{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T01:16:54Z","timestamp":1787620614759,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,3,10]],"date-time":"2021-03-10T00:00:00Z","timestamp":1615334400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hemodialysis International"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Assessment of dry\u2010weight among patients on dialysis is challenging in the absence of reliable markers to define fluid overload (FO). This study aimed to explore the value of two simple clinical signs, pedal edema, and crackles at pulmonary auscultation, in diagnosing hypervolemia, using bioimpendence spectroscopy (BIS) as reference standard.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a cohort of 107 asymptomatic dialysis patients, FO was assessed with physical examination and BIS shortly before the mid\u2010week dialysis session. Patients were also asked to perform home blood pressure (BP) monitoring with a validated, automatic device (HEM\u2010705, Omron, Healthcare) for 1\u2009week in order to determine their BP outside of dialysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Patients within the high tertile of predialysis FO had longer dialysis vintage, lower serum albumin and higher home systolic BP, despite the more aggressive treatment with a higher average number of antihypertensives daily. In receiver\u2010operating\u2010characteristic (ROC) curve analysis, pedal edema (area under curve [AUC]: 0.534; 95% confidence interval [CI]: 0.416\u20130.651) and pulmonary crackles (AUC: 0.551; 95% CI: 0.432\u20130.671) had limited accuracy in detecting excess predialysis FO\u2009&gt;\u20092.2\u2009L. The agreement of pedal edema (k\u2010coefficient: 0.065) and pulmonary crackles (k\u2010coefficient: 0.122) with BIS\u2010derived FO was poor. In multivariate linear regression analysis, longer dialysis vintage (<jats:italic>\u03b2<\/jats:italic>: 0.306, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and higher home systolic BP (<jats:italic>\u03b2<\/jats:italic>: 0.287, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) were the two factors that were associated with predialysis FO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study showed that among asymptomatic dialysis patients, pedal edema and pulmonary crackles in physical examination had limited discriminatory power in detection of FO, as assessed with the method of BIS.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hdi.12920","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T06:48:45Z","timestamp":1615445325000},"page":"391-398","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Physical examination for the detection of hypervolemia among patients on chronic dialysis: A diagnostic\u2010test study"],"prefix":"10.1111","volume":"25","author":[{"given":"Nikolaos C.","family":"Tsikliras","sequence":"first","affiliation":[{"name":"Hemodialysis Unit, 1st Department of Medicine AHEPA Hospital, Aristotle University of Thessaloniki  Thessaloniki Greece"},{"name":"Hemodialysis Unit General Hospital of Xanthi  Xanthi Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis I.","family":"Georgianos","sequence":"additional","affiliation":[{"name":"Hemodialysis Unit, 1st Department of Medicine AHEPA Hospital, Aristotle University of Thessaloniki  Thessaloniki Greece"},{"name":"Therapeutiki Dialysis Center  Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasilios","family":"Vaios","sequence":"additional","affiliation":[{"name":"Hemodialysis Unit, 1st Department of Medicine AHEPA Hospital, Aristotle University of Thessaloniki  Thessaloniki 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