Assesment cardiac effects of overhydration measured by body composition monitor with bnp levels and tissue doppler echocardiography before and after hemodialysis in children with chronic renal failure

Objective: The aim of the study was to evaluate predialysis overhydration status measured by body composition monitor, then calculate the optimal ultrafiltration volume for preventing major cardiovascular risk factors, hypervolemia and hypertension in children with chronic renal failure.Material and Method: We examined 24 hemodialysis in children with chronic renal failure. Baseline urinary creatinine, eGFR, calcium, phosphorus, PTH, haemoglobin and albumin levels were measured. Body weights and blood pressures were measured before and after hemodialysis session. Overhydration status and extracellular liquid volume measured by body composition monitor and ultrafiltration volume determined through dry weight were recorded. The conventional echocardiographic study and also Tissue Doppler echocardiography were performed and NTproBNP levels were measured before and after hemodialysis.Results: There were no statistical difference between pre- and postdialysis NTproBNP levels. NTproBNP levels were statistically higher with restrictive type diastolic dysfunction. In the course of hemodialysis hypotension occured in 38 % of the patients. There were no statistical difference at the echocardiographic findings, NTproBNP levels between the patients that hypotension occurred and didn?t occur. Mitral inflow E/A ratio decreased after hemodialysis, nevertheless mitral annular E/É ratio, MPI determined by Pulse Wave Doppler, left and right ventricular MPI?s determined by Tissue Doppler were not changed significantly with overhydration. There was a positive correlation between weight loss upwards of 2,5 kilograms during hemodialysis and MPI determined by Pulse Wave Doppler echocardiography.Conclusion : Diastolic dysfunction with normal systolic function is determined even in early stages of CRD. Overhydration and pressure loads increase relative wall thickness and left ventricular mass index in hemodialysis patients. Cardiac geometry changes is determined almost all patients with the most frequently consantric hypertrophy pattern. Tissue Doppler echocardiography measurements make proper determination of global and regional cardiac function with the overhydrated patient. NTproBNP is an important indicator of systolic and diastolic dysfunction even in early stages of CRD. Body composition monitor should be used for measuring exracellular liquid volume, predialysis overload setting and setting the optimal ultrafiltration volume.