Published online Jul 25, 2022. doi: 10.5527/wjn.v11.i4.127
Peer-review started: June 19, 2021
First decision: July 31, 2021
Revised: September 19, 2021
Accepted: June 21, 2022
Article in press: June 21, 2022
Published online: July 25, 2022
The burden of chronic kidney disease (CKD) is rising rapidly globally. Fluid overload (FO), an independent predictor of mortality in CKD, should be accurately assessed to guide estimation of the volume of fluid to be removed during haemodialysis (HD). Clinical score (CS) and bio-impedance analysis (BIA) have been utilized in assessment of FO and BIA has demonstrated reproducibility and accuracy in determination of fluid status in patients on HD. There is need to determine the performance of locally-developed CSs in fluid status assessment when evaluated against BIA.
To assess the hydration status of patients on maintenance HD using BIA and a CS, as well as to evaluate the performance of that CS against BIA in fluid status assessment.
This was a single-centre, hospital-based cross-sectional study which recruited adult patients with CKD who were on maintenance HD at Kenyatta National Hospital. The patients were aged 18 years and above and had been on main
From 100 patients on maintenance HD screened for eligibility, 80 were recruited into this study. Seventy-one (88.75%) patients were fluid overloaded when evaluated using BIA with mean extracellular volume of 3.02 ± 1.79 L as opposed to the forty-seven (58.25%) patients who had FO when evaluated using the CS. The difference was significant, with a P value of < 0.0001 (95% confidence interval: 0.1758-0.4242). Using CS, values above 4 were indicative of FO while values less than or equal to 4 denoted the best cut-off for no FO. The sensitivity and specificity for the CS were 63% and 78% respectively. None of the factors evaluated for association with FO showed statistical significance on the multivariable logistic regression model.
FO is very prevalent in patients on chronic HD at the Kenyatta National Hospital. CS detects FO less frequently when compared with BIA. The sensitivity and specificity for the CS were 63% and 78% respectively. None of the factors evaluated for association with FO showed statistical significance on the multivariable logistic regression model.
Core Tip: Bio-impedance analysis (BIA) has been validated as an accurate and reliable tool for determining fluid status in chronic kidney disease (CKD) patients but is not widely available in low-income settings. In this study we assess how a clinical score (CS) compares with BIA in this population for possible use as a low-cost substitute where BIA is not available. Patients with a CS score greater than 4 were considered to have fluid overload (FO), and detected using this parameter in 58.75% of patients. CSs of ≤ 4 represented no FO, and represented 41.25% of patients. The CS had a sensitivity of 63% and a specificity of 78% in making a diagnosis of FO compared with BIA, which was used as the reference in patients with CKD on maintenance haemodialysis.