Assessment of Fluid Status in Peritoneal Dialysis Patients

Konings, Constantijn; Kooman, Jeroen P.; Schonck, Marc; Cox-Reijven, P.L.M.; Kreel, B.K. van; Gladziwa, U.; Wirtz, Joris J. J. M.; Gerlag, P. G. G.; Hoorntje, S. J.; Wolters, Johannes; Heidendal, G. A. K.; Sande, Frank M. van der; Leunissen, Karel M.L.

doi:10.1177/089686080202200607

Cited by 47 publications

(38 citation statements)

References 29 publications

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“…15,16 However, loss of residual function in PD patients has been associated with fluid volume overload, 30 and more importantly left ventricular hypertrophy, 3,8 increased arterial stiffness, 9 and mortality. 10 Previous reports have typically measured volume status in cross-sectional cohorts, 23 and although we have previously shown an association between low RRF and volume overload, 31 we could not determine causality. We have therefore reviewed serial measurements in a cohort of PD patients.…”

Section: Discussionmentioning

confidence: 79%

“…36 Previous reports have suggested that episodes of hypovolemia are important in losing RRF. 16,23,33 As such, we compared patients who were in the lowest ECW/TBW tertile at baseline with those in the middle and upper tertiles for hydration. There was no difference in the change in RRF among the three tertiles; indeed, there did not appear to be any relationship at all between changing hydration status and loss in RRF.…”

Section: Discussionmentioning

confidence: 99%

“…Overhydration is associated with hypertension, left ventricular hypertrophy, 21,23 and excess mortality, 24 and hypertension has been reported to lead to the loss of RRF. 16 In addition, high levels of prohormone of brain natriuretic peptide driven by volume overload 25 have been shown to be an important predictor of survival in the ADEMEX study.…”

Section: In Favor Of Running Patients 'Wet'mentioning

confidence: 99%

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Extracellular volume expansion, measured by multifrequency bioimpedance, does not help preserve residual renal function in peritoneal dialysis patients

McCafferty

Fan

Davenport

2014

Kidney International

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Residual renal function is a major survival determinant for peritoneal dialysis patients. Hypovolemia can cause acute kidney injury and loss of residual renal function, and it has been suggested that patients receiving peritoneal dialysis should preferably be maintained hypervolemic to preserve residual renal function. Here we determined whether hydration status predicted long-term changes in residual renal function. Changes in residual renal function and extracellular water (ECW) to total body water (TBW) measured by multifrequency bioimpedance in 237 adult patients who had paired baseline and serial 12 monthly measurements were examined. Baseline hydration status (ECW/TBW) was not significantly associated with preservation of residual renal function, unlike baseline and follow-up mean arterial blood pressure. When the cohort was split into tertiles according to baseline hydration status, there was no significant correlation seen between change in hydration status and subsequent loss in residual renal function. Increased ECW/TBW in peritoneal dialysis patients was not associated with preservation of residual renal function. Similarly, increments and decrements in ECW/TBW were not associated with preservation or reduction in residual renal function. Thus, our study does not support the view that overhydration preserves residual renal function and such a policy risks the consequences of persistent hypervolemia.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: In Favor Of Running Patients 'Wet'mentioning

confidence: 99%

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Extracellular volume expansion, measured by multifrequency bioimpedance, does not help preserve residual renal function in peritoneal dialysis patients

McCafferty

Fan

Davenport

2014

Kidney International

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“…However, LOA from studies using proprietary models ranged from ±4 to 10 kg, which is a much larger range than observed here (±3.4-3.9 kg). 33,34,36,37 Regression analyses from proprietary models have revealed R 2 ranging from 0.45 to 0.92, slope ranging from 0.9 to 1.0, and intercept ranging from 1.6 to 2.5 kg, with no reports of SEE. [32][33][34][35] Comparing these results to those observed in the current study, R 2 (0.82-0.90) was similar, slope (0.78-0.93) was similar or slightly smaller, and intercepts (−1.7 to +3.7 kg) displayed a much larger range.…”

Section: Discussionmentioning

confidence: 99%

Utility of multi‐frequency bioelectrical impedance compared to deuterium dilution for assessment of total body water

Anderson

Erceg

Schroeder

2014

Nutrition & Dietetics

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Aim Multi‐frequency bioelectrical impedance analysis (MF‐BIA) may provide a quick, cost‐efficient method of total body water (TBW) assessment. We compared TBW estimates from the Biospace InBody 520, 720, and S10 MF‐BIA devices to TBW estimates from isotopic deuterium dilution (D2O). Methods TBW was measured in 25 men and 25 women, 18–49 years, 73.6 ± 15.4 kg on each of the three devices and from D2O analysis. Results All MF‐BIA devices significantly overestimated TBW compared to D2O TBW for men (4.7–5.4 kg, 10.8–12.4%; P < 0.01) and women (3.7–4.3 kg, 12.3–14.3%; P < 0.01). Regression analyses in men revealed R2 (0.86–0.90) and SEE (1.7–2.0 kg), and in women revealed R2 (0.82–0.86) and SEE (1.5–1.6 kg). Bland and Altman analyses revealed similar limits of agreement for men (3.5–3.9 kg) and women (3.4–3.7 kg). Conclusions The Biospace InBody devices significantly overestimate TBW in men and women. The consistent bias for men and the increasing bias with increasing TBW for women may indicate that these devices are suitable for group TBW estimates in men only.

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“…The vector plot enables visualization of the trend toward the body composition changes, but it is inconvenient as most clinicians prefer the volume to be expressed in liters or kilos [32]. All of the bioimpedance techniques are highly reproducible and validated with dilution methods [33]. However, differences in results may occur mainly due to different devices, mathematical models used for the equations, and lack of standardization.…”

Section: Bioelectrical Impedance Techniquesmentioning

confidence: 99%

Assessment of Volume Status in Peritoneal Dialysis Patients

Balafa¹

2016

Some Special Problems in Peritoneal Dialysis

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Ideal volume status of patients with end-stage renal disease is one of the main goals of adequate dialysis. Volume overload has been associated with heart failure, left ventricular hypertrophy, and mortality, both in hemodialysis HD and peritoneal dialysis PD populations. The assessment of normal volume status is traditionally based on clinical parameters such as blood pressure, edema, lung auscultation, and chest X-ray. However, these parameters cannot be trustworthy to direct treatment decisions. Gold standard methods of assessing volume status are mainly isotope dilution analysis techniques. However, these methods are invasive and impractical in clinical routine. " number of handy bedside methods have been developed focusing on objective fluid status assessment, both in HD and PD patients. "ioimpedance techniques can estimate extracellular volume, intracellular volume, and total body water, whereas inferior vena cava diameter measurements, biochemical markers, and lung ultrasound provide information about the intravascular filling state and blood volume. Various studies have used the values of the above-mentioned techniques as tools for determining the overhydration of dialysis patients as well as predictors of mortality. Yet, randomized intervention studies based on these methods with hard end points like echocardiographic parameters modification have not been published so far in PD patients.

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Assessment of Fluid Status in Peritoneal Dialysis Patients

Cited by 47 publications

References 29 publications

Extracellular volume expansion, measured by multifrequency bioimpedance, does not help preserve residual renal function in peritoneal dialysis patients

Extracellular volume expansion, measured by multifrequency bioimpedance, does not help preserve residual renal function in peritoneal dialysis patients

Utility of multi‐frequency bioelectrical impedance compared to deuterium dilution for assessment of total body water

Assessment of Volume Status in Peritoneal Dialysis Patients

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