The Feasibility of Semi-Continuous and Multi-Frequency Thoracic Bioimpedance Measurements by a Wearable Device during Fluid Changes in Hemodialysis Patients.

Repeated single-point measurements of thoracic bioimpedance at a single (low) frequency are strongly related to fluid changes during hemodialysis. Extension to semi-continuous measurements may provide longitudinal details in the time pattern of the bioimpedance signal, and multi-frequency measurements may add in-depth information on the distribution between intra- and extracellular fluid. This study aimed to investigate the feasibility of semi-continuous multi-frequency thoracic bioimpedance measurements by a wearable device in hemodialysis patients. Therefore, thoracic bioimpedance was recorded semi-continuously (i.e., every ten minutes) at nine frequencies (8-160 kHz) in 68 patients during two consecutive hemodialysis sessions, complemented by a single-point measurement at home in-between both sessions. On average, the resistance signals increased during both hemodialysis sessions and decreased during the interdialytic interval. The increase during dialysis was larger at 8 kHz (∆ 32.6 Ω during session 1 and ∆ 10 Ω during session 2), compared to 160 kHz (∆ 29.5 Ω during session 1 and ∆ 5.1 Ω during session 2). Whereas the resistance at 8 kHz showed a linear time pattern, the evolution of the resistance at 160 kHz was significantly different (p < 0.0001). Measuring bioimpedance semi-continuously and with a multi-frequency current is a major step forward in the understanding of fluid dynamics in hemodialysis patients. This study paves the road towards remote fluid monitoring.

Comparison of whole body versus thoracic bioimpedance in relation to ultrafiltration volume and systolic blood pressure during hemodialysis.

In contrast to whole body bioimpedance, which estimates fluid status at a single point in time, thoracic bioimpedance applied by a wearable device could enable continuous measurements. However, clinical experience with thoracic bioimpedance in patients on dialysis is limited. To test the reproducibility of whole body and thoracic bioimpedance measurements and to compare their relationship with hemodynamic changes during hemodialysis, these parameters were measured pre- and end-dialysis in 54 patients during two sessions. The resistance from both bioimpedance techniques was moderately reproducible between two dialysis sessions (intraclass correlations of pre- to end-dialysis whole body and thoracic resistance between session 1 and 2 were 0.711 [0.58-0.8] and 0.723 [0.6-0.81], respectively). There was a very high to high correlation between changes in ultrafiltration volume and changes in whole body thoracic resistance. Changes in systolic blood pressure negatively correlated to both bioimpedance techniques. Although the relationship between changes in ultrafiltration volume and changes in resistance was stronger for whole body bioimpedance, the relationship with changes in blood pressure was at least comparable for thoracic measurements. These results suggest that thoracic bioimpedance, measured by a wearable device, may serve as an interesting alternative to whole body measurements for continuous hemodynamic monitoring during hemodialysis.NEW & NOTEWORTHY We examined the role of whole body and thoracic bioimpedance in hemodynamic changes during hemodialysis. Whole body and thoracic bioimpedance signals were strongly related to ultrafiltration volume and moderately, negatively, to changes in blood pressure. This work supports the further development of a wearable device measuring thoracic bioimpedance longitudinally in patients on hemodialysis. As such, it may serve as an innovative tool for continuous hemodynamic monitoring during hemodialysis in hospital or in a home-based setting.

Predictors and Dynamics of the Humoral and Cellular Immune Response to SARS-CoV-2 mRNA Vaccines in Hemodialysis Patients: A Multicenter Observational Study.

BACKGROUND: Preliminary evidence suggests patients on hemodialysis have a blunted early serological response to SARS-CoV-2 vaccination. Optimizing the vaccination strategy in this population requires a thorough understanding of predictors and dynamics of humoral and cellular immune responses to different SARS-CoV-2 vaccines. METHODS: This prospective multicenter study of 543 patients on hemodialysis and 75 healthy volunteers evaluated the immune responses at 4 or 5 weeks and 8 or 9 weeks after administration of the BNT162b2 or mRNA-1273 vaccine, respectively. We assessed anti-SARS-CoV-2 spike antibodies and T cell responses by IFN-γ secretion of peripheral blood lymphocytes upon SARS-CoV-2 glycoprotein stimulation (QuantiFERON assay) and evaluated potential predictors of the responses. RESULTS: Compared with healthy volunteers, patients on hemodialysis had an incomplete, delayed humoral immune response and a blunted cellular immune response. Geometric mean antibody titers at both time points were significantly greater in patients vaccinated with mRNA-1273 versus BNT162b2, and a larger proportion of them achieved the threshold of 4160 AU/ml, corresponding with high neutralizing antibody titers in vitro (53.6% versus 31.8% at 8 or 9 weeks, P <0.0001). Patients vaccinated with mRNA-1273 versus BNT162b2 exhibited significantly greater median QuantiFERON responses at both time points, and a larger proportion achieved the threshold of 0.15 IU/ml (64.4% versus 46.9% at 8 or 9 weeks, P <0.0001). Multivariate analysis identified COVID-19 experience, vaccine type, use of immunosuppressive drugs, serum albumin, lymphocyte count, hepatitis B vaccine nonresponder status, and dialysis vintage as independent predictors of the humoral and cellular responses. CONCLUSIONS: The mRNA-1273 vaccine's greater immunogenicity may be related to its higher mRNA dose. This suggests a high-dose vaccine might improve the impaired immune response to SARS-CoV-2 vaccination in patients on hemodialysis.

Towards personalized fluid monitoring in haemodialysis patients: thoracic bioimpedance signal shows strong correlation with fluid changes, a cohort study.

BACKGROUND: Haemodialysis (HD) patients are burdened by frequent fluid shifts which amplify their comorbidities. Bioimpedance (bioZ) is a promising technique to monitor changes in fluid status. The aim of this study is to investigate if the thoracic bioZ signal can track fluid changes during a HD session. METHODS: Prevalent patients from a single centre HD unit were monitored during one to six consecutive HD sessions using a wearable multi-frequency thoracic bioZ device. Ultrafiltration volume (UFV) was determined based on the interdialytic weight gain and target dry weight set by clinicians. The correlation between the bioZ signal and UFV was analysed on population level. Additionally regression models were built and validated per dialysis session. RESULTS: 66 patients were included, resulting in a total of 133 HD sessions. Spearman correlation between the thoracic bioZ and UFV showed a significant strong correlation of 0.755 (p < 0.01) on population level. Regression analysis per session revealed a strong relation between the bioZ value and the UFV (R2 = 0.982). The fluid extraction prediction error of the leave-one-out cross validation was very small (56.2 ml [- 121.1-194.1 ml]) across all sessions at all frequencies. CONCLUSIONS: This study demonstrated that thoracic bioZ is strongly correlated with fluid shifts during HD over a large range of UFVs. Furthermore, leave-one-out cross validation is a step towards personalized fluid monitoring during HD and could contribute to the creation of autonomous dialysis.

Increased Intra-Abdominal Pressure During Laparoscopic Pneumoperitoneum Enhances Albuminuria via Renal Venous Congestion, Illustrating Pathophysiological Aspects of High Output Preeclampsia.

Intra-abdominal hypertension (IAH) causes severe organ dysfunction. Our aim is to evaluate the effect of increased intra-abdominal pressure (IAP) on renal function, hypothesizing that venous congestion may increase proteinuria and fluid retention without endothelial dysfunction. Three urine samples were collected from 32 non-pregnant women undergoing laparoscopic-assisted vaginal hysterectomy (LAVH) and from 10 controls placed in Trendelenburg position for 60 min. Urine sampling was done before (PRE), during or immediately after (PER), and two hours after (POST) the procedure. Urinary albumin, protein and creatinine concentrations were measured in each sample, and ratios were calculated and compared within and between groups. During LAVH, the albumin/creatinine ratio (ACR) increased and persisted POST-procedure, which was not observed in controls. A positive correlation existed between the LAVH duration and the relative change in both ACR and protein/creatinine ratio (PCR) PER- and POST-procedure. Iatrogenic IAH increases urinary ACR and PCR in non-pregnant women via a process of venous congestion. This mechanism might explain the presentation of one specific subtype of late-onset preeclampsia, where no drop of maternal cardiac output is observed.