Hence, the general applicability of the computed OHBIA remains uncertain. We see a particular strength of BIA in the direct estimation of ICW that defines body cell mass and cannot be reliably assessed by other routine techniques. Malnutrition, a commonly undiagnosed condition

in dialysis patients, leads to loss of lean body substance [7]. Implementation of serial ICW measurements in individual patients would be able to unmask a clinically inapparent decline in body mass, prevent an increase of OH, and uncover an underlying process possibly requiring further medical intervention. This interpretation is supported by our models, which selected ICW as the most significant BIA parameter in OH assessment. Our analyses make evident that only combinations of several methods and parameters provide an acceptable selleck compound prediction precision. The integrative function of clinical judgment is reflected by the better accuracy of models with implementation of OHCLI and also by the highest predictive importance of OHCLI. Despite similar hydration characteristics, our patients had lower BP than the study subjects reported by Chazot [8]. However, many studies do not report Sirolimus antihypertensive drugs prescribed only for cardioprotection, which creates inconsistency. We think that this different

indication does not eliminate the antihypertensive effect, and included them in our analysis. Investigators from Tassin in France described patients who remain normotensive despite being above calculated DW, and explain this by better clearance of vasoactive substances during the long HD practiced in the Tassin dialysis center [9]. Our patients presented a normal average BP that correlated with OH. This emphasizes that BP changes rather than absolute values in individual patients, even within normal limits, may be indicative of OH. Undetected overhydration, silent hypervolemia, may result in hypertension as late as 12 h after leaving HD [10]. For this reason, we believe that regularly performed 24-h BP monitoring should be a standard component

of hydration evaluation in HD patients. The calf has a relatively uniform Thalidomide structure with better hydration, and recent evidence has suggested that calf BIA may be more sensitive than the whole-body method [11]. We could prove a strong link between calf circumference and OH parameters, and provide further support for this emerging technique. The conventional indicators of volume overload in the non-HD population, chest X-ray or echocardiography, might not be that reliable in HD patients. Fluid oscillations associated with HD can induce organ remodeling (atrial dilatation, ventricular hypertrophy, increased pulmonary vascular resistance), and decrease the specificity and sensitivity of these techniques for fluid overload.