Overhydration prevalence in peritoneal dialysis – A 2 year longitudinal analysis

Aguiar, Pedro; Santos, Olívia; Teixeira, Laetitia; Silva, Fernanda; Azevedo, Pedro; Vidinha, Joana; Ferrer, Francisco; Carvalho, Maria João; Cabrita, António; Rodrigues, Anabela

doi:10.1016/j.nefro.2015.05.020

Cited by 20 publications

(19 citation statements)

References 24 publications

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“…25,26,[30][31][32][33][34][35][36] A negative association between higher diastolic blood pressure and residual renal function has also been reported. 37 Complications associated with overhydration can be asymptomatic.…”

Section: Background and Definition Of The Decision Problem(s)mentioning

confidence: 90%

Multiple-frequency bioimpedance devices for fluid management in people with chronic kidney disease receiving dialysis: a systematic review and economic evaluation

Scotland

Cruickshank

Jacobsen

et al. 2018

Health Technol Assess

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BackgroundChronic kidney disease (CKD) is a long-term condition requiring treatment such as conservative management, kidney transplantation or dialysis. To optimise the volume of fluid removed during dialysis (to avoid underhydration or overhydration), people are assigned a ‘target weight’, which is commonly assessed using clinical methods, such as weight gain between dialysis sessions, pre- and post-dialysis blood pressure and patient-reported symptoms. However, these methods are not precise, and measurement devices based on bioimpedance technology are increasingly used in dialysis centres. Current evidence on the role of bioimpedance devices for fluid management in people with CKD receiving dialysis is limited.ObjectivesTo evaluate the clinical effectiveness and cost-effectiveness of multiple-frequency bioimpedance devices versus standard clinical assessment for fluid management in people with CKD receiving dialysis.Data sourcesWe searched major electronic databases [e.g. MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Science Citation Index and Cochrane Central Register of Controlled Trials (CENTRAL)] conference abstracts and ongoing studies. There were no date restrictions. Searches were undertaken between June and October 2016.Review methodsEvidence was considered from randomised controlled trials (RCTs) comparing fluid management by multiple-frequency bioimpedance devices and standard clinical assessment in people receiving dialysis, and non-randomised studies evaluating the use of the devices for fluid management in people receiving dialysis. One reviewer extracted data and assessed the risk of bias of included studies. A second reviewer cross-checked the extracted data. Standard meta-analyses techniques were used to combine results from included studies. A Markov model was developed to assess the cost-effectiveness of the interventions.ResultsFive RCTs (with 904 adult participants) and eight non-randomised studies (with 4915 adult participants) assessing the use of the Body Composition Monitor [(BCM) Fresenius Medical Care, Bad Homburg vor der Höhe, Germany] were included. Both absolute overhydration and relative overhydration were significantly lower in patients evaluated using BCM measurements than for those evaluated using standard clinical methods [weighted mean difference –0.44, 95% confidence interval (CI) –0.72 to –0.15,p = 0.003,I2 = 49%; and weighted mean difference –1.84, 95% CI –3.65 to –0.03;p = 0.05,I2 = 52%, respectively]. Pooled effects of bioimpedance monitoring on systolic blood pressure (SBP) (mean difference –2.46 mmHg, 95% CI –5.07 to 0.15 mmHg;p = 0.06,I2 = 0%), arterial stiffness (mean difference –1.18, 95% CI –3.14 to 0.78;p = 0.24,I2 = 92%) and mortality (hazard ratio = 0.689, 95% CI 0.23 to 2.08;p = 0.51) were not statistically significant. The economic evaluation showed that, when dialysis costs were included in the model, the probability of bioimpedance monitoring being cost-effective ranged from 13% to 26% at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year gained. With dialysis costs excluded, the corresponding probabilities of cost-effectiveness ranged from 61% to 67%.LimitationsLack of evidence on clinically relevant outcomes, children receiving dialysis, and any multifrequency bioimpedance devices, other than the BCM.ConclusionsBCM used in addition to clinical assessment may lower overhydration and potentially improve intermediate outcomes, such as SBP, but effects on mortality have not been demonstrated. If dialysis costs are not considered, the incremental cost-effectiveness ratio falls below £20,000, with modest effects on mortality and/or hospitalisation rates. The current findings are not generalisable to paediatric populations nor across other multifrequency bioimpedance devices.Future workServices that routinely use the BCM should report clinically relevant intermediate and long-term outcomes before and after introduction of the device to extend the current evidence base.Study registrationThis study is registered as PROSPERO CRD42016041785.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Background and Definition Of The Decision Problem(s)mentioning

confidence: 90%

Multiple-frequency bioimpedance devices for fluid management in people with chronic kidney disease receiving dialysis: a systematic review and economic evaluation

Scotland

Cruickshank

Jacobsen

et al. 2018

Health Technol Assess

View full text Add to dashboard Cite

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“…Modi able risk factors are malnutrition, overweight, smoking, comedication as immunosuppression, depression, low socioeconomic status… In summary, plenty of risk factors for PD-related peritonitis have been identi ed in studies of acceptable methodological quality. Overhydration is common among PD patients and related cardiovascular risk and death [27][28][29]. Prealbumin levels were an independent and sensitive predictor for mortality in incident PD patients, showing a good correlation with nutritional and in ammatory markers [16,30].…”

Section: Factors Predict Peritonitismentioning

confidence: 92%

Overhydration and low serum prealbumin predict peritoneal dialysis-related peritonitis in continuous ambulatory peritoneal dialysis patients

Quy

Huy

Duc³

et al. 2020

Preprint

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Background In this study, we focused on the role of overhydration (OH) and low serum prealbumin concentration in predicting 3-year peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patientsMethods We measured serum prealbumin concentration and OH by body composition monitor on 278 CAPD patients (159 males and 119 females) to predict 3-year peritonitis. We created the baseline demographics of all patients with the mean age of 46 years and the median peritoneal dialysis (PD) duration of 21 months.Results After the 3-year follow-up, 44 patients diagnosed PD-related peritonitis (15.8%). Low education, serum albumin, prealbumin, high CRP-hs and OH were independent risk factors for predicting peritonitis during 36 months in CAPD patients. Based on the Kaplan–Meier analysis, we realized that patients with low prealbumin and high OH were the good predictors of 3-year peritonitis in CAPD patients (Prealbumin: AUC = 0.838, cut-off value = 32.5 mg/dL, Se = 90.9%, OH: AUC = 0.851, cut-off value = 1.33 L, Se = 79.5%, Sp = 85.5%), (Log-rank test p < 0.001).Conclusion Overhydration and low serum prealbumin level were the good predictors of PD-related peritonitis in CAPD patients.

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“…Nonmodi able risk factors consist of ethnicity, old age, female, cardiovascular comorbidities, DM, underlying renal disease as lupus, lose of residual renal function... Modi able risk factors are malnutrition, overweight, smoking, comedication as immunosuppression, depression, low socioeconomic status… In summary, plenty of risk factors for PDrelated peritonitis have been identi ed in studies of acceptable methodological quality. Overhydration is common among PD patients and related cardiovascular risk and death [28][29][30]. Prealbumin levels were an independent and sensitive predictor for mortality in incident PD patients, showing a good correlation with nutritional and in ammatory markers [16,31].…”

Section: Factors Predict Peritonitismentioning

confidence: 92%

Overhydration and low serum prealbumin predict peritoneal dialysis-related peritonitis in continuous ambulatory peritoneal dialysis patients

Quy

Huy

Duc³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: In this study, we focused on the role of overhydration (OH) and low serum prealbumin concentration in predicting 3-year peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients.Methods: We measured serum prealbumin concentration and OH by body composition monitor on 278 CAPD patients (159 males and 119 females) with mean age of 46 years and the median peritoneal dialysis (PD) duration of 21 months. PD-related peritonitis was collected for 3 years. Results: After the 3-year follow-up, 44 patients diagnosed PD-related peritonitis (15.8%). Low education, serum albumin, prealbumin, high CRP-hs and OH were independent risk factors for predicting peritonitis during 36 months in CAPD patients. Based on the ROC curve model and Kaplan–Meier analysis, we realized that patients with low prealbumin and high OH were the independent predictors of 3-year peritonitis in CAPD patients (Prealbumin: AUC = 0.838, cut-off value = 32.5 mg/dL, Se= 90.9%, Sp = 32.9%; OH: AUC = 0.851, cut-off value = 1.33 L, Se = 79.5%, Sp = 85.5%; and Log-rank test p < 0.001, respectively). Conclusion: Overhydration and low serum prealbumin level were the independent predictors of PD-related peritonitis in CAPD patients.

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Overhydration prevalence in peritoneal dialysis – A 2 year longitudinal analysis

Abstract: Peritoneal dialysis maintenance without increasing volume status, nor major deleterious corporal composition trends, is feasible under careful therapy strategies. Longitudinal application of BIA may be a useful clinical tool to evaluate adequacy beyond Kt/V.

Cited by 20 publications

References 24 publications

Multiple-frequency bioimpedance devices for fluid management in people with chronic kidney disease receiving dialysis: a systematic review and economic evaluation

Multiple-frequency bioimpedance devices for fluid management in people with chronic kidney disease receiving dialysis: a systematic review and economic evaluation

Overhydration and low serum prealbumin predict peritoneal dialysis-related peritonitis in continuous ambulatory peritoneal dialysis patients

Overhydration and low serum prealbumin predict peritoneal dialysis-related peritonitis in continuous ambulatory peritoneal dialysis patients

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