of HHD patients in both techniques had been longer on the technique (HHD HD 60.9 months vs NHD HD 36.5 months; HHD PD 36.3 months vs NHD PD 34.8 months), with only those on HD showing a significant difference. The presence of RRF was similar in both techniques, although it was lower in the HHD group (RRF HHD HD 34.9% vs NHD HD 55%; HHD PD 37.5% vs NHD PD 42.9%).According to the data obtained using BCM, patients on HD had significantly greater overhydration (OH) and extracellular/intracellular (E/I) water than those on PD (Table 2).The second phase of the study consisted of assessing each dialysis group, according to the hydration status as measured by ECW/TBW, the echocardiographic characteristics and the correlation among the data obtained by bioimpedance (Table 3).Left atrial volume indexed to body surface (LAVI) and indexed left ventricular mass (ILVM) were significantly greater in patients in the HD group and in the HHD subgroup of both techniques. The OH/ECW ratio was significantly greater in HD patients than in PD patients (>15%, 14.06% in HD vs 3.8% in PD), as well as in HHD patients in each type of dialysis.If we assess the geometry of the left ventricle in our study population, we observe the presence of LVH in 27.6% of the HD group and 13.4% in PD; the most prevalent in both groups being the eccentric one. According to the hydration status, the presence of LVH was greater in the HHD group (HD 27.9% vs PD 20.8%) than in the NHD group (25% vs 9.5%), with eccentric LVH being the most prevalent (Tables 4 and 5). In the univariate study of eccentric LVH with all variations, the only one of significance was eccentric LVH with hydration status (normalised ECW/TBW) with a significance of P=.03 (CI 1.1-11.5). DISCUSSION Bioimpedance is a technique that allows us to detect a large number of HHD patients. It is an easily applicable method and may be considered the gold standard in determining hydration states. Various methods have been used to assess hydration status, but they are unreliable since numerous factors may interfere. The assessment of the hydration status by means of the BP may be distorted by antihypertensive therapy, AHT not dependent on volume, and the presence of heart disease;20 the inferior vena cava shows the intravascular volume by diastolic dysfunction;21 and RRF and the presence of heart diseases,22 among others, may interfere with biochemical markers, such as BNP and pro-BNP.We found in the literature that various parameters have been used to define hydration status by bioimpedance: OH/ECW, ECW/TBW, E/I and OH. Lopot et al determined the optimal dry weight in HD patients using the deviation between ECW/TBW obtained by bioimpedance and that obtained in a control group, according to age and sex. This is based on changes produced in the cell mass (with increasing age, the cell mass and therefore the intracellular water decreases) and the hydration status (with increasing age and/or female gender, the intracellular water decreases).23 Lindley et al determined the dry weight in PD using the difference between ECW/TBW obtained by BIS compared to ECW/TBW of a control group according to patient age and gender (defining HHD as those who had +2.5% standard deviation).13We assessed the hydration status of our patients based on these principles.9,24 In the HD group, we found significantly more HHD patients before HD (67.1%) than in the PD group (46.1%), and almost half had AHT. After the HD session, better control of hydration status is achieved (26.1%). Devolder I et al assessed hydration status by means of OH/ECW (overhydrated OH/ECW>15%),23 Plum et al by ECW/TBW25 and Passauer et al by OH (litres of overhydration >1.1 I).11 They found that hydration status was harder to control in patients on PD than in post-HD patients, which is consistent with our data.The bodily distribution of excess fluid in patients on dialysis varies according to the type of technique. Therefore, the impact of hydration status on BP and at the cardiac level must vary. In the literature, excess fluid in patients on PD is found peripherally in the subcutaneous tissue, while in HD patients it is located in the bloodstream.25 In HD, there is an increase in body weight in the interdialytic period (48 hours), due to the consumption of liquids and food, and a decrease during the session (4 hours) by the ultrafiltration of the accumulated water volume and by the convective and diffusive transport of sodium. Abrupt changes occur at the intravascular level, very slowly from the interstitial space by means of refilling. Interdialytic weight gain is greater in patients who do not have RRF. The PD technique is usually performed continuously, and the balance between the various compartments is produced constantly. Ultrafiltration is produced from the interstitial space.We must remember that bioimpedance assesses the intra-extracellular hydration status, and not hydration at the intravascular level. The increased state of HHD in HD before the session is due to weight gain in the interdialytic period, which is located at the extracellular and intravascular level, resulting in a greater E/I ratio. After the HD session, the hydration status is reduced by the ultrafiltration of the intravascular space, and it takes some time for the various compartments to reach a balance. In PD, we observed a significantly lower E/I ratio than in HD (E/I pre-HD 0.96 vs PD 0.9) due to a lower extracellular water (ECW pre-HD 16 1 vs PD 15.2 1) because ultrafiltration in this technique is performed constantly. Therefore, when we perform bioimpedance in patients on HD, especially after the session, balance has not yet been reached among the various compartments. Probably because of this, hydration parameters in PD compared to post-HD may be distorted.In the literature, the prevalence of AHT in patients on HD is around 60% in the interdialytic period,26 while for PD it is greater (80%).27 Our prevalence of AHT was lower. The presence of high BP readings and/or antihypertensive treatment was greater in PD patients (PD 76.9% vs HD 49.2%), but they had better blood pressure control (BP<140mm Hg, 37.5% HD vs 24.9% PD), probably due to the greater use of antihypertensive drugs. The most widely used drugs in both groups were calcium antagonists and ACEI/ARAII.Diuretics are used more in PD due to the greater prevalence of RRF, and this allows us to increase the diuresis volume and adjust hydration status. The increased presence of RRF in PD is due to PD being a continuous technique, with constant ultrafiltration that precludes abrupt changes in volume, which helps protect the kidney. Moreover, patients on HD usually have poorer renal function due to the greater use of nephrotoxic agents (aminoglycosides, contrast media, non steroidal anti-inflammatory drugs), the bioincompatibility of filter membranes and/or increased frequency of hypotension episodes.28,29 We found an inverse correlation between time on dialysis and presence of RRF in our patients, due to the continuous development of kidney disease over time, which results in a reduced RRF, although in most studies the mean time on the technique is lower than ours.The greater frequency of AHT in PD patients may be due to the greater hydration status (less accuracy in the adjustment of dry weight, continuous changes in the peritoneal membrane, etc.) Patients in HD had greater hydration states before the dialysis session, but decreased after the session, with subsequent increases up to the next session, reflecting these changes in the blood pressure. Patients on HD usually had less antihypertensive treatment because during the HD session a reduction in intravascular volume is produced and this must be adapted. If the patient is undergoing antihypertensive treatment, the compensation and/or vascular adaptation mechanisms are blocked and present continuous vasodilation, which results in hypotension, poor tolerance, and an inability to reach the target dry weight. At the same time, vascular refilling is produced from the interstitial liquid at different speeds, depending on the patient's characteristics (elderly, diabetic, and patients with ventricular dysfunction or pulmonary hypertension present very slow refilling).The prevalence of LVH is 75% among patients on dialysis,30,31,32 and develops in initial stages of CKD. Numerous studies have shown its increase in parallel with the reduction of GFR.33 AHT and hyperhydration have an impact on the heart with the development of LVH, among other risk factors. We found studies, such as the Wang AY et al study, where RRF had considerable influence and 70% of patients with no RRF presented ventricular modelling disorders.34 The development of LVH varies according to the type of overload. Fluid or volume overload is related to the onset of eccentric LVH, while pressure overload and AHT is related to concentric LVH. We found a correlation between eccentric LVH and the hydration state. Foley et al suggest that regression of LVH does not occur after starting dialysis and that it is irreversible, due to high patient mortality.35,36 However, last year we found published studies that demonstrated that LVH regression is possible after years of dialysis. Several therapeutic strategies may work: control of anaemia, control of hydration status, use of antihypertensive drugs in normotensive and hypertensive patients, daily or night-time use of HD, prevention and treatment of hyperphosphataemia, vitamin D administration, and multifactorial intervention.37,38,39 We found regression not only in patients on HD, but also in patients on PD.40,41 In our study, the prevalence of LVH was less (53.5% in HD vs 38.4% in PD). The lower presence of cardiac disorders may be due to acceptable control of hydration status and BP, a high presence of RRF, as well as good control over haemoglobin readings, calcium-phosphorus metabolism, and the use of ACEI and ARA II. The difference found between both dialysis techniques may be explained by the greater percentage of patients with no RRF in HD,31 the lower use of ACEI/ARAII, and greater extracellular water ratio. LAVI shows the average of increased filling pressures,42 the functional situation of the heart and overload, and thus, the hydration status. Patients on HD have a significantly greater LAVI than those on PD, and HHD patients have greater intravascular volume and therefore greater cardiac overload, leading to increased LVH. Lastly, we analysed two emerging markers for the stratification and monitoring of cardiovascular risk in patients with CKD, LAVI and OH/ECW.8,14,17,42 Wizemann et al14 defined the OH/ECW ratio >15 as a cardiovascular risk factor, based on the study performed by Wabel et al in which NHD patients presented an OH/ECW of 6.8%-15%.20 LAVI is a chronic marker of diastolic function that shows the average of increased filling pressures,42  and is considered the best index for assessing filling pressures and the functional situation of the heart, since it is linked to the severity and duration of diastolic dysfunction of the left ventricle.18,19 In our study, both indices are significantly higher in patients on HD, as well as in HHD patients in both groups. Therefore, being HDD according to the normalised ECW/TBW ratio >2.5% is a high cardiovascular risk.We can conclude that bioimpedance detects a greater number of HDD patients on both dialysis techniques. When studying echocardiographic disorders in dialysis patients, we found a high correlation between hydration status and LAVI and ILVM. Additional prospective studies are warranted to assess the hydration states of the dialysis population and to determine whether there is regression in cardiac remodelling with the control of the hydration status by means of bioimpedance. Conflict of interest The authors have no conflicts of interest to declare.<a href="grande/10867_16025_25587_en_t1_10867i2.jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25587_en_t1_10867i2.jpg" alt="Characteristics of patients on peritoneal haemodialysis and dialysis "></img></a>Table 1. Characteristics of patients on peritoneal haemodialysis and dialysis <a href="grande/10867_16025_25589_en_t2_10867i2.jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25589_en_t2_10867i2.jpg" alt="Assessment of the heart and the overhydration-extracellular water ratio according to the state of hydration in each dialysis group "></img></a>Table 2. Assessment of the heart and the overhydration-extracellular water ratio according to the state of hydration in each dialysis group <a href="grande/10867_16025_25590_en_t3_10867i2.jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25590_en_t3_10867i2.jpg" alt="Parameters obtained by bioimpedance in peritoneal haemodialysis and dialysis groups "></img></a>Table 3. Parameters obtained by bioimpedance in peritoneal haemodialysis and dialysis groups <a href="grande/10867_16025_25591_en_t4_10867i2.jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25591_en_t4_10867i2.jpg" alt="Left ventricular geometry according to dialysis type"></img></a>Table 4. Left ventricular geometry according to dialysis type<a href="grande/10867_16025_25592_en_t5_10867i2.jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25592_en_t5_10867i2.jpg" alt="Left ventricular geometry according to hydration state "></img></a>Table 5. Left ventricular geometry according to hydration state <a href="grande/10867_16025_25593_en_f1_10867i.jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25593_en_f1_10867i.jpg" alt="Patterns of left ventricular hypertrophy "></img></a>Figure 1. Patterns of left ventricular hypertrophy <a href="grande/10867_16025_25594_es_f2_10867i3.jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25594_es_f2_10867i3.jpg" alt="Distribution of patients on haemodialysis before the session according to blood pressure readings and the difference of the ECW/TBW ratio "></img></a>Figure 2. Distribution of patients on haemodialysis before the session according to blood pressure readings and the difference of the ECW/TBW ratio <a href="grande/10867_16025_25595_en_f3_10867i.jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25595_en_f3_10867i.jpg" alt="Distribution of patients on haemodialysis after the session according to blood pressure readings and the difference of the ECW/TBW ratio "></img></a>Figure 3. Distribution of patients on haemodialysis after the session according to blood pressure readings and the difference of the ECW/TBW ratio <a href="grande/10867_16025_25596_en_f4_10867i.jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25596_en_f4_10867i.jpg" alt="Distribution of patients on peritoneal dialysis according to blood pressure readings and the difference of the ECW/TBW ratio"></img></a>Figure 4. Distribution of patients on peritoneal dialysis according to blood pressure readings and the difference of the ECW/TBW ratio" "pdfFichero" => "P1-E532-S3377-A10867-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:4 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439185" "palabras" => array:1 [ 0 => "Hipertrofia de ventrículo izquierdo" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439187" "palabras" => array:1 [ 0 => "Bioimpedancia espectroscópica" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439189" "palabras" => array:1 [ 0 => "Estado de hidratación" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439191" "palabras" => array:1 [ 0 => "Volumen de aurícula izquierda indexada" ] ] ] "en" => array:4 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439186" "palabras" => array:1 [ 0 => "Left ventricular hypertrophy" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439188" "palabras" => array:1 [ 0 => "Bioimpedance spectroscopy" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439190" "palabras" => array:1 [ 0 => "Volume status" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439192" "palabras" => array:1 [ 0 => "Left atrial volume index" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "Introducción: La enfermedad cardiovascular es la principal causa de muerte en los pacientes con enfermedad renal crónica. La hipertrofia ventricular izquierda (HVI) es la manifestación más frecuente y está relacionada con la hipertensión arterial y la hiperhidratación. El objetivo del presente trabajo es estratificar a los pacientes en diálisis según el estado de hidratación y valorar las posibles alteraciones ecocardiográficas en los distintos grupos. Métodos: Realizamos un estudio transversal de 117 pacientes, 65 en hemodiálisis (HD) y 52 en diálisis peritoneal (DP). Las exploraciones realizadas fueron: bioimpedancia multifrecuencia con el sistema BCM-Body Composition Monitor de Freesenius, ecocardiografía transtorácica y analítica de sangre. Definimos hiperhidratación cuando el cociente volumen extracelular-volumen corporal total (ECW/TBW) normalizado para edad y sexo es > 2,5% de la desviación estándar.  Resultados: Los pacientes en HD están pre-HD (67,1%) más hiperhidratados de forma significativa que los de DP (46,1%), presentando casi la mitad de la población hiperhidratada hipertensión arterial; tras la sesión de HD se consigue un mejor control del estado de hidratación (26,1%). Los pacientes en DP presentan con más frecuencia cifras de tensión arterial alta y/o llevan tratamiento antihipertensivo (DP 76,9 vs. HD 49,2%). La HVI es más frecuente en los pacientes en HD e hiperhidratados, siendo la más prevalente la HVI excéntrica. Los pacientes hiperhidratados presentan cifras superiores, de forma significativa, del IVAI (volumen de aurícula izquierda indexada por superficie corporal, la IMVI (masa ventricular izquierda indexada) y el cociente sobrehidratación-agua extracelular. Conclusiones: La bioimpedancia es una técnica que nos permite detectar un gran número de pacientes hiperhidratados. Al estudiar las alteraciones ecocardiográficas en los pacientes en diálisis encontramos una alta correlación entre el estado de hidratación por ECW/TBW normalizado para edad y sexo, y el IVAI e IMVI." ] "en" => array:1 [ "resumen" => "Introduction: Cardiovascular disease is the main cause of death in Chronic Kidney Disease patients. Left ventricular hypertrophy is the most common manifestation and it is linked to arterial hypertension and overhydration. The goal of this paper is to stratify dialyzed patients according to hydration status and to make an evaluation about the possible echocardiography alterations of the different groups. Methods: a transversal study was carried out with 117 patients: 65 were on hemodialysis and 52 on peritoneal dialysis. We performed the following tests: multifrequency bioimpedance with the BCM-Body Composition Freesenius’ Monitor system, transthoracic echocardiography, and blood tests. If ECW/TBW (extracellular water vs total body water) normalization ratio for age and gender was > 2.5% SD, the patient was considered overhydrated. Results: HD patients are significantly overhydrated before HD (67.1%) compared to DP patients (46.1%), and almost half of the overhydrated population presents arterial hypertension. However, after an HD session, a better control of the hydration status is reached (26.1%). DP patients frequently present high arterial pressure and/or are under antihypertensive treatment (DP 76.9% vs HD 49.2%). Left ventricular hypertrophy is much more common in HD overhydrated patients, eccentric LVH being more prevalent. Overhydrated patients present significantly high values of LAVI, ILVM, OH/ECW. Conclusions: Bioimpedance technique allows for the detection of a large number of overhydrated patients. Echocardiographic alterations in dialyzed patients show a high correlation between the hydration stage by ECW/TBW normalized ratio for age and gender and the LAVI and ILVM." ] ] "multimedia" => array:9 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10867_16025_25587_en_t1_10867i2.jpg" "Alto" => 1464 "Ancho" => 2126 "Tamanyo" => 857195 ] ] "descripcion" => array:1 [ "en" => "Characteristics of patients on peritoneal haemodialysis and dialysis" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10867_16025_25589_en_t2_10867i2.jpg" "Alto" => 513 "Ancho" => 2126 "Tamanyo" => 360458 ] ] "descripcion" => array:1 [ "en" => "Assessment of the heart and the overhydration-extracellular water ratio according to the state of hydration in each dialysis group" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10867_16025_25590_en_t3_10867i2.jpg" "Alto" => 723 "Ancho" => 2126 "Tamanyo" => 458404 ] ] "descripcion" => array:1 [ "en" => "Parameters obtained by bioimpedance in peritoneal haemodialysis and dialysis groups" ] ] 3 => array:8 [ "identificador" => "fig4" "etiqueta" => "Tab. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10867_16025_25591_en_t4_10867i2.jpg" "Alto" => 325 "Ancho" => 1004 "Tamanyo" => 127492 ] ] "descripcion" => array:1 [ "en" => "Left ventricular geometry according to dialysis type" ] ] 4 => array:8 [ "identificador" => "fig5" "etiqueta" => "Tab. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10867_16025_25592_en_t5_10867i2.jpg" "Alto" => 328 "Ancho" => 2126 "Tamanyo" => 237996 ] ] "descripcion" => array:1 [ "en" => "Left ventricular geometry according to hydration state" ] ] 5 => array:8 [ "identificador" => "fig6" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10867_16025_25593_en_f1_10867i.jpg" "Alto" => 944 "Ancho" => 1004 "Tamanyo" => 222498 ] ] "descripcion" => array:1 [ "en" => "Patterns of left ventricular hypertrophy" ] ] 6 => array:8 [ "identificador" => "fig7" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10867_16025_25594_es_f2_10867i3.jpg" "Alto" => 689 "Ancho" => 1004 "Tamanyo" => 169719 ] ] "descripcion" => array:1 [ "en" => "Distribution of patients on haemodialysis before the session according to blood pressure readings and the difference of the ECW/TBW ratio" ] ] 7 => array:8 [ "identificador" => "fig8" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10867_16025_25595_en_f3_10867i.jpg" "Alto" => 693 "Ancho" => 1004 "Tamanyo" => 173935 ] ] "descripcion" => array:1 [ "en" => "Distribution of patients on haemodialysis after the session according to blood pressure readings and the difference of the ECW/TBW ratio" ] ] 8 => array:8 [ "identificador" => "fig9" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10867_16025_25596_en_f4_10867i.jpg" "Alto" => 687 "Ancho" => 1004 "Tamanyo" => 170708 ] ] "descripcion" => array:1 [ "en" => "Distribution of patients on peritoneal dialysis according to blood pressure readings and the difference of the ECW/TBW ratio" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:42 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Locatelli F, Marcelli D, Conte F, D'Amico M, Del Vecchio L, Limido A, et al. Cardiovascular disease in chronic renal failure: the challenge continues. Nephrol Dial Transplant 2000;15 (suppl.5):69-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11073278" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M,\u{A0}et al. Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 2006;17:2034-47. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16738019" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al.; American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 2003;108(17):2154-69." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "4.\u{A0} Parfrey PS, Foley RN. The clinical epidemiology of cardiac disease in chronic renal failure. J Am Soc Nephrol 1999;10:1606-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10405218" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Silverberg DS, Wexler D, Iaina A, SteinbruchS, Wollman Y, Schwartz D. Anemia, chronic renal disease and congestive heart failure¿the cardio renal anemia syndrome: the nedd for cooperation between cardilogists and nefephrologists.\u{A0}Int Urol Nephrol 2006;38:295-310. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16868702" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kuhlmann MK, Zhu F, Seibert E, Levin NW. Bioimpedance, dry weight and blood pressure control: new metrhods and consequences. Curr Opin Nephrol Hypertens 2005;14:543-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16205473" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bargnoux AS, Kloudche K, Fareh J,\u{A0}\u{A0}Barazer I, Villard-Saussine S, Dupuy AM, et al. Prohormone brain natriuretic peptide (proBNP), BNP and N-terminal-proBNP circulating levels in chronic hemodialysis patients. Correlation with ventricular function, fluid removal and effect of hemodiafiltration. Clin Chem Lab Med 2008;46:1019-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18624622" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Matthie J, Zarowitz B, De Lorenzo A, Andreoli A, Katzarski K, Pan G, et al. Analytic assessment of the various bioimpedance methods used to estimate body water. J Appl Physiol 1998;84:1801-16 <a href="http://www.ncbi.nlm.nih.gov/pubmed/9572833" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Moissl UM, Wabel P, Chamney PW, Bosaeus I, Levin NW, Bosy-Westphal A,\u{A0}et al.\u{A0}Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas 2006;27:921-33. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16868355" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Moissl U, Bosaeus I, Lemmey A, Hovgesen S, Wabel P, Chamney PW,\u{A0}et al.\u{A0}Validation of a 3C model for determination of body fat mass. J Am Soc Nephrol 2007;18:257A." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Passauer J,\u{A0}Petrov H,\u{A0}Schleser A,\u{A0}Leicht J,\u{A0}Pucalka K. Evaluation of clinical dry weight assessment in haemodialysis patients using bioimpedance specctroscopy: a cross-sectional study. Nephrol Dial Transplant 2010;25:545-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19808949" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Wizemann V, Rode C, Wabel P. Whole-body spectroscopy (BCM) in the assessment of normovolemia in hemodialysis patients. Contrib Nephrol 2008;161:115-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18451666" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lindley E, Devine Y, Hall L, Cullen M, Cuthbert S, Woodrow G, et al. A Ward-based procedure for assessment of fluid status in peritoneal dialysis patients using bioimpedance spectroscopy. Perit Dial Int 2005;25 Suppl 3:S46-S48. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16048255" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Wizemann V, Wabel P, Chamney P, Zaluska W, Moissl U, Rode Ch, et al. The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant 2009;24(5):1574-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19131355" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "15.\u{A0}Devereux RB, Lutas EM, Casale PN, Kligfield P, Eisenberg RR, Hammond IW, et al. Standardization of M-mode echocardiographic left ventricular anatomic measurements. J Am Coll Cardiol 1984;4(6):1222-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6238987" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Camp E, Sachs I, et al. Echocardiographic assessment of Left Ventriular Hypertrophy: Comparison to Necropsy Findigs. Am J Cardiol 1986;57(6):450-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2936235" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Quiñoles MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2002;15(2):167-84. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11836492" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tripepi G, Benedetto FA, Mallamaci F, Tripepi R, Malatino L, Zoccali C. Left atrial volumen in end-stage renal disease: a prospective cohort study. J Hypertens 2006;24:1173-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16685218" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tripepi G, Benedetto FA, Mallamaci F, Tripepi R, Malatino L, Zoccali C. Left atrial volumen monitoring and cardiovascular risk in patients with end-stage renal disease: a prospective cohort stuydy. J Am Soc Nephrol 2007;18:1316-22. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17360950" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Wabel P, Moissl U, Chamney P, Jirka T, Machek P, Ponce P,\u{A0}et all. Towards improvend cardiovascular manegement: the necessity of combining blood pressure and fluid overload. Nephrol Dial Transplant 2008;9:2965-71." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "21.Leunissen KM, Kouw P, Kooman JP. New techniques to determine fluid status in hemodialyzed patients. Kidney In 1993;41:S50-S56." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bargnoux AS, Klouche K, Fareh J, Barazer I, Villard-Saussine S, Dupuy AM,\u{A0}et al. Prohormone brain natriuretic peptide (proBNP), BNP and N-terminal-proBNP circulating levels inchronic hemodialysis patients. Correlation with ventricular function, fluid removal and effect of hemodiafiltration. Clin Chem Lab Med 2008;46:1019-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18624622" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Devolder I, Verleysen A, Vijt D, Vanholder R, Van Biesen W. Body composition, hydration, and related parameters in hemodialysis versus peritoneal dialysis patients. Perit Dial Int 2010;30(2):208-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20081049" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lopot F, Nejedly B, Novotna H, Mackova M, Sulkova S. Age-related extracellular to total body water volume ratio (ECV/TBW)- Can it be used for "dry weight" determination in dialysis patients? Application of ultifrequency bioimpedance measurement. Int J Artif Organs 2002;25:762-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12296460" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Plum J, Schoenicke G, Kleophas W, Kulas W, Steffens F, Azem A, et al. Comparison of body fluid distribution between chronic haemodialysis and peritoneal dialysis patients as assessed by biophysical and biochemical methods. Nephrol Dial Transplant 2001;16:2378-85. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11733630" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kooman JP, Gladziwa U, Böcker G, Wijnen AG, van Bortel K, Luik AJ, et al. Blood pressure during the interdialytic period in hemodialysis patients; estimación of representative pressure values. Nephrol Dial Transplant 1992;7:917-23. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1328939" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Menon MK, Naimark DM, Bargman J, Vas SI, Oreopoulos DG. Long-term blood pressure control in a cohort of PD patients and its association with residual renal function. Nephrol Dial Transplant 2001;16:2207-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11682669" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lysaght MJ, Vonesh EF, Gotch F, Ibels L, Keen M, Lindholm B, et al.\u{A0}The influence of dialysis traatment modality on the decline of remaining renal function. ASAIO Trans 1991;37:598-604. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1768496" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gámez C, Teruel JL, Ortuño J. Evolución de la función renal residual en enfermos tratados con hemodiálisis. Nefrología 1992;12:125-9." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Foley RN, Parfrey PS, Harnett JD, Kent GM, Martin CJ, Murray DC, et al. Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int 1995;47(1):186-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7731145" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "López Gómez JM, Verde E, Pérez García R. Blood pressure left ventricular hipertrophy and long term prognosis in hemodialysis patients. Kidney Int Suppl 1998;68:S92-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9839291" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Levin D, Singer J, Thompson CR. Prevalent lsft hypertrophy in the predialysis populations: identiffying opportunities for intervention. Am J Kidney Dis 1996;27:347-54. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8604703" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 32 => array:3 [ "identificador" => "bib33" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bossola M, Tazza L, Vulpio C, Luciani G. Is regression of left ventricular hypertrophy in maintenance hemodialysis patients possible? Semin Dial 2008;21(5):422-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18764802" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 33 => array:3 [ "identificador" => "bib34" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Wang AY, Wangg M, Woo J, Law MC, Chow KM, Li PY, et al. A novel association between resudual renal function and left ventricular hypertrophy in peritoneal dialysis patients. Kidney Int 2002;62:639-47. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12110029" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 34 => array:3 [ "identificador" => "bib35" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Foley RN, Parfrey PS, Kent GM, Harnett JD, Murray DC, Barre PE. Long-term evolution of cardiomiopathy in dialysis patients. Kidney Int 1998;54:1720-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9844150" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 35 => array:3 [ "identificador" => "bib36" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Foley RN, Parfrey PS, Morgan J, Barré PE, Campbell P, Cartier P, et al. Effect of hemoglobin levels in hemodialysis patients with asymptomatic cardiomyopathy. Kidney Int 2000;58(3):1325-35. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10972697" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 36 => array:3 [ "identificador" => "bib37" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "37.\u{A0}Ardeleanu S, Panaghiu L, Prisad¿ O, Sasc¿u R, Voroneanu L, Hoga¿ S, et al.\u{A0}Regression of left ventricular hypertrophy in hemodialyzed patients is possible: a follow-up study. Int Urol Nephrol. [Epub ahead of print]" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 37 => array:3 [ "identificador" => "bib38" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "London GM, Pannier B, Guerin AP, Blacher J, Marchais SJ, Darne B, et al. Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study. J Am Soc Nephrol 2001;12(12):2759-67. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11729246" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 38 => array:3 [ "identificador" => "bib39" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Levin A, Thompson CR, Ethier J, Carlisle EJ, Tobe S, Mendelssohn D, et al. Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Am J Kidney Dis 1999;34(1):125-34. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10401026" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 39 => array:3 [ "identificador" => "bib40" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Wang AY, Wang M, Lam CW, Chan IH, Lui SF, Sanderson JE. Heart Failure in Long-Term Peritoneal Dialysis Patients: A 4-Year Prospective Analysis. Clin J Am Soc Nephrol 2011;6(4):805-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21212423" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 40 => array:3 [ "identificador" => "bib41" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Io H, Ro Y, Sekiguchi Y, Shimaoka T, Inuma J, Hotta Y, et al. Cardiac function and structure in longitudinal analysis of echocardiography in peritoneal dialysis patients. Perit Dial Int 2010;30(3):353-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20338970" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 41 => array:3 [ "identificador" => "bib42" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tsang TS, Barnes ME, Gersh BJ, Bailey KR, Seward JB. Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol 2002;90:1284-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12480035" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003200000001/v0_201502091620/X2013251412000499/v0_201502091620/en/main.assets" "Apartado" => array:4 [ "identificador" => "35441" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Originals" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000001/v0_201502091620/X2013251412000499/v0_201502091620/en/P1-E532-S3377-A10867-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412000499?idApp=UINPBA000064"]

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Repercusión ecocardiográfica del estado de hidratación en los pacientes en diálisis

Isabel Juan Garcíaa, Isabel Juan-Garcíab, María Jesús Puchadesa, María J. Puchadesb, Rafael Sanjuanc, Rafael Sanjuánd, Isidro Torregrosab, Miguel Angel Solisa, Miguel Á. Solísb, Marisa Blascoc, Miguel Gonzálezb, Antonio Martineza, Marisa Blascod, Alfonso Miguela, Antonio Martínezb, Alfonso Miguelb

a NEFROLOGÍA, Hospital Clínico Universitario de Valencia, VALENCIA, VALENCIA, ESPAÑA,

b Servicio de Nefrología, Hospital Clínico Universitario de Valencia,

c MEDICINA INTENSIVA, Hospital Clínico Universitario de Valencia, VALENCIA, VALENCIA, ESPAÑA,

d Servicio de Medicina Intensiva, Hospital Clínico Universitario de Valencia,

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as well as nutritional parameters&#46;</p><p class="elsevierStylePara">The aim of this study was to stratify patients on dialysis according to hydration status&#44; and to assess possible echocardiographic abnormalities in the various groups according to dialysis technique&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">METHOD</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patients</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We performed a cross-sectional observational study on 117 clinically stable patients on the dialysis programme of the University Clinical Hospital of Valencia between 2008 and 2010&#46; The study included 65 patients &#40;41 males&#41; from the Haemodialysis Unit and 52 patients &#40;28 males&#41; from the Peritoneal Dialysis Unit&#46; Those patients who had arrhythmia&#44; severe valvular heart disease&#44; amputation of any limb&#44; pacemakers or metal prostheses that would interfere with bioimpedance were excluded&#46; All patients signed the informed consent and the hospital ethics committee approved the study protocol&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Measurements</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Examinations of patients on haemodialysis &#40;HD&#41; were performed during the middle of the week&#44; while patients on peritoneal dialysis were examined before the first replacement of the morning with an empty peritoneum&#46;</p><p class="elsevierStylePara">To assess hydration status&#44; we used multifrequency bioimpedance with the Fresenius BCM-Body Composition Monitor&#44; which measures 50 different frequencies from 5kHz to 1MHz&#46; This technique has been validated by dilution techniques that are considered the gold standard&#44;<span class="elsevierStyleSup">9</span> dual X-ray absorptiometry and plethysmography&#44;<span class="elsevierStyleSup">10</span> among others&#46;<span class="elsevierStyleSup">11&#44;12</span> For the measurement&#44; we used two pairs of electrodes&#58; one at a distal position&#44; an injector and a sensor&#44; placed dorsally on the hand &#40;third metacarpophalangeal and carpal joints&#44; respectively&#41; and another on the foot &#40;third metatarsophalangeal and tibiotarsal joints&#41;&#46; The reference was the right hemisoma&#59; in HD&#44; the reference was the hemisoma free of vascular accesses&#46; Prior to the procedure&#44; patients were accurately measured and weighed&#46; Examination was performed in the HD group before and after the session&#46; In both HD and peritoneal dialysis &#40;PD&#41;&#44; the patient was placed in supine decubitus for 15-20 minutes before the examination in order to help distribute excess fluid and avoid the presence of oedema that could distort results&#46; After the HD session&#44; we also waited the same amount of time to allow balancing among the various compartments &#40;intravascular-extravascular-cellular&#41;&#46;</p><p class="elsevierStylePara">Among the various parameters obtained by BIS&#44; we chose the extracellular water-total body water ratio &#40;ECW&#47;TBW&#41; to assess hydration status and the overhydration-extracellular water ratio &#40;OH&#47;ECW&#41; for the mortality risk&#46;</p><p class="elsevierStylePara">Patients were classified by hydration status by means of ECW&#47;TBW normalised for age and gender using the method described by Lindley et al&#44; i&#46;e&#46; the difference between the theoretical ratio under normal conditions and that obtained by bioimpedance&#46; If the difference is &#62;2&#46;5&#37;&#44; the patient is hyperhydrated &#40;HHD&#41;&#44; if between &#62;2&#46;5&#37; and &#60;2&#46;5&#37; the patient is normohydrated &#40;NHD&#41;&#44; and dehydrated if &#60;2&#46;5&#37;&#46;<span class="elsevierStyleSup">13</span></p><p class="elsevierStylePara">The OH&#47;ECW is a ratio that currently is defined as a significant and independent predictor of mortality in patients on dialysis when it is greater than 15&#37;&#46;<span class="elsevierStyleSup">14</span></p><p class="elsevierStylePara">We defined AHT in those patients who had blood pressure &#40;BP&#41; readings &#62;140&#47;80mm Hg and&#47;or were taking antihypertensive drugs&#46;</p><p class="elsevierStylePara">On the examination day&#44; a blood test was performed to determine haemoglobin &#40;mg&#47;dl&#41;&#44; calcium &#40;mg&#47;l&#41;&#44; phosphorus &#40;mg&#47;l&#41;&#44; parathormone &#40;pg&#47;ml&#41;&#44; total proteins &#40;g&#47;dl&#41; and albumin &#40;g&#47;dl&#41; in each patient&#46;</p><p class="elsevierStylePara">We performed transthoracic echocardiography with a multifrequency transducer and a tissue Doppler program &#40;Aloka&#41; before the HD session&#44; and after emptying the peritoneal cavity in PD&#46; Readings and measurements were made following the recommendations of the American Society of Echocardiography &#40;ASE&#41;&#46;<span class="elsevierStyleSup">11&#44;15</span> Left ventricular mass &#40;LVM&#41; was calculated using the modified ASE formula&#44;<span class="elsevierStyleSup">16&#44;17</span> which is the most widely used method since it has shown values closely associated with autopsy findings&#58; LVM&#61;0&#46;8x &#91;1&#46;04x &#40;LVTDD &#43; TDTS &#43; TDTPW&#41; 3&#43; &#40;LVTDD&#41;3&#93; &#43;0&#46;6 &#40;LVTDD&#58; LV telediastolic diameter&#59; TDTS&#58; telediastolic thickness of the septum&#59; TDTPW&#58; telediastolic thickness of the posterior wall&#41;&#46; LVM was indexed by body surface &#40;ILVM&#41;&#46; Based on the studies of Devereux et al&#44; the cut-off point for the diagnosis of LVH using the ILVM was &#8805;125g&#47;m2&#44; with no difference by gender &#40;Figure 1&#41;&#46;<span class="elsevierStyleSup">16</span></p><p class="elsevierStylePara">To classify the type of LVH&#44; we calculated the relative thickness &#40;RT&#41; with the formula&#58; RT&#61;2xPW&#47;LVTDD&#59; we considered a normal RT when &#60;0&#46;45&#46;<span class="elsevierStyleSup">16</span></p><p class="elsevierStylePara">The assessment of the left atrium was performed by measuring the left atrium volume by the indexed Simpson&#39;s disc summation method&#44; where the volume of the left atrium is the individual summation of all discs in the series&#46; We used this method for its speed and for correlating well with any method for determining left atrial volume&#46;<span class="elsevierStyleSup">18&#44;19</span></p><p class="elsevierStylePara">Data were processed using the SPSS 15 program&#46; Results are expressed as mean&#44; standard deviation for data with normal distribution&#59; and as median&#44; interquartile range &#40;IQR&#41; and confidence interval &#40;CI&#41; for data that did not have normal distribution&#46; We performed the comparison of means with the Mann-Whitney and Student&#8217;s-t test according to the distribution of the variables&#46; Linear regression was performed with Pearson&#39;s p&#46; To compare means between the two groups&#44; we performed ANOVA for one factor with Bonferroni and Dunnett&#39;s C post-hoc tests&#44; according to the homogeneity of variances&#46; Values of <span class="elsevierStyleItalic">P</span>&#60;&#46;05 were considered statistically significant&#46; We performed a multivariate analysis&#44; using eccentric LVH as the dependent variable and the other study variables as independent variables&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We examined 117 patients&#44; 65 patients in the HD group and 52 in the PD group&#46; The relevant demographic and clinical characteristics and cardiovascular risk factors are shown in Table 1&#46; It is noteworthy that patients who were on HD had been longer on the technique and had lower residual renal function &#40;RRF&#41; than patients on PD&#46; As for laboratory tests&#44; it is noteworthy that patients on HD had higher readings of total proteins and albumin in blood&#46;</p><p class="elsevierStylePara">The presence of AHT was greater in PD patients&#44; although HD had poorer control of readings&#46; The use of antihypertensive drugs and their combination was greater in patients on PD patients &#40;59&#46;6&#37; vs 30&#46;8&#37;&#41;&#46; The most frequently used drugs in both groups were calcium antagonists and angiotensin-converting enzyme inhibitors &#40;ACEI&#41;&#47;angiotensin II receptor antagonists &#40;ARAII&#41;&#46; Diuretics were used more frequently in PD&#46;</p><p class="elsevierStylePara">We initially examined the relationship in each dialysis group between the hydration status and BP&#44; by means of normalised ECW&#47;TBW ratios&#46; Patients on HD before and after performing the session presented hydration states and BP readings that are shown in Figure 2 and Figure 3&#46; The distribution of patients on PD is shown in Figure 4&#46;</p><p class="elsevierStylePara">In the HD group&#44; 37&#46;5&#37; presented systolic blood pressure &#40;SBP&#41; readings &#62;140mm Hg&#44; with 25&#37; being HHD and 12&#46;5&#37; NHD&#46; Some 62&#46;5&#37; were normotensive&#44; with 42&#46;1&#37; being HHD and 18&#46;8&#37; NHD&#46; In the PD group&#44; 24&#46;9&#37; had SBP &#62;140mm Hg&#44; 11&#46;5&#37; were HHD and 11&#46;5&#37; were NHD&#46; Some 74&#46;9&#37; were normotensive&#44; with 34&#46;6&#37; being HHD and 32&#46;6&#37; NHD&#46; We observed a decline in the number of HHD patients in the HD group after the session &#40;67&#46;1&#37; pre-HD compared to 26&#46;1&#37; post-HD&#41;&#44; as well as a decline in blood pressure readings &#40;SBP&#62;140mm Hg - 37&#46;5&#37; to 32&#46;6&#37;&#41;&#46;</p><p class="elsevierStylePara">If we consider the presence of hypertension &#40;&#62;140&#47;80mm Hg or drug treatment&#41; and the hydration status in each dialysis group&#44; we observe AHT in 45&#46;45&#37; of the HD group&#44; of which 30&#46;3&#37; were HHD&#46; After the HD session&#44; we observed a decrease in AHT patients &#40;post-HD 43&#46;4&#37;&#41; and a decrease in the number of HHD patients &#40;68&#46;1&#37; vs 27&#46;3&#37;&#41;&#46; In PD patients&#44; 69&#46;2&#37; had HTA&#44; of which 28&#46;8&#37; were HHD&#46; Therefore&#44; if we consider the readings for BP and drug treatment&#44; we find greater AHT in PD patients and greater HHD states in PD patients than in readings after HD&#46;</p><p class="elsevierStylePara">The presence of HHD according to ECW&#47;TBW was more frequent in HD than in PD before the dialysis session &#40;67&#46;1&#37; pre-HD compared to 46&#46;1&#37; PD&#41;&#44; but after the HD session a better control of the hydration status is achieved &#40;post-HD 26&#46;1&#37;&#41;&#46;</p><p class="elsevierStylePara">When analysing each dialysis group according to hydration status&#44; the subgroup of HHD patients in both techniques had been longer on the technique &#40;HHD HD 60&#46;9 months vs NHD HD 36&#46;5 months&#59; HHD PD 36&#46;3 months vs NHD PD 34&#46;8 months&#41;&#44; with only those on HD showing a significant difference&#46; The presence of RRF was similar in both techniques&#44; although it was lower in the HHD group &#40;RRF HHD HD 34&#46;9&#37; vs NHD HD 55&#37;&#59; HHD PD 37&#46;5&#37; vs NHD PD 42&#46;9&#37;&#41;&#46;</p><p class="elsevierStylePara">According to the data obtained using BCM&#44; patients on HD had significantly greater overhydration &#40;OH&#41; and extracellular&#47;intracellular &#40;E&#47;I&#41; water than those on PD &#40;Table 2&#41;&#46;</p><p class="elsevierStylePara">The second phase of the study consisted of assessing each dialysis group&#44; according to the hydration status as measured by ECW&#47;TBW&#44; the echocardiographic characteristics and the correlation among the data obtained by bioimpedance &#40;Table 3&#41;&#46;</p><p class="elsevierStylePara">Left atrial volume indexed to body surface &#40;LAVI&#41; and indexed left ventricular mass &#40;ILVM&#41; were significantly greater in patients in the HD group and in the HHD subgroup of both techniques&#46; The OH&#47;ECW ratio was significantly greater in HD patients than in PD patients &#40;&#62;15&#37;&#44; 14&#46;06&#37; in HD vs 3&#46;8&#37; in PD&#41;&#44; as well as in HHD patients in each type of dialysis&#46;</p><p class="elsevierStylePara">If we assess the geometry of the left ventricle in our study population&#44; we observe the presence of LVH in 27&#46;6&#37; of the HD group and 13&#46;4&#37; in PD&#59; the most prevalent in both groups being the eccentric one&#46; According to the hydration status&#44; the presence of LVH was greater in the HHD group &#40;HD 27&#46;9&#37; vs PD 20&#46;8&#37;&#41; than in the NHD group &#40;25&#37; vs 9&#46;5&#37;&#41;&#44; with eccentric LVH being the most prevalent &#40;Tables 4 and 5&#41;&#46; In the univariate study of eccentric LVH with all variations&#44; the only one of significance was eccentric LVH with hydration status &#40;normalised ECW&#47;TBW&#41; with a significance of <span class="elsevierStyleItalic">P</span>&#61;&#46;03 &#40;CI 1&#46;1-11&#46;5&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Bioimpedance is a technique that allows us to detect a large number of HHD patients&#46; It is an easily applicable method and may be considered the gold standard in determining hydration states&#46; Various methods have been used to assess hydration status&#44; but they are unreliable since numerous factors may interfere&#46; The assessment of the hydration status by means of the BP may be distorted by antihypertensive therapy&#44; AHT not dependent on volume&#44; and the presence of heart disease&#59;<span class="elsevierStyleSup">20</span> the inferior vena cava shows the intravascular volume by diastolic dysfunction&#59;<span class="elsevierStyleSup">21</span> and RRF and the presence of heart diseases&#44;<span class="elsevierStyleSup">22</span> among others&#44; may interfere with biochemical markers&#44; such as BNP and pro-BNP&#46;</p><p class="elsevierStylePara">We found in the literature that various parameters have been used to define hydration status by bioimpedance&#58; OH&#47;ECW&#44; ECW&#47;TBW&#44; E&#47;I and OH&#46; Lopot et al determined the optimal dry weight in HD patients using the deviation between ECW&#47;TBW obtained by bioimpedance and that obtained in a control group&#44; according to age and sex&#46; This is based on changes produced in the cell mass &#40;with increasing age&#44; the cell mass and therefore the intracellular water decreases&#41; and the hydration status &#40;with increasing age and&#47;or female gender&#44; the intracellular water decreases&#41;&#46;<span class="elsevierStyleSup">23</span> Lindley et al determined the dry weight in PD using the difference between ECW&#47;TBW obtained by BIS compared to ECW&#47;TBW of a control group according to patient age and gender &#40;defining HHD as those who had &#43;2&#46;5&#37; standard deviation&#41;&#46;<span class="elsevierStyleSup">13</span></p><p class="elsevierStylePara">We assessed the hydration status of our patients based on these principles&#46;<span class="elsevierStyleSup">9&#44;24</span> In the HD group&#44; we found significantly more HHD patients before HD &#40;67&#46;1&#37;&#41; than in the PD group &#40;46&#46;1&#37;&#41;&#44; and almost half had AHT&#46; After the HD session&#44; better control of hydration status is achieved &#40;26&#46;1&#37;&#41;&#46; Devolder I et al assessed hydration status by means of OH&#47;ECW &#40;overhydrated OH&#47;ECW&#62;15&#37;&#41;&#44;<span class="elsevierStyleSup">23</span> Plum et al by ECW&#47;TBW<span class="elsevierStyleSup">25</span> and Passauer et al by OH &#40;litres of overhydration &#62;1&#46;1 I&#41;&#46;<span class="elsevierStyleSup">11</span> They found that hydration status was harder to control in patients on PD than in post-HD patients&#44; which is consistent with our data&#46;</p><p class="elsevierStylePara">The bodily distribution of excess fluid in patients on dialysis varies according to the type of technique&#46; Therefore&#44; the impact of hydration status on BP and at the cardiac level must vary&#46; In the literature&#44; excess fluid in patients on PD is found peripherally in the subcutaneous tissue&#44; while in HD patients it is located in the bloodstream&#46;<span class="elsevierStyleSup">25</span> In HD&#44; there is an increase in body weight in the interdialytic period &#40;48 hours&#41;&#44; due to the consumption of liquids and food&#44; and a decrease during the session &#40;4 hours&#41; by the ultrafiltration of the accumulated water volume and by the convective and diffusive transport of sodium&#46; Abrupt changes occur at the intravascular level&#44; very slowly from the interstitial space by means of refilling&#46; Interdialytic weight gain is greater in patients who do not have RRF&#46; The PD technique is usually performed continuously&#44; and the balance between the various compartments is produced constantly&#46; Ultrafiltration is produced from the interstitial space&#46;</p><p class="elsevierStylePara">We must remember that bioimpedance assesses the intra-extracellular hydration status&#44; and not hydration at the intravascular level&#46; The increased state of HHD in HD before the session is due to weight gain in the interdialytic period&#44; which is located at the extracellular and intravascular level&#44; resulting in a greater E&#47;I ratio&#46; After the HD session&#44; the hydration status is reduced by the ultrafiltration of the intravascular space&#44; and it takes some time for the various compartments to reach a balance&#46; In PD&#44; we observed a significantly lower E&#47;I ratio than in HD &#40;E&#47;I pre-HD 0&#46;96 vs PD 0&#46;9&#41; due to a lower extracellular water &#40;ECW pre-HD 16 1 vs PD 15&#46;2 1&#41; because ultrafiltration in this technique is performed constantly&#46; Therefore&#44; when we perform bioimpedance in patients on HD&#44; especially after the session&#44; balance has not yet been reached among the various compartments&#46; Probably because of this&#44; hydration parameters in PD compared to post-HD may be distorted&#46;</p><p class="elsevierStylePara">In the literature&#44; the prevalence of AHT in patients on HD is around 60&#37; in the interdialytic period&#44;<span class="elsevierStyleSup">26</span> while for PD it is greater &#40;80&#37;&#41;&#46;<span class="elsevierStyleSup">27</span> Our prevalence of AHT was lower&#46; The presence of high BP readings and&#47;or antihypertensive treatment was greater in PD patients &#40;PD 76&#46;9&#37; vs HD 49&#46;2&#37;&#41;&#44; but they had better blood pressure control &#40;BP&#60;140mm Hg&#44; 37&#46;5&#37; HD vs 24&#46;9&#37; PD&#41;&#44; probably due to the greater use of antihypertensive drugs&#46; The most widely used drugs in both groups were calcium antagonists and ACEI&#47;ARAII&#46;</p><p class="elsevierStylePara">Diuretics are used more in PD due to the greater prevalence of RRF&#44; and this allows us to increase the diuresis volume and adjust hydration status&#46; The increased presence of RRF in PD is due to PD being a continuous technique&#44; with constant ultrafiltration that precludes abrupt changes in volume&#44; which helps protect the kidney&#46; Moreover&#44; patients on HD usually have poorer renal function due to the greater use of nephrotoxic agents &#40;aminoglycosides&#44; contrast media&#44; non steroidal anti-inflammatory drugs&#41;&#44; the bioincompatibility of filter membranes and&#47;or increased frequency of hypotension episodes&#46;<span class="elsevierStyleSup">28&#44;29</span> We found an inverse correlation between time on dialysis and presence of RRF in our patients&#44; due to the continuous development of kidney disease over time&#44; which results in a reduced RRF&#44; although in most studies the mean time on the technique is lower than ours&#46;</p><p class="elsevierStylePara">The greater frequency of AHT in PD patients may be due to the greater hydration status &#40;less accuracy in the adjustment of dry weight&#44; continuous changes in the peritoneal membrane&#44; etc&#46;&#41; Patients in HD had greater hydration states before the dialysis session&#44; but decreased after the session&#44; with subsequent increases up to the next session&#44; reflecting these changes in the blood pressure&#46; Patients on HD usually had less antihypertensive treatment because during the HD session a reduction in intravascular volume is produced and this must be adapted&#46; If the patient is undergoing antihypertensive treatment&#44; the compensation and&#47;or vascular adaptation mechanisms are blocked and present continuous vasodilation&#44; which results in hypotension&#44; poor tolerance&#44; and an inability to reach the target dry weight&#46; At the same time&#44; vascular refilling is produced from the interstitial liquid at different speeds&#44; depending on the patient&#39;s characteristics &#40;elderly&#44; diabetic&#44; and patients with ventricular dysfunction or pulmonary hypertension present very slow refilling&#41;&#46;</p><p class="elsevierStylePara">The prevalence of LVH is 75&#37; among patients on dialysis&#44;<span class="elsevierStyleSup">30&#44;31&#44;32</span> and develops in initial stages of CKD&#46; Numerous studies have shown its increase in parallel with the reduction of GFR&#46;<span class="elsevierStyleSup">33</span> AHT and hyperhydration have an impact on the heart with the development of LVH&#44; among other risk factors&#46; We found studies&#44; such as the Wang AY et al study&#44; where RRF had considerable influence and 70&#37; of patients with no RRF presented ventricular modelling disorders&#46;<span class="elsevierStyleSup">34</span> The development of LVH varies according to the type of overload&#46; Fluid or volume overload is related to the onset of eccentric LVH&#44; while pressure overload and AHT is related to concentric LVH&#46; We found a correlation between eccentric LVH and the hydration state&#46; Foley et al suggest that regression of LVH does not occur after starting dialysis and that it is irreversible&#44; due to high patient mortality&#46;<span class="elsevierStyleSup">35&#44;36</span> However&#44; last year we found published studies that demonstrated that LVH regression is possible after years of dialysis&#46; Several therapeutic strategies may work&#58; control of anaemia&#44; control of hydration status&#44; use of antihypertensive drugs in normotensive and hypertensive patients&#44; daily or night-time use of HD&#44; prevention and treatment of hyperphosphataemia&#44; vitamin D administration&#44; and multifactorial intervention&#46;<span class="elsevierStyleSup">37&#44;38&#44;39</span> We found regression not only in patients on HD&#44; but also in patients on PD&#46;<span class="elsevierStyleSup">40&#44;41</span>&#160;</p><p class="elsevierStylePara">In our study&#44; the prevalence of LVH was less &#40;53&#46;5&#37; in HD vs 38&#46;4&#37; in PD&#41;&#46; The lower presence of cardiac disorders may be due to acceptable control of hydration status and BP&#44; a high presence of RRF&#44; as well as good control over haemoglobin readings&#44; calcium-phosphorus metabolism&#44; and the use of ACEI and ARA II&#46; The difference found between both dialysis techniques may be explained by the greater percentage of patients with no RRF in HD&#44;<span class="elsevierStyleSup">31</span> the lower use of ACEI&#47;ARAII&#44; and greater extracellular water ratio&#46; LAVI shows the average of increased filling pressures&#44;<span class="elsevierStyleSup">42</span> the functional situation of the heart and overload&#44; and thus&#44; the hydration status&#46; Patients on HD have a significantly greater LAVI than those on PD&#44; and HHD patients have greater intravascular volume and therefore greater cardiac overload&#44; leading to increased LVH&#46;&#160;</p><p class="elsevierStylePara">Lastly&#44; we analysed two emerging markers for the stratification and monitoring of cardiovascular risk in patients with CKD&#44; LAVI and OH&#47;ECW&#46;<span class="elsevierStyleSup">8&#44;14&#44;17&#44;42</span> Wizemann et al<span class="elsevierStyleSup">14</span> defined the OH&#47;ECW ratio &#62;15 as a cardiovascular risk factor&#44; based on the study performed by Wabel et al in which NHD patients presented an OH&#47;ECW of 6&#46;8&#37;-15&#37;&#46;<span class="elsevierStyleSup">20</span> LAVI is a chronic marker of diastolic function that shows the average of increased filling pressures&#44;<span class="elsevierStyleSup">42</span> &#160;and is considered the best index for assessing filling pressures and the functional situation of the heart&#44; since it is linked to the severity and duration of diastolic dysfunction of the left ventricle&#46;<span class="elsevierStyleSup">18&#44;19</span> In our study&#44; both indices are significantly higher in patients on HD&#44; as well as in HHD patients in both groups&#46; Therefore&#44; being HDD according to the normalised ECW&#47;TBW ratio &#62;2&#46;5&#37; is a high cardiovascular risk&#46;</p><p class="elsevierStylePara">We can conclude that bioimpedance detects a greater number of HDD patients on both dialysis techniques&#46; When studying echocardiographic disorders in dialysis patients&#44; we found a high correlation between hydration status and LAVI and ILVM&#46; Additional prospective studies are warranted to assess the hydration states of the dialysis population and to determine whether there is regression in cardiac remodelling with the control of the hydration status by means of bioimpedance&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflict of interest<br></br></span><br></br>The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10867&#95;16025&#95;25587&#95;en&#95;t1&#95;10867i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25587_en_t1_10867i2.jpg" alt="Characteristics of patients on peritoneal haemodialysis and dialysis "></img></a></p><p class="elsevierStylePara">Table 1&#46; Characteristics of patients on peritoneal haemodialysis and dialysis </p><p class="elsevierStylePara"><a href="grande&#47;10867&#95;16025&#95;25589&#95;en&#95;t2&#95;10867i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25589_en_t2_10867i2.jpg" alt="Assessment of the heart and the overhydration-extracellular water ratio according to the state of hydration in each dialysis group "></img></a></p><p class="elsevierStylePara">Table 2&#46; Assessment of the heart and the overhydration-extracellular water ratio according to the state of hydration in each dialysis group </p><p class="elsevierStylePara"><a href="grande&#47;10867&#95;16025&#95;25590&#95;en&#95;t3&#95;10867i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25590_en_t3_10867i2.jpg" alt="Parameters obtained by bioimpedance in peritoneal haemodialysis and dialysis groups "></img></a></p><p class="elsevierStylePara">Table 3&#46; Parameters obtained by bioimpedance in peritoneal haemodialysis and dialysis groups </p><p class="elsevierStylePara"><a href="grande&#47;10867&#95;16025&#95;25591&#95;en&#95;t4&#95;10867i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25591_en_t4_10867i2.jpg" alt="Left ventricular geometry according to dialysis type"></img></a></p><p class="elsevierStylePara">Table 4&#46; Left ventricular geometry according to dialysis type</p><p class="elsevierStylePara"><a href="grande&#47;10867&#95;16025&#95;25592&#95;en&#95;t5&#95;10867i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25592_en_t5_10867i2.jpg" alt="Left ventricular geometry according to hydration state "></img></a></p><p class="elsevierStylePara">Table 5&#46; Left ventricular geometry according to hydration state </p><p class="elsevierStylePara"><a href="grande&#47;10867&#95;16025&#95;25593&#95;en&#95;f1&#95;10867i&#46;jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25593_en_f1_10867i.jpg" alt="Patterns of left ventricular hypertrophy "></img></a></p><p class="elsevierStylePara">Figure 1&#46; Patterns of left ventricular hypertrophy </p><p class="elsevierStylePara"><a href="grande&#47;10867&#95;16025&#95;25594&#95;es&#95;f2&#95;10867i3&#46;jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25594_es_f2_10867i3.jpg" alt="Distribution of patients on haemodialysis before the session according to blood pressure readings and the difference of the ECW&#47;TBW ratio "></img></a></p><p class="elsevierStylePara">Figure 2&#46; Distribution of patients on haemodialysis before the session according to blood pressure readings and the difference of the ECW&#47;TBW ratio </p><p class="elsevierStylePara"><a href="grande&#47;10867&#95;16025&#95;25595&#95;en&#95;f3&#95;10867i&#46;jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25595_en_f3_10867i.jpg" alt="Distribution of patients on haemodialysis after the session according to blood pressure readings and the difference of the ECW&#47;TBW ratio "></img></a></p><p class="elsevierStylePara">Figure 3&#46; Distribution of patients on haemodialysis after the session according to blood pressure readings and the difference of the ECW&#47;TBW ratio </p><p class="elsevierStylePara"><a href="grande&#47;10867&#95;16025&#95;25596&#95;en&#95;f4&#95;10867i&#46;jpg" class="elsevierStyleCrossRefs"><img src="10867_16025_25596_en_f4_10867i.jpg" alt="Distribution of patients on peritoneal dialysis according to blood pressure readings and the difference of the ECW&#47;TBW ratio"></img></a></p><p class="elsevierStylePara">Figure 4&#46; Distribution of patients on peritoneal dialysis according to blood pressure readings and the difference of the ECW&#47;TBW ratio</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;n&#58;</span> La enfermedad cardiovascular es la principal causa de muerte en los pacientes con enfermedad renal cr&#243;nica&#46; La hipertrofia ventricular izquierda &#40;HVI&#41; es la manifestaci&#243;n m&#225;s frecuente y est&#225; relacionada con la hipertensi&#243;n arterial y la hiperhidrataci&#243;n&#46; El objetivo del presente trabajo es estratificar a los pacientes en di&#225;lisis seg&#250;n el estado de hidrataci&#243;n y valorar las posibles alteraciones ecocardiogr&#225;ficas en los distintos grupos&#46; <span class="elsevierStyleBold">M&#233;todos&#58;</span>&#160;Realizamos un estudio transversal de 117 pacientes&#44; 65 en hemodi&#225;lisis &#40;HD&#41; y 52 en di&#225;lisis peritoneal &#40;DP&#41;&#46; Las exploraciones realizadas fueron&#58; bioimpedancia multifrecuencia con el sistema BCM-Body Composition Monitor de Freesenius&#44; ecocardiograf&#237;a transtor&#225;cica y anal&#237;tica de sangre&#46; Definimos hiperhidrataci&#243;n cuando el cociente volumen extracelular-volumen corporal total &#40;ECW&#47;TBW&#41; normalizado para edad y sexo es &#62; 2&#44;5&#37; de la desviaci&#243;n est&#225;ndar&#46; &#160;<span class="elsevierStyleBold">Resultados&#58;</span>&#160;Los pacientes en HD est&#225;n pre-HD &#40;67&#44;1&#37;&#41; m&#225;s hiperhidratados de forma significativa que los de DP &#40;46&#44;1&#37;&#41;&#44; presentando casi la mitad de la poblaci&#243;n hiperhidratada hipertensi&#243;n arterial&#59; tras la sesi&#243;n de HD se consigue un mejor control del estado de hidrataci&#243;n &#40;26&#44;1&#37;&#41;&#46; Los pacientes en DP presentan con m&#225;s frecuencia cifras de tensi&#243;n arterial alta y&#47;o llevan tratamiento antihipertensivo &#40;DP 76&#44;9 vs&#46; HD 49&#44;2&#37;&#41;&#46; La HVI es m&#225;s frecuente en los pacientes en HD e hiperhidratados&#44; siendo la m&#225;s prevalente la HVI exc&#233;ntrica&#46; Los pacientes hiperhidratados presentan cifras superiores&#44; de forma significativa&#44; del IVAI &#40;volumen de aur&#237;cula izquierda indexada por superficie corporal&#44; la IMVI &#40;masa ventricular izquierda indexada&#41; y el cociente sobrehidrataci&#243;n-agua extracelular&#46; <span class="elsevierStyleBold">Conclusiones&#58;</span>&#160;La bioimpedancia es una t&#233;cnica que nos permite detectar un gran n&#250;mero de pacientes hiperhidratados&#46; Al estudiar las alteraciones ecocardiogr&#225;ficas en los pacientes en di&#225;lisis encontramos una alta correlaci&#243;n entre el estado de hidrataci&#243;n por ECW&#47;TBW normalizado para edad y sexo&#44; y el IVAI e IMVI&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Cardiovascular disease is the main cause of death in Chronic Kidney Disease patients&#46; Left ventricular hypertrophy is the most common manifestation and it is linked to arterial hypertension and overhydration&#46; The goal of this paper is to stratify dialyzed patients according to hydration status and to make an evaluation about the possible echocardiography alterations of the different groups&#46; <span class="elsevierStyleBold">Methods&#58;</span> a transversal study was carried out with 117 patients&#58; 65 were on hemodialysis and 52 on peritoneal dialysis&#46; We performed the following tests&#58; multifrequency bioimpedance with the BCM-Body Composition Freesenius&#8217; Monitor system&#44; transthoracic echocardiography&#44; and blood tests&#46; If ECW&#47;TBW &#40;extracellular water vs total body water&#41; normalization ratio for age and gender was &#62; 2&#46;5&#37; SD&#44; the patient was considered overhydrated&#46; <span class="elsevierStyleBold">Results&#58;</span>&#160;HD patients are significantly overhydrated before HD &#40;67&#46;1&#37;&#41; compared to DP patients &#40;46&#46;1&#37;&#41;&#44; and almost half of the overhydrated population presents arterial hypertension&#46; However&#44; after an HD session&#44; a better control of the hydration status is reached &#40;26&#46;1&#37;&#41;&#46; DP patients frequently present high arterial pressure and&#47;or are under antihypertensive treatment &#40;DP 76&#46;9&#37; vs HD 49&#46;2&#37;&#41;&#46; Left ventricular hypertrophy is much more common in HD overhydrated patients&#44; eccentric LVH being more prevalent&#46; Overhydrated patients present significantly high values of LAVI&#44; ILVM&#44; OH&#47;ECW&#46; <span class="elsevierStyleBold">Conclusions&#58;</span>&#160;Bioimpedance technique allows for the detection of a large number of overhydrated patients&#46; Echocardiographic alterations in dialyzed patients show a high correlation between the hydration stage by ECW&#47;TBW normalized ratio for age and gender and the LAVI and ILVM&#46;</p>"
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            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Locatelli F, Marcelli D, Conte F, D'Amico M, Del Vecchio L, Limido A, et al. Cardiovascular disease in chronic renal failure: the challenge continues. Nephrol Dial Transplant 2000;15 (suppl.5):69-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11073278" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
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            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M,\u{A0}et al. Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 2006;17:2034-47. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16738019" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al.; American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 2003;108(17):2154-69."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "4.\u{A0} Parfrey PS, Foley RN. The clinical epidemiology of cardiac disease in chronic renal failure. J Am Soc Nephrol 1999;10:1606-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10405218" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Silverberg DS, Wexler D, Iaina A, SteinbruchS, Wollman Y, Schwartz D. Anemia, chronic renal disease and congestive heart failure¿the cardio renal anemia syndrome: the nedd for cooperation between cardilogists and nefephrologists.\u{A0}Int Urol Nephrol 2006;38:295-310. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16868702" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kuhlmann MK, Zhu F, Seibert E, Levin NW. Bioimpedance, dry weight and blood pressure control: new metrhods and consequences. Curr Opin Nephrol Hypertens 2005;14:543-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16205473" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bargnoux AS, Kloudche K, Fareh J,\u{A0}\u{A0}Barazer I, Villard-Saussine S, Dupuy AM, et al. Prohormone brain natriuretic peptide (proBNP), BNP and N-terminal-proBNP circulating levels in chronic hemodialysis patients. Correlation with ventricular function, fluid removal and effect of hemodiafiltration. Clin Chem Lab Med 2008;46:1019-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18624622" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Matthie J, Zarowitz B, De Lorenzo A, Andreoli A, Katzarski K, Pan G, et al. Analytic assessment of the various bioimpedance methods used to estimate body water. J Appl Physiol 1998;84:1801-16 <a href="http://www.ncbi.nlm.nih.gov/pubmed/9572833" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Moissl UM, Wabel P, Chamney PW, Bosaeus I, Levin NW, Bosy-Westphal A,\u{A0}et al.\u{A0}Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas 2006;27:921-33. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16868355" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Moissl U, Bosaeus I, Lemmey A, Hovgesen S, Wabel P, Chamney PW,\u{A0}et al.\u{A0}Validation of a 3C model for determination of body fat mass. J Am Soc Nephrol 2007;18:257A."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Passauer J,\u{A0}Petrov H,\u{A0}Schleser A,\u{A0}Leicht J,\u{A0}Pucalka K. Evaluation of clinical dry weight assessment in haemodialysis patients using bioimpedance specctroscopy: a cross-sectional study. Nephrol Dial Transplant 2010;25:545-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19808949" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
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                0 => array:3 [
                  "referenciaCompleta" => "Wizemann V, Rode C, Wabel P. Whole-body spectroscopy (BCM) in the assessment of normovolemia in hemodialysis patients. Contrib Nephrol 2008;161:115-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18451666" target="_blank">[Pubmed]</a>"
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                  "contribucion" => array:1 [
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                  "referenciaCompleta" => "Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Camp E, Sachs I, et al. Echocardiographic assessment of Left Ventriular Hypertrophy: Comparison to Necropsy Findigs. Am J Cardiol 1986;57(6):450-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2936235" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "Quiñoles MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2002;15(2):167-84. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11836492" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "host" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Tripepi G, Benedetto FA, Mallamaci F, Tripepi R, Malatino L, Zoccali C. Left atrial volumen in end-stage renal disease: a prospective cohort study. J Hypertens 2006;24:1173-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16685218" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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                ]
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            ]
            18 => array:3 [
              "identificador" => "bib19"
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              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Tripepi G, Benedetto FA, Mallamaci F, Tripepi R, Malatino L, Zoccali C. Left atrial volumen monitoring and cardiovascular risk in patients with end-stage renal disease: a prospective cohort stuydy. J Am Soc Nephrol 2007;18:1316-22. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17360950" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              ]
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                0 => array:3 [
                  "referenciaCompleta" => "Wabel P, Moissl U, Chamney P, Jirka T, Machek P, Ponce P,\u{A0}et all. Towards improvend cardiovascular manegement: the necessity of combining blood pressure and fluid overload. Nephrol Dial Transplant 2008;9:2965-71."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "21.Leunissen KM, Kouw P, Kooman JP. New techniques to determine fluid status in hemodialyzed patients. Kidney In 1993;41:S50-S56."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
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                0 => array:3 [
                  "referenciaCompleta" => "Bargnoux AS, Klouche K, Fareh J, Barazer I, Villard-Saussine S, Dupuy AM,\u{A0}et al. Prohormone brain natriuretic peptide (proBNP), BNP and N-terminal-proBNP circulating levels inchronic hemodialysis patients. Correlation with ventricular function, fluid removal and effect of hemodiafiltration. Clin Chem Lab Med 2008;46:1019-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18624622" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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            22 => array:3 [
              "identificador" => "bib23"
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              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Devolder I, Verleysen A, Vijt D, Vanholder R, Van Biesen W. Body composition, hydration, and related parameters in hemodialysis versus peritoneal dialysis patients. Perit Dial Int 2010;30(2):208-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20081049" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lopot F, Nejedly B, Novotna H, Mackova M, Sulkova S. Age-related extracellular to total body water volume ratio (ECV/TBW)- Can it be used for "dry weight" determination in dialysis patients? Application of ultifrequency bioimpedance measurement. Int J Artif Organs 2002;25:762-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12296460" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Plum J, Schoenicke G, Kleophas W, Kulas W, Steffens F, Azem A, et al. Comparison of body fluid distribution between chronic haemodialysis and peritoneal dialysis patients as assessed by biophysical and biochemical methods. Nephrol Dial Transplant 2001;16:2378-85. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11733630" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kooman JP, Gladziwa U, Böcker G, Wijnen AG, van Bortel K, Luik AJ, et al. Blood pressure during the interdialytic period in hemodialysis patients; estimación of representative pressure values. Nephrol Dial Transplant 1992;7:917-23. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1328939" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Menon MK, Naimark DM, Bargman J, Vas SI, Oreopoulos DG. Long-term blood pressure control in a cohort of PD patients and its association with residual renal function. Nephrol Dial Transplant 2001;16:2207-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11682669" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lysaght MJ, Vonesh EF, Gotch F, Ibels L, Keen M, Lindholm B, et al.\u{A0}The influence of dialysis traatment modality on the decline of remaining renal function. ASAIO Trans 1991;37:598-604. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1768496" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Gámez C, Teruel JL, Ortuño J. Evolución de la función renal residual en enfermos tratados con hemodiálisis. Nefrología 1992;12:125-9."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Foley RN, Parfrey PS, Harnett JD, Kent GM, Martin CJ, Murray DC, et al. Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int 1995;47(1):186-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7731145" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "López Gómez JM, Verde E, Pérez García R. Blood pressure left ventricular hipertrophy and long term prognosis in hemodialysis patients. Kidney Int Suppl 1998;68:S92-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9839291" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
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              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Levin D, Singer J, Thompson CR. Prevalent lsft hypertrophy in the predialysis populations: identiffying opportunities for intervention. Am J Kidney Dis 1996;27:347-54. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8604703" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
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              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bossola M, Tazza L, Vulpio C, Luciani G. Is regression of left ventricular hypertrophy in maintenance hemodialysis patients possible? Semin Dial 2008;21(5):422-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18764802" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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                ]
              ]
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            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Wang AY, Wangg M, Woo J, Law MC, Chow KM, Li PY, et al. A novel association between resudual renal function and left ventricular hypertrophy in peritoneal dialysis patients. Kidney Int 2002;62:639-47. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12110029" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              ]
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              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Foley RN, Parfrey PS, Kent GM, Harnett JD, Murray DC, Barre PE. Long-term evolution of cardiomiopathy in dialysis patients. Kidney Int 1998;54:1720-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9844150" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
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              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Foley RN, Parfrey PS, Morgan J, Barré PE, Campbell P, Cartier P, et al. Effect of hemoglobin levels in hemodialysis patients with asymptomatic cardiomyopathy. Kidney Int 2000;58(3):1325-35. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10972697" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
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              "identificador" => "bib37"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "37.\u{A0}Ardeleanu S, Panaghiu L, Prisad¿ O, Sasc¿u R, Voroneanu L, Hoga¿ S, et al.\u{A0}Regression of left ventricular hypertrophy in hemodialyzed patients is possible: a follow-up study. Int Urol Nephrol. [Epub ahead of print]"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
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                0 => array:3 [
                  "referenciaCompleta" => "London GM, Pannier B, Guerin AP, Blacher J, Marchais SJ, Darne B, et al. Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study. J Am Soc Nephrol 2001;12(12):2759-67. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11729246" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "host" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Levin A, Thompson CR, Ethier J, Carlisle EJ, Tobe S, Mendelssohn D, et al. Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Am J Kidney Dis 1999;34(1):125-34. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10401026" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "Wang AY, Wang M, Lam CW, Chan IH, Lui SF, Sanderson JE. Heart Failure in Long-Term Peritoneal Dialysis Patients: A 4-Year Prospective Analysis. Clin J Am Soc Nephrol 2011;6(4):805-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21212423" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "host" => array:1 [
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              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Io H, Ro Y, Sekiguchi Y, Shimaoka T, Inuma J, Hotta Y, et al. Cardiac function and structure in longitudinal analysis of echocardiography in peritoneal dialysis patients. Perit Dial Int 2010;30(3):353-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20338970" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Tsang TS, Barnes ME, Gersh BJ, Bailey KR, Seward JB. Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol 2002;90:1284-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12480035" target="_blank">[Pubmed]</a>"
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Article information

ISSN: 20132514
Original language: English

DOI:10.3265/Nefrologia.pre2011.Nov.10867

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	5	6	11
2024 October	63	42	105
2024 September	64	45	109
2024 August	66	72	138
2024 July	49	34	83
2024 June	66	60	126
2024 May	67	40	107
2024 April	78	32	110
2024 March	67	23	90
2024 February	49	35	84
2024 January	38	24	62
2023 December	60	30	90
2023 November	65	33	98
2023 October	110	33	143
2023 September	282	30	312
2023 August	378	27	405
2023 July	389	34	423
2023 June	169	26	195
2023 May	72	47	119
2023 April	46	26	72
2023 March	64	27	91
2023 February	63	37	100
2023 January	40	25	65
2022 December	62	41	103
2022 November	72	34	106
2022 October	84	37	121
2022 September	85	39	124
2022 August	45	50	95
2022 July	48	37	85
2022 June	58	36	94
2022 May	43	30	73
2022 April	51	48	99
2022 March	50	67	117
2022 February	52	53	105
2022 January	45	31	76
2021 December	61	41	102
2021 November	42	43	85
2021 October	50	45	95
2021 September	49	44	93
2021 August	25	35	60
2021 July	46	43	89
2021 June	48	33	81
2021 May	81	37	118
2021 April	172	73	245
2021 March	78	41	119
2021 February	74	23	97
2021 January	55	22	77
2020 December	37	12	49
2020 November	24	16	40
2020 October	27	11	38
2020 September	46	10	56
2020 August	40	16	56
2020 July	47	7	54
2020 June	39	17	56
2020 May	48	12	60
2020 April	30	10	40
2020 March	41	12	53
2020 February	47	19	66
2020 January	52	17	69
2019 December	53	20	73
2019 November	62	18	80
2019 October	48	17	65
2019 September	65	21	86
2019 August	65	17	82
2019 July	42	22	64
2019 June	58	39	97
2019 May	49	23	72
2019 April	82	40	122
2019 March	50	25	75
2019 February	43	19	62
2019 January	38	39	77
2018 December	138	49	187
2018 November	166	21	187
2018 October	116	18	134
2018 September	129	31	160
2018 August	76	26	102
2018 July	57	30	87
2018 June	74	17	91
2018 May	77	30	107
2018 April	91	12	103
2018 March	88	12	100
2018 February	96	10	106
2018 January	107	14	121
2017 December	115	15	130
2017 November	73	16	89
2017 October	76	10	86
2017 September	64	14	78
2017 August	43	20	63
2017 July	53	15	68
2017 June	62	27	89
2017 May	70	20	90
2017 April	72	13	85
2017 March	65	25	90
2017 February	102	22	124
2017 January	56	17	73
2016 December	70	10	80
2016 November	122	16	138
2016 October	179	15	194
2016 September	223	3	226
2016 August	241	12	253
2016 July	224	12	236
2016 June	180	0	180
2016 May	172	0	172
2016 April	131	0	131
2016 March	141	0	141
2016 February	134	0	134
2016 January	148	0	148
2015 December	193	0	193
2015 November	134	0	134
2015 October	123	0	123
2015 September	95	0	95
2015 August	88	0	88
2015 July	94	0	94
2015 June	50	0	50
2015 May	63	0	63
2015 April	6	0	6

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