Association of Lean Body Mass Index and Peritoneal Protein Clearance in Peritoneal Dialysis Patients

Fan, Jinjin; Ye, Hongjian; Zhang, Xiaodan; Cao, Pengfei; Guo, Qunying; Mao, Haiping; Yu, Xueqing; Yang, Xiao

doi:10.1159/000498841

Cited by 14 publications

(14 citation statements)

References 25 publications

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“…In the present population, higher PPCl was associated with higher LBM and LBMI, higher extracellular body mass/body cell mass ratio, and higher skeletal muscle mass index, challenging the conventional viewpoint that higher PPCl may cause malnutrition [1]. These are in agreement with results from a study in Chinese patients, which also showed a relationship between LBMI and PPCl in univariable analysis [43]. However, most of these nutritional parameters are also influenced by fluid status.…”

Section: Discussionsupporting

confidence: 89%

Overhydration May Be the Missing Link between Peritoneal Protein Clearance and Mortality

Guedes

Marques

Domingos

et al. 2021

Nephron

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Introduction: Peritoneal protein loss (PPL) has been associated with mortality. Inflammation was assumed a putative cause with malnutrition as a consequence. Hydrostatic convection is a major drive for microvascular protein transport, but most studies in peritoneal dialysis (PD) patients overlooked this mechanism. An association between peritoneal protein clearance (PPCl) and venous congestion has been reported recently. The aim of this study was to explore the importance of fluid overload in PPCl in PD. Methods: Sixty-seven prevalent PD patients were assessed with peritoneal equilibration test and multifrequency bioelectrical impedance assessment (BIA). PPL and PPCl were calculated from simultaneously obtained 24-h peritoneal effluent. Results: PPL averaged 5.2 g/24 h. It was higher in patients on continuous treatment than in those without a long dwell. Significant associations between PPCl and BIA parameters of overhydration were found in both univariable and multivariable analyses. Lean mass index, partly dependent on hydration status, was associated with PPCl in univariable but not in multivariable analysis. A multiple linear model identified extracellular water excess and higher D/P creatinine as predictors of higher PPCl, independent of PD duration, type of PD, age, gender, albumin, cardiovascular disease, C-reactive protein, or lean mass index. Conclusions: The uni- and multivariable strong associations between fluid overload and PPCl support the importance of hydrostatic pressure-induced convection for PPCl. Also, peritoneal small solute transport was associated with PPCl. Both are amenable by adjusted dialysis prescription, especially focused on fluid status and avoidance of overhydration. The assumption of an association with inflammation and malnutrition was not confirmed.

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Section: Discussionsupporting

confidence: 89%

Overhydration May Be the Missing Link between Peritoneal Protein Clearance and Mortality

Guedes

Marques

Domingos

et al. 2021

Nephron

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“…Moreover, Zitt et al (20) proposed that albumin and phosphorus interact with each other in their associations with mortality in patients undergoing HD, and concurrent low phosphorus and high albumin was associated with the lowest risk of mortality in patients undergoing HD, but this relationship was not found in patients treated by peritoneal dialysis (PD) possibly because of small study population (n = 38). Unlike HD, peritoneal protein loss via peritoneal effluent has been recognized as a major disadvantage in PD; patients on PD have lower serum albumin than those undergoing HD (23)(24)(25)(26). Meanwhile, Mehrotra et al (27) has found that serum albumin levels as a risk factor for mortality were shifted to a lower range in PD, as compared to HD.…”

Section: Introductionmentioning

confidence: 99%

Serum Phosphorus and Albumin in Patients Undergoing Peritoneal Dialysis: Interaction and Association With Mortality

Huang

Fan

et al. 2021

Front. Med.

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Hyperphosphatemia and hypoalbuminemia confer worse clinical outcomes, whether these risk factors interact to predispose to mortality is unclear. In this prospective cohort study, 2,118 patients undergoing incident continuous ambulatory peritoneal dialysis (CAPD) were enrolled and categorized into four groups based on the changing point regarding mortality at 1.5 mmol/L for serum phosphorus and 35 g/L for serum albumin. Risks of all-cause and cardiovascular mortality were examined independently and interactively in overall and subgroups. There was no association between serum phosphorus with all-cause and cardiovascular mortality, but significant interactions (p = 0.02) between phosphorus and albumin existed in overall population. Patients in subgroup with high phosphorus and low albumin were at greater risk of all-cause (HR 1.95, 95%CI 1.27–2.98, p = 0.002) but not cardiovascular mortality (HR 0.37, 95%CI 0.10–1.33, p = 0.13), as compared to those with low phosphorus and high albumin. In contrast, patients with both low parameters had a higher risk of all-cause (HR 1.75, 95%CI 1.22–2.50, p = 0.002) and cardiovascular mortality (HR 1.92, 95%CI 1.07–3.45, p = 0.03). Notably, an elevated risk of both all-cause and cardiovascular mortality was observed in those with low serum albumin, irrespective of phosphorus levels, suggesting low albumin may be useful to identify a higher-risk subgroup of patients undergoing CAPD with different serum phosphorus levels.

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“…Previous studies have shown a negative correlation between the peritoneal albumin loss and serum albumin level in PD patients [20,22]. Furthermore, the peritoneal albumin loss was demonstrated to be positively associated with peritoneal CCL in a cross-sectional study including 351 PD patients [23]. Therefore, the mechanism of the inverse association between the peritoneal UA clearance and serum albumin level may be elucidated as follows: the greater peritoneal UA clearance itself signifying more removal of albumin from peritoneum caused lower circulating albumin reserves, which was mainly on account of the inadequate albumin synthesis to compensate the peritoneal albumin loss [20].…”

Section: Discussionmentioning

confidence: 78%

Not Residual Kidney Removal but Peritoneal Clearance Dominates in Uric Acid Control in Peritoneal Dialysis

Xiao¹,

Ye²,

Chen³

et al. 2019

Preprint

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Background: There’s a paucity of systematic study focusing on clearance of uric acid (UA) in peritoneal dialysis (PD). The aim of this study was to investigate peritoneal UA removal and its influencing factors in PD patients. Methods: This was a cross-sectional study. Patients who performed peritoneal equilibration test (PET) and Kt/V from April 1, 2018 to August 31, 2019 were enrolled. The demographic data, clinical and laboratory parameters including the UA levels in the dialysate, blood and urine samples were collected. Results: Finally, there were 180 prevalent PD patients (52.8% male). Compared with normal serum UA (SUA) group, the hyperuricemia group showed significantly lower peritoneal UA clearance (39.1±6.2 vs. 42.0±8.0 L/week/1.73m2, P=0.008). Peritoneal UA clearance but not residual kidney removal was revealed to be independently associated with continuous [standardized coefficients (β) -0.21, 95% confidence interval (CI) -0.07, -0.006] and categorical SUA level [odds ratio (OR) 0.91, 95% CI 0.84,0.98]. Furthermore, the higher (high or high-average) transporters showed greater peritoneal UA clearance than the lower (low or low-average) transporters (42.0±7.0 vs. 36.4±5.6 L/week/1.73 m2, P<0.001). Among the widely used solute removal indicators, peritoneal creatinine clearance (CCL) performed best to predict higher peritoneal UA clearance in ROC analysis [area under curve (AUC) 0.96, 95% CI 0.93-0.99]. In multiple linear regression, lower albumin level (β -0.06, 95%CI -2.09, -0.19), higher transporters (β 0.06, 95%CI 0.05, 1.69) and greater peritoneal CCL (β 0.95, 95%CI 0.81, 0.93) were independently associated with higher peritoneal UA clearance. Conclusions: It was peritoneal removal but not residual kidney function that dominated in SUA balance of PD patients. Albumin level, peritoneal transport type and peritoneal CCL were identified as independent determinants of peritoneal UA clearance.

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Association of Lean Body Mass Index and Peritoneal Protein Clearance in Peritoneal Dialysis Patients

Cited by 14 publications

References 25 publications

Overhydration May Be the Missing Link between Peritoneal Protein Clearance and Mortality

Overhydration May Be the Missing Link between Peritoneal Protein Clearance and Mortality

Serum Phosphorus and Albumin in Patients Undergoing Peritoneal Dialysis: Interaction and Association With Mortality

Not Residual Kidney Removal but Peritoneal Clearance Dominates in Uric Acid Control in Peritoneal Dialysis

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