Effect of ultrafiltration during hemodialysis on hepatic and total-body water: an observational study

Claire J Grant¹, Trevor P Wade², Charles A McKenzie², Guido Filler^{1

3

4

5

6}, Christopher W McIntyre^{1

2

3

4

5}, Shih-Han S Huang^{7

8

9

10

11}

Affiliations

¹ The Lilibeth Caberto Kidney Clinical Research Unit, Victoria Hospital, Western University, A2-344, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
² Department of Medical Biophysics, Western University, London, ON, Canada.
³ Department of Paediatrics, Western University, London, ON, Canada.
⁴ Lawson Health Research, London Health Sciences Centre, London, ON, Canada.
⁵ Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada.
⁶ Department of Pathology & Laboratory Medicine, Western University, London, ON, Canada.
⁷ The Lilibeth Caberto Kidney Clinical Research Unit, Victoria Hospital, Western University, A2-344, 800 Commissioners Road East, London, ON, N6A 5W9, Canada. shuang45@uwo.ca.
⁸ Department of Medical Biophysics, Western University, London, ON, Canada. shuang45@uwo.ca.
⁹ Department of Paediatrics, Western University, London, ON, Canada. shuang45@uwo.ca.
¹⁰ Lawson Health Research, London Health Sciences Centre, London, ON, Canada. shuang45@uwo.ca.
¹¹ Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada. shuang45@uwo.ca.

PMID: 30541478
PMCID: PMC6292051
DOI: 10.1186/s12882-018-1150-8

Observational Study

Effect of ultrafiltration during hemodialysis on hepatic and total-body water: an observational study

Claire J Grant et al. BMC Nephrol. 2018.

. 2018 Dec 12;19(1):356.

doi: 10.1186/s12882-018-1150-8.

Authors

Claire J Grant¹, Trevor P Wade², Charles A McKenzie², Guido Filler^{1

3

4

5

6}, Christopher W McIntyre^{1

2

3

4

5}, Shih-Han S Huang^{7

8

9

10

11}

Affiliations

¹ The Lilibeth Caberto Kidney Clinical Research Unit, Victoria Hospital, Western University, A2-344, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
² Department of Medical Biophysics, Western University, London, ON, Canada.
³ Department of Paediatrics, Western University, London, ON, Canada.
⁴ Lawson Health Research, London Health Sciences Centre, London, ON, Canada.
⁵ Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada.
⁶ Department of Pathology & Laboratory Medicine, Western University, London, ON, Canada.
⁷ The Lilibeth Caberto Kidney Clinical Research Unit, Victoria Hospital, Western University, A2-344, 800 Commissioners Road East, London, ON, N6A 5W9, Canada. shuang45@uwo.ca.
⁸ Department of Medical Biophysics, Western University, London, ON, Canada. shuang45@uwo.ca.
⁹ Department of Paediatrics, Western University, London, ON, Canada. shuang45@uwo.ca.
¹⁰ Lawson Health Research, London Health Sciences Centre, London, ON, Canada. shuang45@uwo.ca.
¹¹ Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada. shuang45@uwo.ca.

PMID: 30541478
PMCID: PMC6292051
DOI: 10.1186/s12882-018-1150-8

Abstract

Background: The hepatic circulation is involved in adaptive systemic responses to circulatory stress. However, it is vulnerable to both chronic hypervolemia and cardiac dysfunction. The influence of hemodialysis (HD) and ultrafiltration (UF) upon liver water content has been understudied. We conducted a detailed pilot study to characterize the effects of HD upon liver water content and stiffness, referenced to peripheral fluid mobilization and total body water.

Methods: We studied 14 established HD patients without liver disease. Magnetic resonance imaging (MRI) together with ultrasound-based elastography and bioimpedance assessment were employed to measure hepatic water content and stiffness, body composition, and water content in the calf pre- and post-HD.

Results: Mean UF volume was 8.13 ± 4.4 mL/kg/hr. Fluid removal was accompanied with effective mobilization of peripheral water (measured with MRI within the thigh) from 0.85 ± 0.21 g/mL to 0.83 ± 0.18 g/mL, and reduction in total body water (38.9 ± 9.4 L to 37.4 ± 8.6 L). However, directly-measured liver water content did not decrease (0.57 ± 0.1 mL/g to 0.79 ± 0.3 m L/g). Liver water content and IVC diameter were inversely proportional (r = - 0.57, p = 0.03), a relationship which persisted after dialysis.

Conclusions: In contrast to the reduced total body water content, liver water content did not decrease post-HD, consistent with a diversion of blood to the hepatic circulation, in those with signs of greater circulatory stress. This novel observation suggests that there is a unique hepatic response to HD with UF and that the liver may play a more important role in intradialytic hypotension and fluid shifts than currently appreciated.

Keywords: Chronic hemodialysis; Fluid overload; Intradilyatic hypotension; Magnetic resonance imaging; Ultrafiltration.

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Conflict of interest statement

Authors’ information

CJG has complated her MD and is pursing her PhD in Medicine. The result of this study will form part of her thesis. SSH is a mid-career scientist, who completed her MD in 2005 and PhD in medical biophysics in 2015. Her research expertise is in the areas of extracorporeal therapies. She has received several grants to conduct novol imaging studies in patients with renal disease. She is a co-supervisor for CJG.

Ethics approval and consent to participate

This observational study was approved by the Health Sciences Research Ethics Board at the University of Western Ontario (HSREB106868). Written consent was obtained from all patients who took part in this study.

Consent for publication

Not applicable.

Competing interests

CAM reports grants from General Electric outside the submitted work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 1**
Water image from CSE-MRI reconstruction showing the Region of Interest (ROI) in the liver for which liver water content was computed. ROIs were drawn to avoid major vessels, and regions which contained water-fat swaps. A water phantom is shown in the lower left, which was used for normalization to obtain absolute. These two images were from Patient 14. Top: pre-dialysis (0.7) and bottom: post-dialysis (0.83)

**Fig. 2**
FSE image indicating the inferior vena cava and abdominal aorta, and the major diameter of each

**Fig. 3**
Relationship between liver water content and IVC diameter pre-dialysis

**Fig. 4**
Change in liver water content with dialysis and the relationship with haemodynamic stability during HD. a: Liver water before and after dialysis. b: Liver water and fall in blood pressure c: Liver water and nadir blood pressure. d: IVC diameter and nadir blood pressure

See this image and copyright information in PMC

Cited by

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Sars B, van der Sande FM, Kooman JP. Sars B, et al. Blood Purif. 2020;49(1-2):158-167. doi: 10.1159/000503776. Epub 2019 Dec 18. Blood Purif. 2020. PMID: 31851975 Free PMC article. Review.
Multitargeted interventions to reduce dialysis-induced systemic stress.
Canaud B, Stephens MP, Nikam M, Etter M, Collins A. Canaud B, et al. Clin Kidney J. 2021 Dec 27;14(Suppl 4):i72-i84. doi: 10.1093/ckj/sfab192. eCollection 2021 Dec. Clin Kidney J. 2021. PMID: 34987787 Free PMC article. Review.
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Suksai N, Yongsiri S, Witoon R, Chueansuwan R, Juttuporn A. Suksai N, et al. Hepatol Forum. 2025 Feb 18;6(2):57-61. doi: 10.14744/hf.2024.2024.0044. eCollection 2025. Hepatol Forum. 2025. PMID: 40248674 Free PMC article.
Exploring the Link Between Hepatic Perfusion and Endotoxemia in Hemodialysis.
Marants R, Qirjazi E, Lai KB, Szeto CC, Li PKT, Li F, Lee TY, McIntyre CW. Marants R, et al. Kidney Int Rep. 2021 Feb 9;6(5):1336-1345. doi: 10.1016/j.ekir.2021.02.008. eCollection 2021 May. Kidney Int Rep. 2021. PMID: 34013112 Free PMC article.

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