Impact of hemodialysis on the state of water compartments in CKD VD patients

  • L. Surzhko State Institute «Institute of Nephrology of the National Academy of Medical Sciences of Ukraine»
  • A. Rysev Odessa Regional Center of Nephrology and Dialysis
  • N. Molchanova Odessa Regional Center of Nephrology and Dialysis
Keywords: water balance, hemodialysis, residual kidney function, bioimpedansometry, ultrafiltration.


Understanding of changes in water compartments during hemodialysis (HD) is an important part of ensuring the effectiveness of the procedure and minimizing both intra- and post-dialysis complications.

 The purpose of our study was to investigate the direction of changes in water sectors in patients with CKD 5D with preserved residual kidney function (RKF) and without RKF.

Methods. Prospective observational study enrolled 88 hemodialysis (HD) patients. All patients performed laboratory examinations and measurements of water balance using the BCM monitor before HD, hourly after the start, and 30 minutes after the end of the session. Depending on the presence of residual kidney function, patients were divided into two groups. The first group with RKF included 52 patients, the second - without RKF - 36.

Results. Analysis of water balance parameters allowed to conclude that 26 patients (26.13%) were hyperhydrated (OH/ECW above 15%), including 13 (36,11%) in the group without RKF and 10 (19,2%) - in the group with the preserved RKF. There was no statistically significant difference in the groups. When comparing baseline values between groups of patients, it was found that in the group with preserved RKF the albumin level was significantly higher at 8.94% (p<0.05), levels of phosphorus and potassium were lower by 18.27% and 20.24%, respectively. There was no statistically significant difference between other clinical parameters in the groups. Subsequent analysis of the water balance indicators allowed establishing a reliable positive correlation between the level of ultrafiltration (UV) and total body water (TBW). The higher the UV level, the higher the ECW (p < 0.05). Similar results were obtained when analyzing the relationship between extracellular fluid (ECW) and UV (p < 0,001). As a result of the correlation analysis between the level of UV and diuresis, the mean inverse correlation relationship is shown, which shows - the lower the diuresis, the higher the level of ultrafiltration (p < 0,001). During HD the TBW (ΔTBW = 1.5 ± 1.8) and ECW (ΔECW = 1.92 ± 0.85) progressively decrease, the ICW compartment is practically unchanged (ΔICW = -0.17 ± 0.89). In patients with preserved RKF the change in ECW is significantly lower comparatively with the group without RKF (p <0.05).

Conclusions. Obtained data indicate that the clinical evaluation of hyperhydration is not always adequate. The obtained results confirm the fact that the presence of RKF provides better phosphorus and potassium levels control in patients with CKD. During HD the removal of fluid occurs directly from the extracellular space, in the group with the RKF to a lesser extent, indicating that the presence of diuresis provides a lower volume of OH, TBW, ECW before HD session, and therefore the level of ultrafiltration appears to be less. Thus the RKF also provides better control of water balance. The results of the dynamics of water sector changes during HD can be used to assess the refilling in the future.


Download data is not yet available.


Kolesnyk MO, hol. redaktor. Natsionalnyi reiestr khvorykh na khronichnu khvorobu nyrok ta patsiientiv z  hostrym poshkodzhenniam nyrok: 2018 rik / uklad. NI Kozliuk, SS Nikolaienko, OО Razvazhaieva; Derzhavna ustanova «Instytut nefrolohii NAMN Ukrainy». Kyiv; 2019.178 s. [In Ukrainian]

WizemannV, Wabel P, Chamney P, et al. The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant. 2009;24(5):1574–1579. doi:10.1093/ndt/gfn707

Kim YJ, Jeon HJ, Kim YH, et al. Overhydration measured by bioimpedance analysis and the survival of patients on maintenance hemodialysis: a single-center study. Kidney Res Clin Pract. 2015;34(4):212–218. doi:10.1016/j.krcp.2015.10.006

Barth C, Boer W, Garzoni D, et al. Characteristics of hypotension‐prone haemodialysis patients: is there a critical relative blood volume? Nephrol Dial Transplant, 2003;18(7):1353–1360. doi:10.1093/ndt/gfg171

Shoji T, Tsubakihara Y, Fujii M, Imai E. Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients. Kidney Int. 2004;66:1212–1220.doi:10.1111/j.1523-1755.2004.00812.x

Vasko R, Müller GA, Ratliff BB, Jung K, Gauczinski S, Koziolek MJ. Clinical judgment is the most important element in overhydration assessment of chronic hemodialysis patients. Clin Exp Nephrol. 2013;17(4):563–568. doi:10.1007/s10157-012-0745-9

Brummelhuis WJ, van Geest RJ, van Schelven LJ, Boer WH. Sodium profiling, but not cool dialysate, increases the absolute plasma refill rate during hemodialysis. ASAIO J. 2009;55:575-80. doi: 10.1097/MAT.0b013e3181bea710

Harzallah K, Daiki M, Baffoun A, et al. Comparative study of perdialytic volemia variability in chronic dialysis patients between acetate-free biofiltration and bicarbonate hemodialysis. Saudi J Kidney Dis Transpl. 2011;22:982–989. doi: 10.1053/j.ajkd.2004.11.008

Pietribiasi, Mauro; Katzarski, Krassimir; et al. Kinetics of Plasma Refilling During Hemodialysis Sessions with Different Initial Fluid Status ASAIO Journal. 2015;61(3):350–356. doi: 10.1097/MAT.0000000000000206

Minutolo R, De Nicola L, Bellizzi V, et al. Intra- and post-dialytic changes of haemoglobin concentrations in non-anaemic haemodialysis patients. Nephrol Dial Transplant. 2003;18:2606–2612. doi: 10.1093/ndt/gfg387

Kusztal M, Kleszczyński J, Weyde W, Makulska I, Porażko T, Gołębiowski T, Krajewska M, Zwolińska D, Klinger M: Pulse Volume Changes Recorded by Air Plethysmography during Single Hemodialysis Sessions. Blood Purif 2008;26:498-504. doi: 10.1159/000161078

Seibert E, Zhu F, Kuhlmann MK, et al. Slope analysis of blood volume and calf bioimpedance monitoring in hemodialysis patients. Nephrol Dial Transplant. 2012;27:4430–4436. doi: 10.1093/ndt/gfr734

Robert G. Carroll. Body Fluid Distribution,Elsevier's Integrated Physiology,Mosby,2007:19-26,ISBN 9780323043182,doi: 10.1016/B978-0-323-04318-2.50009-1.

Lee SW, Song JH, Kim GA, Lim HJ, Kim MJ. Plasma brain natriuretic peptide concentration on assessment of hydration status in hemodialysis patient. Am J Kidney Dis. 2003;41:1257–1266.doi:10.1016/S0272-6386(03)00358-5.

Ando Y, Yanagiba S, Asano Y. The inferior vena cava diameter as a marker of dry weight in chronic hemodialyzed patients. Artif Organs. 1995;19:1237–1242. doi:10.1111/j.1525-1594.1995.tb02292.x

Steuer RR, Germain MJ, Leypoldt JK, Cheung AK. Enhanced fluid removal guided by blood volume monitoring during chronic hemodialysis. Artif Organs. 1998;22:627–632.doi:10.1046/j.1525-1594.1998.06036.x

Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis: part I: review of principles and methods. Clin Nutr. 2004;23:1226–1243. doi: 10.1016/j.clnu.2004.06.004

Hannan WJ, Cowen SJ, Fearon KC, Plester CE, Falconer JS, Richardson RA. Evaluation of multi-frequency bio-impedance analysis for the assessment of extracellular and total body water in surgical patients. Clin Sci (Lond) 1994;86:479–485. doi: 10.1042/cs0860479

Sartorio A, Malavolti M, Agosti F, et al. Body water distribution in severe obesity and its assessment from eight-polar bioelectrical impedance analysis. Eur J Clin Nutr. 2005;59:155–160. doi: 10.1038/sj.ejcn.1602049

Kuhlmann MK, Zhu F, Seibert E, Levin NW. Bioimpedance, dry weight and blood pressure control: new methods and consequences. Curr Opin Nephrol Hypertens. 2005;14:543–549. doi:10.1097/01.mnh.0000185983.48319.00

Paul W Chamney, Peter Wabel, Ulrich M Moissl, et al. A whole-body model to distinguish excess fluid from the hydration of major body tissues, The American Journal of Clinical Nutrition, Volume 85, Issue 1, January 2007,P.80–89. doi:10.1093/ajcn/85.1.80

Tattersall J. Bioimpedance analysis in dialysis: state of the art and what we can expect. Blood Purif. 2009;27:70–74. doi: 10.1159/000167012

Wabel P, Moissl U, Chamney P, et al. Towards improved cardiovascular management: The necessity of combining blood pressure and fluid overload. Nephrol Dial Transplant. 2008;23:2965–71. doi: 10.1093/ndt/gfn228

Wizemann V, Wabel P, Chamney P, et al. The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant. 2009;24:1574–9. doi:10.1093/ndt/gfn707

Rhee H, Yang JY, Jung WJ, et al. Significance of residual renal function for phosphate control in chronic hemodialysis patients. Kidney Res Clin Pract. 2014;33(1):58–64. doi:10.1016/j.krcp.2014.01.001

Block, GA, Hulbert-Shearon TE et al. Association of serum phosphorus and calcium×phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998; 31: 607–617. doi:10.1053/ajkd.1998.v31.pm9531176

Tentori F, Blayney MJ, Albert JM et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: The Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 52: 519–530, 2008.doi: 10.1053/j.ajkd.2008.03.020

Slinin Y, Foley RN, Collins AJ: Calcium, phosphorus, parathyroid hormone, and cardiovascular disease in hemodialysis patients: The USRDS waves 1, 3, and 4 study. J Am Soc Nephrol 16: 1788–1793, 2005. doi:10.1681/ASN.2004040275

Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM: Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol 15: 2208–2218, 2004. doi:10.1097/01.ASN.0000133041.27682.A2

Raggi P, Boulay A, Chasan-Taber S, et al. Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol 39: 695–701, 2002. doi:10.1016/S0735-1097(01)01781-8.

Yu SJ, Kim DH, Oh DJ, et al. Assessment of Fluid Shifts of Body Compartments using Both Bioimpedance Analysis and Blood Volume Monitoring. J Korean Med Sci. 2006 Feb;21(1):75-80. doi:10.3346/jkms.2006.21.1.75

How to Cite
Surzhko, L., Rysev, A., & Molchanova, N. (2019). Impact of hemodialysis on the state of water compartments in CKD VD patients. Ukrainian Journal of Nephrology and Dialysis, (2(62), 24-32.