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Inferior vena cava diameter and left atrial diameter measure volume but not dry weight.

ABSTRACT: Hypervolemia is an important and modifiable cause of hypertension. Hypertension improves with probing dry weight, but its effect on echocardiographic measures of volume is unknown.Shortly after dialysis, echocardiograms were obtained at baseline and longitudinally every 4 weeks on two occasions. Among 100 patients in the additional ultrafiltration group, 198 echocardiograms were performed; among 50 patients in the control group, 104 echocardiograms were performed.Baseline inferior vena cava (IVC)(insp) diameter was approximately 5.1 mm/m(2); with ultrafiltration, change in IVC(insp) diameter was -0.95 mm/m(2) more compared with the control group at 4 weeks and -1.18 mm/m(2) more compared with the control group at 8 weeks. From baseline IVC(exp) diameter of approximately 8.2 mm/m(2), ultrafiltration-induced change at 4 weeks was -1.06 mm/m(2) more and at 8 weeks was -1.07 mm/m(2) more (P=0.044). From a baseline left atrial diameter of 2.1 cm/m(2), ultrafiltration-induced change at 4 weeks was -0.14 cm/m(2) more and at 8 weeks was -0.15 cm/m(2) more. At baseline, there was no relationship between interdialytic ambulatory BP and echocardiographic parameters of volume. The reduction in interdialytic ambulatory BP was also independent of change in the echocardiographic volume parameters.The inferior vena cava and left atrial diameters are echocardiographic parameters that are responsive to probing dry weight; thus, they reflect excess volume. However, echocardiographic volume parameters are poor determinants of interdialytic BP, and their change does not predict the BP response to probing dry weight.

SUBMITTER: Agarwal R

PROVIDER: S-EPMC3087772 | biostudies-literature | 2011 May

REPOSITORIES: biostudies-literature

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Inferior vena cava diameter and left atrial diameter measure volume but not dry weight.

Agarwal Rajiv R Bouldin J Michael JM Light Robert P RP Garg Ashok A

Clinical journal of the American Society of Nephrology : CJASN 20110217 5

<h4>Background and objectives</h4>Hypervolemia is an important and modifiable cause of hypertension. Hypertension improves with probing dry weight, but its effect on echocardiographic measures of volume is unknown.<h4>Design, setting, participants, & measurements</h4>Shortly after dialysis, echocardiograms were obtained at baseline and longitudinally every 4 weeks on two occasions. Among 100 patients in the additional ultrafiltration group, 198 echocardiograms were performed; among 50 patients i ...[more]

PMID: 21330484

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Project description:BACKGROUND:Radical nephrectomy with inferior vena cava thrombectomy (RN-IVCT) is a complicated procedure for which the impact of hospital case volume on overall survival (OS) is unknown. OBJECTIVE:To assess the degree to which renal cell carcinoma (RCC) with inferior vena cava tumor thrombus (IVC-TT) care is centralized and to evaluate the impact of hospital case volume on outcomes following RN-IVCT. DESIGN, SETTING, AND PARTICIPANTS:The National Cancer Data Base was queried for patients with pT3b-c RCC treated with RN-IVCT. Hospitals were classified by case volume percentile as low (<75th percentile, <0.67 cases annually), intermediate (75th-95th percentile, 0.67-2.99 cases annually), or high (>95th percentile, >3 cases annually). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:The primary outcome was OS. Secondary outcomes were short-term (30- and 90-d) mortality rates according to hospital case volume. Kaplan-Meier curves and Cox regression model were used to evaluate OS and the effect of covariables. RESULTS AND LIMITATIONS:There were 2664 cases of RN-IVCT for pT3b-c tumors reported by 573 institutions, of which 435, 108, and 30 were classified as low, intermediate, and high volume, accounting for 28.5%, 34.5%, and 37% of cases, respectively. Treatment at high-volume institutions was associated with better OS: the median OS was 42, 53, and 60 months for low, intermediate and high-volume centers, respectively (p=0.009). After multivariable adjustment, treatment at a high-volume institution was associated with a 24% relative risk reduction for all-cause mortality compared to treatment at a low-volume institution (hazard ratio 0.76, 95% confidence interval 0.65-0.89; p=0.001). There was no significant difference in short-term mortality following RN-IVCT when stratified by hospital case volume. CONCLUSIONS:Higher hospital case volume was associated with longer OS for patients undergoing RN-IVCT. These findings support efforts to centralize care for cases of advanced RCC. PATIENT SUMMARY:In this study we looked at the impact of hospital case volume on survival following surgery for renal cell carcinoma and inferior vena cava thrombectomy. Survival was significantly better in high-volume hospitals performing three or more procedures per year.

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Inferior vena cava diameter and left atrial diameter measure volume but not dry weight.

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Inferior vena cava diameter and left atrial diameter measure volume but not dry weight.

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