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Clinical trial for the control of water intake of patients undergoing hemodialysis treatment.
Oller, GASAO, Oliveira, MP, Cesarino, CB, Teixeira, CRS, Costa, JACD, Kusumota, L
Revista latino-americana de enfermagem. 2018;:e3091
Abstract
OBJECTIVE to analyze the impact of an educational and motivational intervention for patients with a chronic kidney disease, undergoing hemodialysis treatment, on the control of fluid intake during interdialytic periods. METHOD a quasi-experimental, non-randomized clinical trial with patients from a Nephrological Unit of the State of São Paulo. Participants were included in two groups: Control Group with 106 patients and Intervention Group with 86 patients, totaling 192 participants. The used intervention was an educational and motivational video to control liquid intake, based on the Bandura's Theory. The measure of control of water intake was the percentage of lost weight, also considered the variable outcome of the research. For the data analysis, descriptive analyses and regression analysis of the Inflated Beta Model were used. RESULTS patients who participated in the intervention had a decrease in the pattern of weight gain in interdialytic periods, with a 3.54 times more chance of reaching the goal of 100% of weight loss when compared to participants from the control group. CONCLUSION the educational and motivational intervention was effective in reducing the percentage of weight loss in patients undergoing hemodialysis. Brazilian Clinical Trials Registry (ReBEC) under the opinion RBR-4XYTP6.
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2.
Effects of fluid overload on heart rate variability in chronic kidney disease patients on hemodialysis.
Ferrario, M, Moissl, U, Garzotto, F, Cruz, DN, Clementi, A, Brendolan, A, Tetta, C, Gatti, E, Signorini, MG, Cerutti, S, et al
BMC nephrology. 2014;:26
Abstract
BACKGROUND While fluid overload (FO) and alterations in the autonomic nervous system (ANS) such as hypersympathetic activity, are known risk factors for cardiovascular morbidity and mortality in patients on chronic hemodialysis (HD), their relationship has not been thoroughly studied. METHODS In this observational study involving 69 patients on chronic HD, FO was assessed by whole body bioimpedance measurements before the midweek HD session and ANS activity reflected by Heart Rate Variability (HRV) was measured using 24-hour Holter electrocardiogram recordings starting before the same HD treatment. In total, 13 different HRV indices were analyzed, comprising a mixture of time domain, frequency domain and complexity parameters. A correlation analysis was performed between the HRV indices and hydration status indices. Successively, patients were retrospectively assigned to a high FO (H, FO > 2.5 L) or low FO (L, FO ≤ 2.5 L) group and these were further compared also after stratification by diabetes mellitus. Finally, a small number of patients without diabetes with significant and persistent FO were followed up for 3 months post-study to investigate how normalization of fluid status affects HRV. RESULTS SDANN, VLF, LZC and HF% parameters significantly correlate with FO (correlation coefficients were respectively r = -0.40, r = -0.37, r = -0.28 and r = 0.26, p-value < 0.05). Furthermore, LF% and LF/HF were inversely correlated with hydration status (correlation coefficients were respectively r = -0.31 and r = -0.33, p-value < 0.05). These results indicate an association between FO and reduced HRV, higher parasympathetic activation and reduced sympathetic response to the HD session. Indeed, group H tended to have lower values of SDANN, VLF and LZC, and higher values of HF% than patients in the L group. Finally, there was a trend towards lower LF% measured during the last 30 minutes of HD for the H group versus the L group. Reduction in FO achieved over 3 months by implementation of a strict fluid management plan resulted in an increase of HRV. CONCLUSIONS Our results suggest that depressed HRV is associated with fluid overload and that normalization of hydration status is accompanied by improved HRV.
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Dietary sodium citrate supplementation enhances rehydration and recovery from rapid body mass loss in trained wrestlers.
Timpmann, S, Burk, A, Medijainen, L, Tamm, M, Kreegipuu, K, Vähi, M, Unt, E, Oöpik, V
Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. 2012;(6):1028-37
Abstract
This study assessed the effects of dietary sodium citrate supplementation during a 16 h recovery from 5% rapid body mass loss (RBML) on physiological functions, affective state, and performance in trained wrestlers. Sixteen wrestlers performed an upper body intermittent sprint performance (UBISP) test under three conditions: before RBML, after RBML, and after a 16 h recovery from RBML. During recovery, the subjects ate a prescribed diet supplemented with sodium citrate (600 mg·kg(-1); CIT group, N = 8) or placebo (PLC group, N = 8) and drank water ad libitum. RBML reduced (p < 0.05) UBISP mean power and increased urine specific gravity (USG). Reduction in mean power was associated with changes in plasma volume (PV) (r = 0.649, p = 0.006) and USG (r = -0.553, p = 0.026). During the 16 h recovery, increases in body mass (BM) and PV were greater (p < 0.05) in the CIT group than in the PLC group. BM gain was associated with water retention in the CIT group (r = 0.899, p = 0.002) but not in the PLC group (r = 0.335, p = 0.417). Blood pH, HCO(3)(-) concentration, and base excess increased (p < 0.05) only in the CIT group. Changes in UBISP, general negative affect, and general positive affect did not differ in the two groups. In conclusion, ingestion of sodium citrate increases blood buffering capacity and PV and stimulates BM regain during a 16 h recovery from RBML in trained wrestlers. However, sodium citrate does not improve UBISP nor does it have an impact on the affective state.
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Limited hydration may reduce intraoperative blood loss in retropubic radical prostatectomy.
Shigemura, K, Yasufuku, T, Yamanaka, K, Yamashita, M, Uefuji, T, Arakawa, S, Fujisawa, M
The Kobe journal of medical sciences. 2010;(1):E18-23
Abstract
Retropubic radical prostatectomy (RRP) may involve major intraoperative blood loss. This study focuses on how limited intraoperative hydration, especially in the early part of the surgery, affects the total blood loss. Fifteen prostate cancer patients were enrolled in this study in which the RRPs were performed by a single surgeon with limited (no more than 1500 ml as a rule) intraoperative hydration in the first 2 hours of the surgery when ligation of intrapelvic lymph node, dorsal vein complex (DVC), neurovascular bundle (NVB) and cut of urethra are assumed to be finished, and were compared with the control group in which no intervention of hydration was undertaken. Intervention group (n=15) had significantly less intraoperative blood loss (p<0.05) compared with control group even though blood pressure at the first 2 hours was not significantly different. Limited hydration did not cause apparent adverse events resulted from dehydration. In conclusion, limited hydration especially in the first half of operation may reduce intraoperative blood loss without any side effects of dehydration. This study could help to establish detailed guidelines for hydration methods for less blood loss during RRP.
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5.
Glycerol hyperhydration: physiological responses during cold-air exposure.
O'Brien, C, Freund, BJ, Young, AJ, Sawka, MN
Journal of applied physiology (Bethesda, Md. : 1985). 2005;(2):515-21
Abstract
Hypohydration occurs during cold-air exposure (CAE) through combined effects of reduced fluid intake and increased fluid losses. Because hypohydration is associated with reduced physical performance, strategies for maintaining hydration during CAE are important. Glycerol ingestion (GI) can induce hyperhydration in hot and temperate environments, resulting in greater fluid retention compared with water (WI) alone, but it is not effective during cold-water immersion. Water immersion induces a greater natriuresis and diuresis than cold exposure; therefore, whether GI might be effective for hyperhydration during CAE remains unknown. This study examined physiological responses, i.e., thermoregulatory, cardiovascular, renal, vascular fluid, and fluid-regulating hormonal responses, to GI in seven men during 4 h CAE (15 degrees C, 30% relative humidity). Subjects completed three separate, double-blind, and counterbalanced trials including WI (37 ml water/l total body water), GI (37 ml water/l total body water plus 1.5 g glycerol/l total body water), and no fluid. Fluids were ingested 30 min before CAE. Thermoregulatory responses to cold were similar during each trial. Urine flow rates were higher (P = 0.0001) with WI (peak 11.8 ml/min, SD 1.9) than GI (5.0 ml/min, SD 1.8), and fluid retention was greater (P = 0.0001) with GI (34%, SD 7) than WI (18%, SD 5) at the end of CAE. Differences in urine flow rate and fluid retention were the result of a greater free water clearance with WI. These data indicate glycerol can be an effective hyperhydrating agent during CAE.