No abstract

Relationship of bioelectrical impedance parameters to nutrition and survival in peritoneal dialysis patients.Background. Malnutrition is highly prevalent in peritoneal dialysis (PD) patients and is associated with higher mortality in these patients. In this study, we have prospectively examined the relationship of bioimpedance indexes to the nutritional status and survival in PD patients.Methods. We enrolled 48 PD patients beginning in November 2000. On enrollment, bioelectrical impedance analysis (BIA) (BIA-101; RJL/Akern, Clinton Township, MI, USA) was performed and monthly blood was analyzed for biochemical markers, including prealbumin. Patients were followed until April 2003.Results. The mean age of PD patients was 51 Ϯ 15 (SD) years. Fifty-eight percent of the patients were female and 23% of the patients were diabetic. Mean body mass index (BMI) was 25.7 Ϯ 5.0 kg/m 2 . Mean resistance, reactance, and phase angle were 521 Ϯ 104 ohms, 57 Ϯ 19 ohms, and 6.16 Ϯ 1.6 degrees, respectively. During the study period, 8 patients (17%) expired. The Kaplan-Meier method was used to compute observed survival. The cumulative observed survival of PD patients with enrollment phase angle greater than or equal to 6 degrees was significantly higher (P ϭ 0.008) than that of patients with phase angle less than 6. Using Cox's multivariate regression analysis, phase angle was an independent predictor (relative risk ϭ 0.39, P ϭ 0.027) of more than two years' survival in PD patients. Serum prealbumin was directly correlated with phase angle (r ϭ 0.54, P Ͻ 0.0001), reactance (r ϭ 0.55, P Ͻ 0.0001), and resistance (r ϭ 0.29, P ϭ 0.06).Conclusion. BIA indexes reflect nutritional status and may be useful in monitoring nutritional status in PD patients. Phase angle is a strong prognostic index in PD patients. It is useful to incorporate prealbumin and BIA parameters in the regular assessment of PD patients, whose survival may be improved by better management of malnutrition and overall health status.Bioelectrical impedance analysis (BIA) is a quick, inexpensive, safe, and noninvasive method for estimating body composition and nutritional status in various patient populations [1][2][3][4][5]. The use of BIA to measure body

Malnutrition and inflammation in peritoneal dialysis patients.Background. Malnutrition, cardiovascular disease, and heightened inflammation are highly prevalent in dialysis patients, and major contributors to morbidity and mortality. We have investigated the inter-relationship between malnutrition and inflammation, and their impact on morbidity and mortality in peritoneal dialysis (PD) patients.Method. We enrolled 63 PD patients beginning in November 2000, and measured C-reactive protein (CRP) and various nutritional markers, including prealbumin.Results. CRP level was elevated in 29% of the PD patients. Diabetics had higher CRP than non-diabetics (24 vs. 9.3 mg/L, P ϭ 0.016). Patients who were hospitalized during the study had higher enrollment CRP (16 vs. 12.5 mg/L, P ϭ 0.05) and lower enrollment albumin (3.5 vs. 3.9 g/dL, P ϭ 0.002), blood urea nitrogen (BUN) (40 vs. 49 mg/dL, P ϭ 0.034), and protein catabolic rate (nPCR) (0.88 vs. 1.0 g/kg/day, P ϭ 0.02) than those who were not hospitalized. Enrollment level of CRP was inversely correlated with nutritional markers prealbumin (r ϭ Ϫ0.5, P Ͻ 0.0001) and creatinine (r ϭϪ0.35, P Ͻ 0.01). After adjusting for age, race, gender, diabetes, and CRP level, prealbumin continued to correlate with other nutritional markers. There was a trend toward association of elevated CRP with all-cause mortality in PD patients.Conclusion. It is useful to incorporate prealbumin and CRP in the regular assessment of PD patients, whose survival may be improved by better management of malnutrition and inflammation.

Urinary red blood cells (RBC) are usually small and morphologically abnormal in glomerular (GN) hematuria, and slightly enlarged and morphologically normal in nonglomerular (NG) hematuria. This study was performed to evaluate the diagnostic value of urinary red cell size and morphology and to investigate the mechanism of the alteration in cell size. In 34 consecutive patients with hematuria we examined the urinary RBC size distribution and mean corpuscular volume (MCV) by electronic sizing of suspensions of RBC in an isotonic medium and, in 28 cases, compared it with the presence of 50% or greater dysmorphia. In 15 consecutive cases, we correlated MCV values with urine chemistries. In two GN cases we recorded the urine MCV serially during a furosemide-induced diuresis. In vitro incubations of peripheral or urinary RBC in various electrolyte solutions prior to sizing were also performed. The MCVs were significantly lower in GN (p < 10∼⁶) and probable GN (p < 10–⁴) than NG hematuria. A cutoff of 72 fl completely separated GN and probable GN from NG cases. Fifty percent or more ‘dysmorphic’ RBC were seen in 12 of 13 GN, 3 of 4 probable GN but in no NG sediments. In patients with NG hematuria, the ratio of urinary to peripheral MCV tended to be greater than unity and correlated strongly with pH (r = -0.97; p < 0.002). The effect of pH was confirmed in vitro. Furosemide diuresis induced a partial correction of the microcytosis of GN RBC, which correlated with the changes in urine composition. Furosemide had no effect on GN cells in vitro. Incubation of venous RBC in saline ranging from 0.5 to 6% did not alter MCV. Saline of 0.45% or less caused partial to total hemolysis and the appearance of RBC fragments with extremely low ‘MCV values. We conclude that electronic RBC sizing is a highly accurate and objective method for differentiating GN from NG hematuria. Urinary pH is an important determinant of MCV for NG RBC. A hypothesis is proposed to explain the microcytosis of GN RBC.

Calciphylaxis is a complication caused by secondary hyperparathyroidism in patients with chronic renal failure. These patients may present with clinical findings of ischemic necrosis involving the skin and muscle resulting in subsequent gangrene and vascular calcifications. We report a rare case of necrotizing mastopathy caused by calciphylaxis in a 70-year-old female with end-stage renal disease whose symptoms resolved with a total parathyroidectomy.