The first-hour refill index is a potentially useful indicator of volume overload in children receiving long-term hemodialysis

Abstract

Abstract Background Cardiovascular diseases are considered a common complication in end-stage kidney disease (ESKD) patients on regular hemodialysis,and volume overload is a strong risk factor for this. The first-hour refill index (RI) is a favourable indicator for evaluating volume overload in pediatric hemodialysis patients, a prevalent and significant contributor to cardiovascular complications. Method This cross-sectional study included 52 ESKD children who were on regular hemodialysis. Demographic, clinical data, dialysis-related parameters, and laboratory data were obtained for patients. An echocardiographic assessment with the refill index (RI) calculation was done for every patient. Results Volume overload was observed in 48.1% of patients, and 30% were hypertensive. The refill index (RI) had a mean of 2.39 ± 1.31 ml/kg/hr.Higher Na levels are significantly associated with a higher refill index ( p = 0.029).Systolic, diastolic blood pressure Z-score readings, Interdialytic weight gain (IDWG), and Kt/V demonstrated statistically significant positive correlations with the RI ( P = 0.043,0.012, 0.002, and 0.001,respectively). Non-significant Correlations between RI and left ventricular mass index Z-score. Conclusion The RI is higher in patients with higher IDWG and predialysis sodium levels indicating volume overload despite showing non-significant correlations with left ventricular Z-score dimensions, this highlights the multifactorial nature of fluid status assessment and its clinical implications in pediatric dialysis patients.