VCD and collapsibility variations have been reported as sensitive indicators of OH, but the recommended interval of at least 1 h after HD limits the use of MK-0518 VC sonography in ambulatory

patients [12]. Our models showed a high predictive role for VCCI in OH estimation (second best after OHCLI), also before HD. There are only a few studies examining the effects of HD on pulmonary functional parameters. The importance of spirometry in OH assessment has not been studied so far, and our data indicate rather an inferior role in HD. It is evident that any of the single parameters is accurate enough to predict the extent of OH by itself. Clinical judgment of an experienced physician was the single most significant element in OH assessment, and showed the highest predictive value in combination with other variables as well. Admittedly, clinical judgment is observer-dependent and difficult to standardize. Nevertheless, the non-standardized decision choice is precisely the unique feature of clinical judgment. Studies

examining different approaches to OH assessment in large patient populations typically report only the average values of the accuracy, without correlations to their standard method, which obscures the performance in individual patients. We need a method that can be applied and remains precise and reliable also in smaller groups of patients, typically www.selleckchem.com/products/MK-2206.html encountered by Thiazovivin dialysis physicians in routine clinical practice. Our study demonstrated that a combination of integrative clinical judgment with routine techniques is a precise and valuable tool in hydration status assessment in HD patients. BIA, a quick, reproducible and non-invasive bedside measurement, may help to identify changes in body compartments not fully appreciated by clinical or biochemical assessment. However, the most important question, whether the improved accuracy of OH assessment resulting from implementation of technological advances will also be reflected in

improved patient outcomes, requires further investigation. Open AccessThis article is distributed under the terms of the Creative Commons Attribution Rutecarpine License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited. Electronic supplementary material Below is the link to the electronic supplementary material. Supplementary material 1 (DOC 55.5 kb) References 1. Eldehni MT. McIntyre CW. Are there neurological consequences of recurrent intradialytic hypotension? Semin Dial. 2012; 25(3):253–6. 2. Burton JO, et al. Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol. 2009;4(5):914–20.PubMedCrossRef 3. Wizemann V, Schilling M. Dilemma of assessing volume state—the use and the limitations of a clinical score. Nephrol Dial Transplant. 1995;10(11):2114–7.PubMed 4. Kuhlmann MK, et al.