Inflammation and Extracellular Volume Expansion are Related to Sodium and Water Removal in Patients on Peritoneal Dialysis

Abstract

Background Inflammation is an important risk for mortality in dialysis patients. Extracellular fluid volume (ECFv) expansion, a condition commonly seen in peritoneal dialysis (PD) patients, may be associated with inflammation. However, published support for this relationship is scarce. Objectives To quantify the proportion of patients on PD with inflammation and to analyze the role of ECFv expansion and the factors related to these conditions. Design A prospective, multicenter cross-sectional study in six hospitals with a PD program. Patients and Methods Adult patients on PD were studied. Clinical data, body composition, and sodium and fluid intake were recorded. Biochemical analysis, C-reactive protein (CRP), and peritoneal and urinary fluid and sodium removal were also measured. Results CRP values positive (≥ 3.0 mg/L) for inflammation were found in 147 (80.3%) and negative in 36 patients. Patients with positive CRP had higher ECFv/total body water (TBW) ratio (women 47.69 ± 0.69 vs 47.36 ± 0.65, men 43.15 ± 1.14 vs 42.84 ± 0.65; p < 0.05), higher serum glucose (125.09 ± 81.90 vs 103.28 ± 43.30 mg/dL, p < 0.03), and lower serum albumin (2.86 ± 0.54 vs 3.17 ± 0.38 g/dL, p < 0.001) levels. They also had lower ultrafiltration (1003 ± 645 vs 1323 ± 413 mL/day, p < 0.005) and total fluid removal (1260 ± 648 vs 1648 ± 496 mL/day, p < 0.001), and less peritoneal (15.59 ± 162.14 vs 78.11 ± 110.70 mEq/day, p < 0.01) and total sodium removal (42.06 ± 142.49 vs 118.60 ± 69.73 mEq/day, p < 0.001). In the multivariate analysis, only ECFv/TBW was significantly ( p < 0.04) and independently associated with inflammation. ECFv/TBW was correlated with fluid removal ( r = 0.16, p < 0.03) and renal sodium removal ( r = 0.2, p < 0.01). Conclusion The data suggest that ECFv expansion may have a significant role as an inflammatory stimulus. The results disclose a relationship between the two variables, ECFv expansion and inflammation, identified as independent risk factors for mortality in PD patients.

Treatment Time, Chronic Inflammation, and Hemodynamic Stability: The Overlooked Parameters in Hemodialysis Quantification

“…One of the major shortcomings of short thrice weekly dialysis is inadequate removal of volume and consequent difficulty in controlling blood pressure (63)(64)(65). Volume overload is known to be associated with increased inflammatory markers and hypoalbuminemia (47,48).…”

A fresh look at dry weight

“…31 This may be a contributing factor to elevated inflammatory markers in HD patients. 32,33 This notion is corroborated in observations made in patients with CHF showing that therapy with loop diuretics results in lower levels of circulating endotoxins with edema reduction. 34 Bowel wall edema may also result in protein losing enteropathy and fat malabsorption, as it also has been shown in patients with CHF.…”

The association of overhydration with chronic inflammation in chronic maintenance hemodiafiltration patients

“…39,40 Chronic inflammation, often presenting as the malnutrition inflammation complex syndrome, is also very common in prevalent dialysis populations with as many as 30% to 60% dialysis patients affected in the United States and Europe. 12 Numerous studies on congestive heart failure, [41][42][43] predialysis chronic kidney disease, 17 and peritoneal dialysis populations [19][20][21][22] have demonstrated that fluid overload and markers of chronic inflammation strongly correlate. Our present paper is one of the firsts to demonstrate similar relationships in a population on stable maintenance hemodiafiltration.…”

“…10 Recently, two important phenomena were added as factors intertwined with inadequate volume control and poor outcomes: chronic inflammation [11][12][13] frequently manifesting in malnutrition-inflammation complex syndrome 14 and myocardial stunning often seen in the setting of hemodynamic instability during the hemodialysis procedure. 13,15,16 The majority of studies exploring these relationships were performed in either predialysis 17,18 or peritoneal dialysis patients [19][20][21][22] or hemodialysis patients who were recently hospitalized or discharged and data on maintenance hemodiafiltration is scarce. 23,24 Here, studied the relationship between fluid overload, inflammatory markers, and serum albumin in stable end-stage renal disease (ESRD) patients on maintenance hemodiafiltration, who received bioimpedance spectroscopy analysis as part of their routine care.…”