Comparison of body fluid distribution between chronic haemodialysis and peritoneal dialysis patients as assessed by biophysical and biochemical methods

Plum, J; Schoenicke, Gerrit; Kleophas, Werner; Kulas, Wolfgang; Steffens, Frank; Azem, Amjad; Grabensee, B

doi:10.1093/ndt/16.12.2378

Cited by 109 publications

(91 citation statements)

References 13 publications

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“…BP control in the icodextrin group was, in fact, rather better at the start of the study, and any changes observed might reflect a regression to the mean, especially because these patients were more likely to have their antihypertensive treatment reduced. The inability to relate changes in BP to those in ECF may not be that surprising, however, because the extracellular fluid expansion seen in PD patients does not necessarily reflect an increase in intravascular volume (25).…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…These earlier studies provide additional support and rationale for the current multicontact electrode BIA system for regional and whole-body fat and SM research and clinical applications. The present BIA system is single frequency, 50 kHz, and the addition of a multiple frequency chip would afford the opportunity to quantify fluid distribution (Plum et al, 2001). Additionally, improved prediction of some components at frequencies other than 50 kHz may be possible.…”

Section: Discussionmentioning

confidence: 99%

New bioimpedance analysis system: improved phenotyping with whole-body analysis

et al. 2004

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Objective: Bioimpedance analysis (BIA) is a potential field and clinical method for evaluating skeletal muscle mass (SM) and %fat. A new BIA system has 8-(two on each hand and foot) rather than 4-contact electrodes allowing for rapid 'whole-body' and regional body composition evaluation. Design: This study evaluated the 50 kHz BC-418 8-contact electrode and TBF-310 4-contact electrode foot-foot BIA systems (Tanita Corp., Tokyo, Japan). Subjects: There were 40 subject evaluations in males (n ¼ 20) and females (n ¼ 20) ranging in age from 6 to 64 y. BIA was evaluated in each subject and compared to reference lean soft-tissue (LST) and %fat estimates in the appendages and remainder (trunk þ head) provided by dual-energy X-ray absorptiometry (DXA). Appendicular LST (ALST) estimates from both BIA and DXA were used to derive total body SM mass. Results: The highest correlation between total body LST by DXA and impedance index (Ht 2 /Z) by BC-418 was for the foot-hand segments (r ¼ 0.986; left side only) compared to the arm (r ¼ 0.970-0.979) and leg segments (r ¼ 0.942-0.957)(all Po0.001).The within-and between-day coefficient of variation for %fat and ALST evaluated in five subjects was o1% and B1-3.7%, respectively. The correlations between 8-electrode predicted and DXA appendicular (arms, legs, total) and trunk þ head LST were strong and highly significant (all rX0.95, Po0.001) and group means did not differ across methods. Skeletal muscle mass calculated (Kim equation) from total ALST by DXA (X7s.d.)(23.779.7 kg) was not significantly different and highly correlated with BC-418 estimates (25.279.6 kg; r ¼ 0.96, Po0.001). There was a good correlation between total body %fat by 8-electrode BIA vs DXA (r ¼ 0.87, Po0.001) that exceeded the corresponding association with 4-electrode BIA (r ¼ 0.82, Po0.001). Group mean segmental %fat estimates from BC-418 did not differ significantly from corresponding DXA estimates. No betweenmethod bias was detected in the whole body, ALST, and skeletal muscle analyses. Conclusions:The new 8-electrode BIA system offers an important new opportunity of evaluating SM in research and clinical settings. The additional electrodes of the new BIA system also improve the association with DXA %fat estimates over those provided by the conventional foot-foot BIA.

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“…The leading hypothesis to explain the increase in relative risk for death for PD patients postulates that with increasing dialysis vintage, PD patients become volume overloaded (60,61). Single-center studies suggested that patients who were treated with continuous ambulatory PD had greater worsening of their volume status with increasing dialysis vintage than MHD patients.…”

Section: Possible Biologic Explanations For Differences In Outcomes Bmentioning

confidence: 99%

Is the Declining Use of Long-Term Peritoneal Dialysis Justified by Outcome Data?

Khawar

Kalantar-Zadeh

et al. 2007

Clinical Journal of the American Society of Nephrology

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In the past decade, peritoneal dialysis use among patients with end-stage renal disease has declined in many countries. Studies from the United States indicate that many academic centers do not have adequate resources to train fellows, most incident dialysis patients are not offered peritoneal dialysis, and more than half of dialysis clinics do not have the infrastructure to support peritoneal dialysis. Some are concerned that the outcomes of peritoneal dialysis and maintenance hemodialysis patients may not be equivalent, a notion that is not supported by outcome studies. Given the effect of modality selection on patients' lifestyle, attempts to conduct a randomized, controlled comparison of maintenance hemodialysis and peritoneal dialysis have been unsuccessful. Most observational studies showed that peritoneal dialysis is associated with a survival advantage that diminishes over time; it is unclear whether any of the differences over time are attributable to the modality. Between 1996 and 2003, the early outcomes of peritoneal dialysis patients further improved, whereas those for maintenance hemodialysis patients remained unchanged. Differences in outcomes may be due to residual statistical confounding; however, several biologic mechanisms can be postulated: The early survival advantage may be related to the better preservation of residual renal function with peritoneal dialysis, and the diminution of the survival advantage may be related to worsened volume control. There is a need for large observational and interventional studies among peritoneal dialysis patients to sustain and enforce the improvements in both dialysis therapies.

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Comparison of body fluid distribution between chronic haemodialysis and peritoneal dialysis patients as assessed by biophysical and biochemical methods

Cited by 109 publications

References 13 publications

Icodextrin Improves the Fluid Status of Peritoneal Dialysis Patients

Icodextrin Improves the Fluid Status of Peritoneal Dialysis Patients

New bioimpedance analysis system: improved phenotyping with whole-body analysis

Is the Declining Use of Long-Term Peritoneal Dialysis Justified by Outcome Data?

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