Can a reduction in extracellular fluid volume result in increased serum albumin in peritoneal dialysis patients?

Jones, Colin; Wells, Louise; Stoves, John; Farquhar, Fiona; Woodrow, Graham

doi:10.1053/ajkd.2002.32010

Cited by 61 publications

(47 citation statements)

References 16 publications

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“…The lack of influence of improved ultrafiltration on BP control in this study is on the surface disappointing and differs from the findings of uncontrolled studies (18,21,22). It should be noted, however, that achieved BP control throughout the study in both patient groups was very satisfactory, reflecting both a good quality of care by participating physicians and the freedom to use drug therapy as required in the study protocol.…”

Section: Discussioncontrasting

confidence: 93%

“…We found that when icodextrin is used during the long exchange compared with 2.27% glucose, ultrafiltration is better preserved and a sustained reduction in weight, primarily attributable to changes in the ECF, occurs. This supports the changes in weight observed in a recent randomized study (17) and in uncontrolled studies of manipulation of fluid status in PD patients, although in these reports, the changes in BP were greater (18,21,22). Furthermore, this change does not appear to have a detrimental effect of residual urine volume.…”

Section: Discussionsupporting

confidence: 84%

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Icodextrin Improves the Fluid Status of Peritoneal Dialysis Patients

Davies¹,

Woodrow

Donovan

et al. 2003

Journal of the American Society of Nephrology

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320

261

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Abstract. Worsening fluid balance results in reduced technique and patient survival in peritoneal dialysis. Under these conditions, the glucose polymer icodextrin is known to enhance ultrafiltration in the long dwell. A multicenter, randomized, double-blind, controlled trial was undertaken to compare icodextrin versus 2.27% glucose to establish whether icodextrin improves fluid status. Fifty patients with urine output Ͻ750 ml/d, high solute transport, and either treated hypertension or untreated BP Ͼ140/90 mmHg, or a requirement for the equivalent of all 2.27% glucose exchanges, were randomized 1:1 and evaluated at 1, 3, and 6 mo. Members of the icodextrin group lost weight, whereas the control group gained weight. Similar differences in total body water were observed, largely explained by reduced extracellular fluid volume in those receiving icodextrin, who also achieved better ultrafiltration and total sodium losses at 3 mo (P Ͻ 0.05) and had better maintenance of urine volume at 6 mo (P ϭ 0.039). In patients fulfilling the study's inclusion criteria, the use of icodextrin, when compared with 2.27% glucose, in the long exchange improves fluid removal and status in peritoneal dialysis. This effect is apparent within 1 mo of commencement and was sustained for 6 mo without harmful effects on residual renal function.

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Section: Discussioncontrasting

confidence: 93%

Section: Discussionsupporting

confidence: 84%

Icodextrin Improves the Fluid Status of Peritoneal Dialysis Patients

Davies¹,

Woodrow

Donovan

et al. 2003

Journal of the American Society of Nephrology

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320

261

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“…Linear regression of BCI and albumin suggested that the presence of albumin and other unmeasured substance reduce the capacitive indexes. Previous literature has discussed regarding the survival predictive value of albumin [17] and the potential relation of hypoalbuminaemia with overhydration [16]. In current study, although BCI has higher predictive value than albumin alone in predictive model, we are still not able to differentiate the causal-result relationship of fluid and nutrition with BCI.…”

Section: Discussioncontrasting

confidence: 56%

“…In order to improve the evaluation of nutritional and hydration status of the chronic dialysis patients, BIA has been advocated for both chronic ambulatory peritoneal dialysis (CAPD) patients [1,10,16,17] and hemodialysis patients [18][19][20]. Phase angle has been shown to be predictive of survival in dialysis population [21].…”

Section: Discussionmentioning

confidence: 99%

Ratio of Capacitance/BMI Reflects Deficit in Nutritional Concentration While CH2 Reflects Total Nutritional Deficit in CAPD Patients and General Population

Koh¹,

Wong²

2013

OJNeph

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Traditionally phase angle was the best predictor in BIA for nutrition and survival in dialysis population. We recently showed that normalized bioimpedance indices are a better risk discriminator for dialysis patients and the general population. We hereby aimed to explore discriminating factors behind them. Methods: We assessed the body capacitive index (BCI = Capacitance × Height ) which represents total body capacitive volume in physics. We initially performed BIA for 206 female, 116 male healthy volunteers, followed by, prospective study for 128 CAPD patients (47 diabetes mellitus (DM), 81 non-DM; 59 male, 69 female) for >2 years. Results: Moderately good negative correlation of albumin and BCI (r = −0.533, p < 0.001) with linear regression (BCI = 8.780 − 0.184 × [albumin], R 2 = 0.339, p < 0.001) was shown in CAPD patients. BCI and CH 2 were much higher in CAPD patients in comparison to healthy volunteers (3.4 ± 0.1 vs 2.0 ± 0.0 nFm 2 /kg, p < 0.001 and 203 ± 8 vs 125 ± 1 nFm 2 , p < 0.001, respectively). In age and gender adjusted logistic regression model of 128 CAPD patients versus 322 healthy volunteers, the best risk discriminator was BCI (X 2 = 165.6), followed by CH 2 (X 2 = 140), phase angle (X 2 = 59.3) and BRI (X 2 = 52.2). Thirty five (27.3%) patients died during the study period (Fatal cause: infection (54%), cardiovascular (26%)). In Cox regression, CH 2 ( 2 4 X = 32.4) was the best predictor for all-cause mortality, followed by BCI ( 2 4 X = 27.7) and phase angle ( 2 4 X = 19.3). Conclusion: The phase angle was a compound parameter of the body capacity index (BCI) and body resistive index (BRI). BCI has a moderately good negative correlation with albumin and this supports its role in reflecting the severity of malnutrition in CAPD patients. CH 2 represents total nutrition deficit and thus the major risk indicator for the survival of CAPD patients.

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“…Thus it is more likely that the lower sodium is associated with relative water retention as found in inflammatory states associated with chronic illness, often associated with loss of fat and poor nutrition (25,26), and this is in keeping with the reduced albumin (27). A relative increase in body water without sodium expands intracellular and extracellular volumes, therefore the overall ratio is not affected (28). In these patients, the osmotic gradient is increased because of the reduced capillary osmotic and oncotic pressure due to the lower sodium and albumin concentrations, resulting in greater PET ultrafiltration volumes.…”

Section: Discussionmentioning

confidence: 99%

Hydration Status Does Not Influence Peritoneal Equilibration Test Ultrafiltration Volumes

Davenport

Willicombe

2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: The peritoneal equilibration test (PET) was developed some 25 yr ago and has been used to help prescribe peritoneal dialysis. However, PET is affected by several factors, including diabetes and inflammation. It was speculated that extracellular fluid overload would increase PET ultrafiltration volumes, and therefore the usefulness of the PET in routine clinical practice was audited.Design, setting, participants, & measurements: Data from 211 consecutive patients attending a university teaching hospital for a standard PET who had multifrequency bioimpedance performance were analyzed to determine which factors affected net PET ultrafiltration volumes.Results: Net PET ultrafiltration volume was independent of gender, age, diabetes, residual renal function, peritoneal dialysis prescriptions (modes and dialysates), extracellular fluid volume, or C-reactive protein (CRP). There was an inverse regression with serum albumin and sodium on multiple logistical regression analysis (F ‫؍‬ 13.4, P < 0.001 and F ‫؍‬ 10.1, P ‫؍‬ 0.001, respectively) and a positive regression with 24-h net peritoneal ultrafiltration volumes (F ‫؍‬ 15.5, P < 0.001). As expected, there was a strong correlation with net sodium losses (r ‫؍‬ 0.99, P < 0001).Conclusions: It was found that PET test ultrafiltration volume in routine clinical practice was not affected by CRP, hyperglycemia, or extracellular fluid volume overload. Ultrafiltration volumes were increased in those patients with reduced serum sodium and albumin, most likely because of inflammation and protein malnutrition.

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Can a reduction in extracellular fluid volume result in increased serum albumin in peritoneal dialysis patients?

Cited by 61 publications

References 16 publications

Icodextrin Improves the Fluid Status of Peritoneal Dialysis Patients

Icodextrin Improves the Fluid Status of Peritoneal Dialysis Patients

Ratio of Capacitance/BMI Reflects Deficit in Nutritional Concentration While CH2 Reflects Total Nutritional Deficit in CAPD Patients and General Population

Hydration Status Does Not Influence Peritoneal Equilibration Test Ultrafiltration Volumes

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