Kronik Böbrek Hastalığında Vücut Sıvısını Değerlendirme Yöntemleri
Synopsis
Accurate evaluation of body fluid status in individuals with chronic kidney disease (CKD) is of critical importance for determining target weight and preventing severe cardiovascular complications such as hypertension, left ventricular hypertrophy, and congestive heart failure. Traditional clinical findings like edema, elevated blood pressure, venous engorgement, and dyspnea possess low sensitivity and specificity, making them insufficient for quantitatively determining volume overload and explaining fluid distribution. Bioelectrical impedance analysis (BIA), commonly used in clinical practice to overcome these limitations, is a simple, safe, fast, and non-invasive method that calculates total body water as well as intracellular and extracellular fluid volumes by utilizing the electrical conductivity properties of body tissues; multi-frequency BIA systems provide superior data compared to single-frequency devices by determining the resistances of fluid compartments. Among imaging methods, inferior vena cava ultrasonography provides information on intravascular volume, and lung ultrasonography helps evaluate pulmonary congestion; however, both techniques have disadvantages such as operator dependence and an inability to assess total body water. Biomarkers such as natriuretic peptides (BNP, ANP) have limited clinical utility when used alone to evaluate fluid status in CKD patients due to being influenced by concomitant cardiovascular diseases. Consequently, since no single ideal method exists for detecting volume overload, clinicians are advised to adopt a multimodal approach that integrates clinical evaluations, including body weight and blood pressure monitoring, with novel technological methods.
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