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Robert G Hahn - One of the best experts on this subject based on the ideXlab platform.

  • preoperative Fluid Retention increases blood loss during major open abdominal surgery
    Perioperative medicine (London England), 2017
    Co-Authors: Robert G Hahn, Hans Bahlmann, Lena Nilsson
    Abstract:

    Quantification of renal Fluid conservation is possible by urine analysis, and the results can indicate dehydration. The present report sought to determine whether this Fluid Retention correlates with Fluid requirements during major abdominal surgeries that have estimated operating times ≥ 2 h. Urine colour, specific weight, osmolality and creatinine concentration were used to calculate a composite “Fluid Retention index” (FRI) in 97 patients prior to major abdominal surgery. Goal-directed Fluid volume optimization, with hydroxyethyl starch supplemented with a background administration of crystalloid Fluid, was used. The median preoperative FRI was 3.0. Fluid Retention, considered as present when FRI ≥ 3.5, was found in 37% of the patients. Fluid Retention was followed by a significantly larger blood loss (+ 125%; 450 vs. 200 ml), higher haemorrhage rate (+ 41%; 123 vs. 87 ml/h) and greater need for both colloid (+ 43%; 1.43 vs. 1.00 l) and crystalloid (+ 18%; 1.28 vs. 1.08 l) Fluids. Despite the larger blood loss, the total Fluid balance was more positive after surgery in the dehydrated patients (+ 26%; 1.91 vs. 1.51 l; P < 0.02). Preoperative Fluid Retention, as detected in a urine sample, was associated with a greater blood loss and a more positive Fluid balance during major abdominal surgery. ClinicalTrials.gov , NCT01458678

  • Preoperative Fluid Retention increases blood loss during major open abdominal surgery
    Perioperative medicine (London England), 2017
    Co-Authors: Robert G Hahn, Hans Bahlmann, Lena Nilsson
    Abstract:

    Quantification of renal Fluid conservation is possible by urine analysis, and the results can indicate dehydration. The present report sought to determine whether this Fluid Retention correlates with Fluid requirements during major abdominal surgeries that have estimated operating times ≥ 2 h. Urine colour, specific weight, osmolality and creatinine concentration were used to calculate a composite “Fluid Retention index” (FRI) in 97 patients prior to major abdominal surgery. Goal-directed Fluid volume optimization, with hydroxyethyl starch supplemented with a background administration of crystalloid Fluid, was used. The median preoperative FRI was 3.0. Fluid Retention, considered as present when FRI ≥ 3.5, was found in 37% of the patients. Fluid Retention was followed by a significantly larger blood loss (+ 125%; 450 vs. 200 ml), higher haemorrhage rate (+ 41%; 123 vs. 87 ml/h) and greater need for both colloid (+ 43%; 1.43 vs. 1.00 l) and crystalloid (+ 18%; 1.28 vs. 1.08 l) Fluids. Despite the larger blood loss, the total Fluid balance was more positive after surgery in the dehydrated patients (+ 26%; 1.91 vs. 1.51 l; P 

  • urinary analysis of Fluid Retention in the general population a cross sectional study
    PLOS ONE, 2016
    Co-Authors: Robert G Hahn, Nina Grankvist, Camilla Krizhanovskii
    Abstract:

    Renal conservation (Retention) of Fluid might affect the outcome of hospital care and can be indicated by increased urinary concentrations of metabolic waste products. We obtained a reference material for further studies by exploring the prevalence of Fluid Retention in a healthy population.Spot urine sampling was performed in 300 healthy hospital workers. A previously validated algorithm summarized the urine-specific gravity, osmolality, creatinine, and color to a Fluid Retention index (FRI), where 4.0 is the cut-off for Fluid Retention consistent with dehydration. In 50 of the volunteers, we also studied the relationships between FRI, plasma osmolality, and water-retaining hormones.The cut-off for Fluid Retention (FRI ≥ 4.0) was reached by 38% of the population. No correlation was found between the FRI and the time of the day of urine sample collection, and the FRI was only marginally correlated with the time period spent without Fluid intake. Volunteers with Fluid Retention were younger, generally men, and more often had albuminuria (88% vs. 34%, P < 0.001). Plasma osmolality and plasma sodium were somewhat higher in those with a high FRI (mean 294.8 vs. 293.4 mosmol/kg and 140.3 vs. 139.9 mmol/l). Plasma vasopressin was consistently below the limit of detection, and the plasma cortisol, aldosterone, and renin concentrations were similar in subjects with a high or low FRI. The very highest FRI values (≥ 5.0, N = 61) were always accompanied by albuminuria.Fluid Retention consistent with moderate dehydration is common in healthy staff working in a Swedish hospital.

  • Fluid Retention is Alleviated by Crystalloid but Not by Colloid Fluid afterInduction of General Anesthesia: An Open-Labeled Clinical Trial
    Journal of Anesthesia and Clinical Research, 2016
    Co-Authors: Robert G Hahn, Yuhong Li, Rui He
    Abstract:

    Background: Renal Fluid conservation, which is possible to quantify by urine analysis, is often caused by dehydration. The present study aimed to determine whether such Fluid Retention could be reversed by crystalloid and/or colloid Fluid during surgery. Methods: Urine colour, specific weight, osmolality and creatinine concentration were used to calculate a “Fluid Retention index” (FRI) in 108 patients undergoing major abdominal surgery. Urine was collected at baseline and after flow-guided Fluid volume optimisation with hydroxyethyl starch 130/0.4 (n=86) or Ringer's lactate (n=22). The third sample was taken after one hour of surgery. Results: The mean preoperative FRI was 3.4 (SD 1.1) and did not change during the volume optimization. The FRI was unchanged from starch during the first hour of surgery, whereas it decreased from 3.6 to 2.9 in response to Ringer´s lactate (P

  • Fluid Retention index predicts the 30 day mortality in geriatric care
    Scandinavian Journal of Clinical & Laboratory Investigation, 2015
    Co-Authors: Peter Johnson, Robert G Hahn, Nana Waldreus, Helena Stenstrom, Fredrik Sjostrand
    Abstract:

    AbstractThe incidence and medical consequences of dehydration and Fluid Retention in senior citizens are unclear. The present study used urine sampling to detect renal conservation of water, which is an early sign of dehydration, and assessed its relationship to mortality in elderly patients admitted for acute hospital care. A urine sample was collected from 256 patients (mean age 82 years) and analyzed for color, specific gravity and osmolality. These markers were used to calculate a composite index of Fluid Retention, which was indicated by urine color ≥ 4, specific gravity ≥ 1.020 and osmolality ≥ 600 mOsmol/kg as suggested from eight previous studies of exercise-induced dehydration, of which one extends to age 69. Concentrated urine consistent with dehydration was present in 39 (16%) of the patients. This finding was relatively more common among those with confusion and/or dementia, but less common in patients with medical disease, and in those taking diuretics daily. Patients with such Fluid retentio...

Artur Katz - One of the best experts on this subject based on the ideXlab platform.

  • Pemetrexed-Induced Fluid Retention
    Journal of Thoracic Oncology, 2010
    Co-Authors: Diogo Assed Bastos, Aknar Calabrich, Artur Katz
    Abstract:

    Despite the favorable toxicity and safety profiles of pemetrexed, several adverse events have been reported, including blood and lymphatic system disorders, gastrointestinal and general disorders. We describe a case series consisting of eight patients who developed clinically significant Fluid Retention, an uncommon adverse effect associated with the use of pemetrexed. All patients have received vitamin supplementation and were pretreated with corticosteroids as indicated in the package insert. Other causes of edema were excluded and all patients had normal echocardiogram, normal levels of B-type natriuretic peptide and albumin, normal renal, hepatic and thyroid function tests and no significant proteinuria. Most patients presented with mild to moderate edema, mainly in periorbital area, while 4 developed pleural effusions. One of these patients required a bilateral thoracocentesis was necessary for symptom relief and the pleural effusion analysis was consistent with an exsudate with no malignant cells and negative cultures. There was complete disappearance of generalized edema and bilateral pleural effusion after discontinuation of pemetrexed treatment. Other patients also had complete resolution of the Fluid Retention (including pleural effusion) after pemetrexed was discontinued due to disease progression. All other cases were managed with observation only or salt restriction and diuretics, with limited control of this side effect. Pemetrexed-associated peripheral and eyelid edema has been rarely reported, with an estimated incidence of 1% in clinical trails. To our knowledge there were no severe cases reported with need for treatment discontinuation until now. The mechanism involved in the development of Fluid Retention and consequent edema is unknown but may be due to capillary leakage syndrome. Now that pemetrexed has demonstrated efficacy in the first line setting and is an option as maintenance or early second line therapy, more patients will be exposed to this agent and therefore more individuals will potentially develop this treatment related adverse effect. Therefore, we believe it is important to report this unusual adverse event and to understand its pathophysiology in order to attempt to develop strategies to avoid and manage this side effect.

Dercherng Tarng - One of the best experts on this subject based on the ideXlab platform.

  • association of Fluid Retention with anemia and clinical outcomes among patients with chronic kidney disease
    Journal of the American Heart Association, 2015
    Co-Authors: Szuchun Hung, Chinghsiu Peng, Chehsiung Wu, Yichun Wang, Dercherng Tarng
    Abstract:

    Background Observational studies have demonstrated an association between anemia and adverse outcomes in patients with chronic kidney disease (CKD). However, randomized trials failed to identify a benefit of higher hemoglobin concentrations, suggesting that the anemia‐outcome association may be confounded by unknown factors. Methods and Results We evaluated the influence of Fluid status on hemoglobin concentrations and the cardiovascular and renal outcomes in a prospective cohort of 326 patients with stage 3 to 5 CKD. Fluid status, as defined by overhydration (OH) level measured with bioimpedance, was negatively correlated with hemoglobin concentrations at baseline ( r =−0.438, P <0.001). In multivariate regression analysis, OH remained an independent predictor of hemoglobin, second only to estimated glomerular filtration rate. Patients were stratified into 3 groups: no anemia (n=105), true anemia (n=82), and anemia with excess OH (n=139) (relative OH level ≥7%, the 90th percentile for the healthy population). During a median follow‐up of 2.2 years, there was no difference in cardiovascular and renal risks between patients with true anemia and those with no anemia in the adjusted Cox proportional hazards models. However, patients with anemia with excess OH had a significantly increased risk of cardiovascular morbidity and mortality and CKD progression relative to those with true anemia and those with no anemia, respectively. Conclusions Fluid Retention is associated with the severity of anemia and adverse cardiovascular and renal outcomes in patients with CKD. Further research is warranted to clarify whether the correction of Fluid Retention, instead of increasing erythropoiesis, would improve outcomes of CKD‐associated anemia.

Giancarlo Viberti - One of the best experts on this subject based on the ideXlab platform.

  • effect of spironolactone and amiloride on thiazolidinedione induced Fluid Retention in south indian patients with type 2 diabetes
    Clinical Journal of The American Society of Nephrology, 2013
    Co-Authors: Vijay Viswanathan, Viswanathan Mohan, Poongothai Subramani, Nandakumar Parthasarathy, Gayathri Subramaniyam, Deepa Manoharan, Chandru Sundaramoorthy, Luigi Gnudi, Janaka Karalliedde, Giancarlo Viberti
    Abstract:

    Summary Background and objectives Thiazolidinediones (pioglitazone and rosiglitazone) induce renal epithelial sodium channel (ENaC)–mediated sodium reabsorption, resulting in plasma volume (PV) expansion. Incidence and long-term management of Fluid Retention induced by thiazolidinediones remain unclear. Design, setting, participants, & measurements In a 4-week run-in period, rosiglitazone, 4 mg twice daily, was added to a background anti-diabetic therapy in 260 South Indian patients with type 2 diabetes mellitus. Patients with PV expansion (absolute reduction in hematocrit in run-in, ≥1.5 percentage points) entered a randomized, placebo-controlled study to evaluate effects of amiloride and spironolactone on attenuating rosiglitazone-induced Fluid Retention. Primary endpoint was change in hematocrit in each diuretic group versus placebo (control group). Results Of the 260 patients, 70% (n=180) had PV expansion. These 180 patients (70% male; mean age, 47.8 years [range, 30–80 years]) were randomly assigned to rosiglitazone, 4 mg twice daily, plus spironolactone, 50 mg once daily; rosiglitazone, 4 mg twice daily, plus amiloride, 10 mg once daily; or rosiglitazone, 4 mg twice daily, plus placebo for 24 weeks. Hematocrit continued to decrease significantly in control and spironolactone groups (mean absolute change, −1.2 [P=0.01] and −0.7 [P=0.02] percentage points, respectively), suggesting continued PV expansion. No change occurred with amiloride (mean change, 0.0 percentage points). Amiloride, but not spironolactone, was superior to control (mean hematocrit difference [95% confidence interval] relative to control, 1.27 [0.21–2.55] and 0.49 [−0.79–1.77] percentage points [P=0.04 and P=0.61], respectively). Conclusions Prevalence of rosiglitazone-induced Fluid Retention in South Indian patients with type 2 diabetes is high. Amiloride, a direct ENaC blocker, but not spironolactone, prevented protracted Fluid Retention in these patients.

  • effect of various diuretic treatments on rosiglitazone induced Fluid Retention
    Journal of The American Society of Nephrology, 2006
    Co-Authors: Janaka Karalliedde, Murray Stewart, R Buckingham, Margaret Starkie, Daniel Lorand, Giancarlo Viberti
    Abstract:

    The efficacy of diuretics in the management of rosiglitazone (RSG)-induced Fluid Retention was evaluated in a multicenter, randomized, open-label, parallel-group, proof-of-concept study. Of 381 patients who had type 2 diabetes and were on treatment with sulfonylurea or sulfonylurea plus metformin, 260 (63% male, 37% female) showed evidence of volume expansion as defined by an absolute reduction in hematocrit (Hct) of >0.5% after 12 wk of rosiglitazone 4 mg twice daily. They were randomly assigned to five treatments for 7 d: (1) Continuation of RSG (RSG-C), (2) RSG furosemide (RSGFRUS), (3) RSG hydrochlorothiazide (RSGHCTZ), (4) RSG spironolactone (RSGSPIRO), and (5) discontinuation of RSG. The primary end point was change in Hct at day 7 of diuretic treatment phase, powered to compare each diuretic group and the RSG discontinuation with the control group of RSG-C, with adjustments for multiple testing. After 12 wk on RSG, Hct fell by mean of 2.92% (95% confidence interval [CI] 3.10 to 2.63%; P < 0.001) and extracellular Fluid volume increased by 0.62 L/1.73 m 2 (95% CI 0.26 to 0.90 L/1.73 m 2 ; P < 0.001). After treatment, the RSGSPIRO group only showed a mean increase in Hct of 0.24%. The estimated mean difference in Hct reduction was significant: 1.14% (95% CI 0.29 to 1.98%) for RSGSPIRO (P 0.004) and 0.87% (95% CI 0.03 to 1.71%) for RSGHCTZ (P 0.041) only. In additional analyses of between-diuretic treatment effects SPIRO induced a greater Hct rescue at 0.88% (95% CI 0.12 to 1.87%; P 0.095) and extracellular Fluid volume reduction of 0.75 L/1.73 m 2 (95% CI 1.52 to 0.03 L/1.73 m 2 ; P 0.06) compared with FRUS, suggesting superiority in the management of RSG-associated Fluid Retention. There were no significant differences between SPIRO and HCTZ. These findings are consistent with peroxisome proliferator–activated receptor- agonist activation of the epithelial sodium channel in the distal collecting duct, a site of action of SPIRO and a potential target for thiazide diuretics.

Miroslaw Wlodarczyk - One of the best experts on this subject based on the ideXlab platform.

  • thiazolidinedione induced Fluid Retention recent insights into the molecular mechanisms
    Ppar Research, 2013
    Co-Authors: Jerzy Beltowski, Jolanta Rachanczyk, Miroslaw Wlodarczyk
    Abstract:

    Peroxisome proliferator-activated receptor-γ (PPARγ) agonists such as rosiglitazone and pioglitazone are used to improve insulin sensitivity in patients with diabetes mellitus. However, thiazolidinediones induce Fluid Retention, edema, and sometimes precipitate or exacerbate heart failure in a subset of patients. The mechanism through which thiazolidinediones induce Fluid Retention is controversial. Most studies suggest that this effect results from the increase in tubular sodium and water reabsorption in the kidney, but the role of specific nephron segments and sodium carriers involved is less clear. Some studies suggested that PPARγ agonist stimulates Na