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How Good is Clinical Examination in the Assessment of Volume Status in PD Patients?

Gangji AS|Al-Helal B|Brimble S|Churchill DN|Margetts PJ
Abstract presented at American Society of Nephrology Meeting, Philadelphia PA, USA October 2005
Clinical assessment of a PD patient’s volume status is of critical importance, but has not been studied extensively. We evaluated 18 stable, established PD patients with a structured clinical examination. This exam included 9 history and 10 physical exam items along with an overall summary assessment. We compared this with two objective measures of extracellular fluid volume: bioimpedance analysis (BIA, Quadscan 4000, BodyStat), and N terminal B-type naturietic propeptide (N-BNP, Roche Diagnostics). BIA has reasonable correlation with dilutional measures of fluid in dialysis patients. BNP has not been studied extensively in PD patients. Clinical assessment was carried out independently by 2 physicians who were blinded to BIA and BNP results.
N-BNP did not correlate well with BIA measures of extracellular water (ECW) (r=0.125, p=0.62). N-BNP did correlate with systolic BP (r=0.523, p=0.04). Overall clinical volume assessment correlated with ECW (r=0.564, p=0.015) and total body water (TBW) (r=0.478, p=0.045) measured by BIA. The overall history correlated better than the overall physical examination score. Of the specific items assessed, a history of weight gain (r=0.635, p=0.005) and CVP (r=0.749, p<0.001) showed the highest correlation with BIA ECW. Interestingly, patient’s self assessment of volume status was even better than the overall physician assessment in predicting BIA measured ECW (r=0.689, p=0.003).
CONCLUSION: Clinical examination correlates with BIA assessment of volume status and remains a useful tool in the evaluation of PD patients. N-BNP did not correlate with BIA. Patient’s self assessment strongly correlated with BIA.
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