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Objective Methods of Assessing Fluid Status to Optimize Volume Management...
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Objective Methods of Assessing Fluid Status to Optimize Volume Management in Kidney Disease and Hypertension

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (15 March 2024) | Viewed by 3497

Special Issue Editors

Dr. Mihály Tapolyai

E-Mail Website
Guest Editor
1. Department of Internal Medicine, Division of Dialysis, Szent Margit Hospital, Budapest 1032, Hungary
2. Department of Medicine (Nephrology Section), Raph H. Johnson VA Medical Center, Charleston, SC 29401, USA
Interests: volume measurements; volume status; hypertension; bioimpedance; BNP
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Tibor Fülöp

E-Mail Website
Guest Editor
Department of Medicine, Division of Nephrology, Medical University of South Carolina and Ralph H. Johnson VA Medical Center, 96 Jonathan Lucas Street, MSC 629, CSB 822, Charleston, SC 29425, USA
Interests: critical care nephrology; metabolic acidosis; meta-analysis; uremic toxins; volume overload
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue will explore the methods of assessing fluid status to optimize volume management in kidney diseases and hypertension. Assessing the ideal volume status is an ongoing challenge in kidney disease patients, including recipients of kidney replacement therapies. A related but distinctively separate issue is tailoring the optimal diuretic dosage for patients with hypertension. Beyond clinical assessment, over the last two decades, a plethora of new technologies have emerged, such as bioimpedance-based methods (both whole-body and segmental), ultrasound technology (e.g., assessing inferior vena cava diameter, lung congestion, echocardiography) or biochemical markers of volume status (e.g., brain-type natriuretic peptides).

For this Special Issue, we are also seeking papers that examine the impact of emerging and newly discovered pharmacological agents on the assessment of volume status. We are particularly interested in the correlation and relative value of these technologies in various settings; new results obtained using existing technologies; and possible incremental values of each technology. The emergence of artificial intelligence and machine learning offers yet another tool with which to assess the values of current or novel technologies. Objective methods of volume assessment will have educational value in fine-tuning clinical skills of early learners and providing new ways to validate our patients’ voices and concerns.

Dr. Mihály Tapolyai
Prof. Dr. Tibor Fülöp
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • critical care nephrology

  • fluid overload
  • diuretics
  • hypertension
  • meta-analysis
  • uremic toxins
  • volume overload

Published Papers (4 papers)

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Research

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24 pages, 3451 KiB  
Article
Analyzing Monthly Blood Test Data to Forecast 30-Day Hospital Readmissions among Maintenance Hemodialysis Patients
by Cheng-Han Tsai, Dong-Her Shih, Jue-Hong Tu, Ting-Wei Wu, Ming-Guei Tsai and Ming-Hung Shih
J. Clin. Med. 2024, 13(8), 2283; https://doi.org/10.3390/jcm13082283 - 15 Apr 2024
Viewed by 482
Abstract
Background: The increase in the global population of hemodialysis patients is linked to aging demographics and the prevalence of conditions such as arterial hypertension and diabetes mellitus. While previous research in hemodialysis has mainly focused on mortality predictions, there is a gap [...] Read more.
Background: The increase in the global population of hemodialysis patients is linked to aging demographics and the prevalence of conditions such as arterial hypertension and diabetes mellitus. While previous research in hemodialysis has mainly focused on mortality predictions, there is a gap in studies targeting short-term hospitalization predictions using detailed, monthly blood test data. Methods: This study employs advanced data preprocessing and machine learning techniques to predict hospitalizations within a 30-day period among hemodialysis patients. Initial steps include employing K-Nearest Neighbor (KNN) imputation to address missing data and using the Synthesized Minority Oversampling Technique (SMOTE) to ensure data balance. The study then applies a Support Vector Machine (SVM) algorithm for the predictive analysis, with an additional enhancement through ensemble learning techniques, in order to improve prediction accuracy. Results: The application of SVM in predicting hospitalizations within a 30-day period among hemodialysis patients resulted in an impressive accuracy rate of 93%. This accuracy rate further improved to 96% upon incorporating ensemble learning methods, demonstrating the efficacy of the chosen machine learning approach in this context. Conclusions: This study highlights the potential of utilizing machine learning to predict hospital readmissions within a 30-day period among hemodialysis patients based on monthly blood test data. It represents a significant leap towards precision medicine and personalized healthcare for this patient group, suggesting a paradigm shift in patient care through the proactive identification of hospitalization risks. Full article
(This article belongs to the Special Issue Objective Methods of Assessing Fluid Status to Optimize Volume Management in Kidney Disease and Hypertension)
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11 pages, 2319 KiB  
Article
Associations between N-Terminal Pro-B-Type Natriuretic Peptide, Body Fluid Imbalance and Quality of Life in Patients Undergoing Hemodialysis: A Cross-Sectional Study
by Keisuke Yamazaki, Shingo Ishii, Mai Hitaka, Motoyuki Masai and Yasushi Ohashi
J. Clin. Med. 2023, 12(23), 7356; https://doi.org/10.3390/jcm12237356 - 28 Nov 2023
Viewed by 823
Abstract
Natriuretic peptides may be associated with the complex interaction between malnutrition and fluid overload. This study assessed the relationship between N-terminal pro-B-type natriuretic peptide (NT-proBNP), body fluid composition, and quality of life (QOL) domains. A multicenter, cross-sectional study was conducted between 2019 and [...] Read more.
Natriuretic peptides may be associated with the complex interaction between malnutrition and fluid overload. This study assessed the relationship between N-terminal pro-B-type natriuretic peptide (NT-proBNP), body fluid composition, and quality of life (QOL) domains. A multicenter, cross-sectional study was conducted between 2019 and 2022. The QOL survey of 322 patients undergoing maintenance hemodialysis (227 men and 95 women; mean age, 65 ± 12 years) was conducted using the Kidney Disease QOL-Short Form v. 1.3. The patients in the higher NT-proBNP quartile group were older and had a longer dialysis vintage; lower body mass index, serum albumin, blood urea nitrogen, creatinine, sodium, uric acid, total cholesterol, triglycerides, and hemoglobin levels; lower geriatric nutritional risk index (GNRI), skeretal mascle mass index, and phase angle (PhA); and higher pre- and post-dialysis systolic blood pressure (BP), cardiothoracic index, and C-reactive protein (CRP) (p < 0.05). Multivariate analysis revealed that post-dialysis systolic BP, CRP, and GNRI or PhA were independently associated with NT-proBNP. The higher NT-proBNP group experienced muscle attenuation and/or inflammation and an enlarged left atrium. Consequently, the elevated NT-proBNP by such an imbalance in body fluid composition is associated with lower health-related QOL. Full article
(This article belongs to the Special Issue Objective Methods of Assessing Fluid Status to Optimize Volume Management in Kidney Disease and Hypertension)
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Review

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14 pages, 8506 KiB  
Review
Objective Methods of Assessing Fluid Status to Optimize Volume Management in Kidney Disease and Hypertension: The Importance of Ultrasound
by Sharad Patel, Adam Green, Sandhya Ashokumar, Andrew Hoke and Jean-Sebastien Rachoin
J. Clin. Med. 2023, 12(19), 6368; https://doi.org/10.3390/jcm12196368 - 05 Oct 2023
Viewed by 1056
Abstract
Fluid overload, a prevalent complication in patients with renal disease and hypertension, significantly impacts patient morbidity and mortality. The daily clinical challenges that clinicians face include how to identify fluid overload early enough in the course of the disease to prevent adverse outcomes [...] Read more.
Fluid overload, a prevalent complication in patients with renal disease and hypertension, significantly impacts patient morbidity and mortality. The daily clinical challenges that clinicians face include how to identify fluid overload early enough in the course of the disease to prevent adverse outcomes and to guide and potentially reduce the intensity of the diuresis. Traditional methods for evaluating fluid status, such as pitting edema, pulmonary crackles, or chest radiography primarily assess extracellular fluid and do not accurately reflect intravascular volume status or venous congestion. This review explores the rationale, mechanism, and evidence behind more recent methods used to assess volume status, namely, lung ultrasound, inferior vena cava (IVC) ultrasound, venous excess ultrasound score, and basic and advanced cardiac echocardiographic techniques. These methods offer a more accurate and objective assessment of fluid status, providing real-time, non-invasive measures of intravascular volume and venous congestion. The methods we discuss are primarily used in inpatient settings, but, given the increased pervasiveness of ultrasound technology, some could soon expand to the outpatient setting. Full article
(This article belongs to the Special Issue Objective Methods of Assessing Fluid Status to Optimize Volume Management in Kidney Disease and Hypertension)
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41 pages, 447 KiB  
Review
A Critical Reassessment of the Kidney Risk Caused by Tetrastarch Products in the Perioperative and Intensive Care Environments
by Csaba Kopitkó, Tibor Fülöp, Mihály Tapolyai and Tibor Gondos
J. Clin. Med. 2023, 12(16), 5262; https://doi.org/10.3390/jcm12165262 - 12 Aug 2023
Cited by 1 | Viewed by 740
Abstract
Purpose: To reassess the results of former meta-analyses focusing on the relationship between novel HES preparations (130/0.4 and 130/0.42) and acute kidney injury. Previous meta-analyses are based on studies referring to partially or fully unpublished data or data from abstracts only. Methods: [...] Read more.
Purpose: To reassess the results of former meta-analyses focusing on the relationship between novel HES preparations (130/0.4 and 130/0.42) and acute kidney injury. Previous meta-analyses are based on studies referring to partially or fully unpublished data or data from abstracts only. Methods: The studies included in the former meta-analyses were scrutinized by the authors independently. We completed a critical analysis of the literature, including the strengths, weaknesses and modifiers of the studies when assessing products, formulations and outcomes. Results: Both the published large studies and meta-analyses show significant bias in the context of the deleterious effect of 6% 130/0.4–0.42 HES. Without (1) detailed hemodynamic data, (2) the exclusion of other nephrotoxic events and (3) a properly performed evaluation of the dose–effect relationship, the AKI-inducing property of 6% HES 130/0.4 or 0.42 should not be considered as evidence. The administration of HES is safe and effective if the recommended dose is respected. Conclusions: Our review suggests that there is questionable evidence for the deteriorating renal effect of these products. Further well-designed, randomized and controlled trials are needed. Additionally, conclusions formulated for resource-rich environments should not be extended to more resource-scarce environments without proper qualifiers provided. Full article
(This article belongs to the Special Issue Objective Methods of Assessing Fluid Status to Optimize Volume Management in Kidney Disease and Hypertension)
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