The Effect of Overhydration on Mortality and Technique Failure Among Peritoneal Dialysis Patients: A Systematic Review and Meta-Analysis

Shu, Ying; Liu, Jing; Zeng, Xiaoxi; Hong, Hyokyoung Grace; Li, Yang; Zhong, Hui; Ma, Liang; Fu, Ping

doi:10.1159/000492148

Cited by 46 publications

(35 citation statements)

References 42 publications

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“…Fluid overload is common in PD patients [37][38][39][40][41][42][43][44] and an independent predictor of all-cause mortality [39,42]. Ng et al [41] reported that fluid overload was common in asymptomatic incident PD patients and a strong predictor of patient survival and cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

Association between Dialysis Modality and Cardiovascular Diseases: A Comparison between Peritoneal Dialysis and Hemodialysis

et al. 2019

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Introduction: In patients with end-stage kidney disease (ESKD), cardiovascular diseases (CVDs) are the most common causes of hospitalization and death. Objective: We aimed to determine the association between dialysis modality and CVDs. Methods: This retrospective observational cohort study compared the emergency hospitalization and mortality of patients with CVDs who underwent peritoneal dialysis (PD) versus hemodialysis (HD). After propensity score matching, the risk factors were evaluated using Cox proportional hazards regression models. Results: A total of 260 patients were matched: 130 of 135 PD (75 men; age, 65.4 years; dialysis vintage, 3.3 years) and 130 of 706 HD (70 men [p = 0.5]; 66.6 years [p = 0.4]; dialysis vintage, 3.1 years [p = 0.5]) patients. Emergency hospitalization rates (hospitalizations/person-years) for overall CVDs (0.138 vs. 0.066, p = 0.002) and pulmonary edema (0.048 vs. 0.019, p = 0.03) were significantly higher in patients who underwent PD than those who underwent HD. The log-rank test revealed that all-cause and CVD mortalities were significantly higher in PD (both p < 0.001). Mortality rates (deaths/person-years) for overall CVDs (0.058 vs. 0.015, p < 0.002), cerebrovascular disease (0.019 vs. 0.004, p = 0.03), and ischemic heart disease (0.010 vs. 0, p = 0.02) were significantly higher in PD. The Cox proportional hazards regression model showed that PD and age were significant predictors of emergency hospitalization (hazard ratio [HR] 2.70; 95% CI 1.53-4.77; p = 0.001) and mortality (HR 4.41; 95% CI 1.66-11.72; p = 0.003) for CVDs. Conclusions: PD is a risk factor for emergency hospitalization and mortality associated with CVDs in dialysis patients with ESKD. Strict control of body fluid balance may prevent cardiovascular events in patients undergoing PD. tains fluid volumes, uremic toxin levels, and electrolyte balance, thereby leading to the preservation of residual kidney function (RKF) [7], and has been successfully used for anuric patients [8]. However, decreased or loss of RKF may lead to uremic complications [9].The influence of dialysis modality on all-cause mortality has been evaluated in several studies [10][11][12][13][14][15][16][17][18][19][20][21][22]. However, few reports have evaluated the effect of dialysis modality (PD or HD) on hospitalization and mortality for CVDs. Moreover, the association between dialysis modality and CVDs remains controversial [10,12,22,23].Thus, we examined the emergency hospitalization, mortality for CVDs, and all-cause mortality in ESKD patients. We evaluated the association between dialysis modality and CVDs by comparing propensity score-matched PD and HD patients; we also evaluated the association between other patient factors and CVDs.

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Section: Discussionmentioning

confidence: 99%

Association between Dialysis Modality and Cardiovascular Diseases: A Comparison between Peritoneal Dialysis and Hemodialysis

et al. 2019

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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: 94%

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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“…Вступ. Гіпергідратація є частим ускладненням у пацієнтів, які лікуються методом перитонеального діалізу (ПД), яке асоціюється зі зниженням виживаності техніки ПД та збільшенням ризику серцево-судинних подій і смертності [1][2][3]. Проте, гідратаційний статус пацієнта складно оцінити клінічно, адже існуючі до останнього часу методи визначення сухої ваги були трудомісткими, високовартісними та не підходили для масового застосування у клінічній практиці [4].…”

Section: Original Papersunclassified

“…На сьогодні біоімпедансометрія є рутинним методом дослідження складу тіла ПД-пацієнтів, який використовується у повсякденній клінічній практиці [7]. За допомогою біоімпедансометрії Y. Shu зі співавторами продемонстрував, що гіпергідратація, яка визначалась у разі високого співвідношення позаклітинної рідини та загальної рідини тіла (ECW/TBW), є незалежним предиктором зниження виживаності методу ПД та смертності пацієнтів від усіх причин [2]. Це та інші дослідження підкреслюють важливість визначення складу тіла ПД хворих [2,5,6].…”

Section: Original Papersunclassified

“…За допомогою біоімпедансометрії Y. Shu зі співавторами продемонстрував, що гіпергідратація, яка визначалась у разі високого співвідношення позаклітинної рідини та загальної рідини тіла (ECW/TBW), є незалежним предиктором зниження виживаності методу ПД та смертності пацієнтів від усіх причин [2]. Це та інші дослідження підкреслюють важливість визначення складу тіла ПД хворих [2,5,6]. Проте, слід зазначити, що опубліковані наукові дослідження присвячені в основному дослідженням впливу гіпергідратації на показники адекватності ПД та виживаності пацієнтів.…”

Section: Original Papersunclassified

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The relationship between overhydration, increased oxidative stress and peritoneal dialysis adequacy

Stepanova

Korol

Burdeyna

et al. 2019

Ukr. J. Nephrol. and Dial.

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The present study was undertaken to investigate the association of hydration status measured by bioimpedance analysis with oxidative stress biomarkers and peritoneal dialysis (PD) adequacy. Methods. It was a case-control study involved 85 PD patients from 2 dialysis centers in Ukraine. Among the examined patients, there were 56/85 (65.9%) men and 29/85 (34.1%) women. All patients had been undergoing PD for more than 3 months (median was 25.4 [14.0-49.5] months). Average age was 48.8 ± 12.5 years. Fluid compartments [extracellular water (ECW) and overhydration index (OH)] were measured using Multifrequency bio-impedance (BCM®, Fresenius Medical Care, Germany). Overhydration was defined as OH/ECW> 15%. Malondialdehyde concentration in serum (MDAs) and erythrocytes (MDAe) was defined as an indicator of lipid peroxidation. Such parameters as the concentration of ceruloplasmin (CP), transferrin (TR) and sulfhydryl groups (SH-groups) in the blood and total peroxidase activity in erythrocyte (TPAe) were studied as the indicators of antioxidant system. Moreover, to determine the intraperitoneal oxidative stress induction, we studied MDA and TPO in PD effluent. Results. Among 85 PD participants, there were 38(44.7%) patients in normohydration range and 47 (55.3%) overhydrated pаtients according to the OH/ECW ratio. There were a significant increase in serum and PD effluent MDA (p = 0.01 and p = 0.001, respectively) in overhydrated PD patients whereas the concentrations of serum CP and TPA in PD effluent were significantly lower compared with normohydrated patients (p = 0.008 and p = 0.04, respectively). In addition, ECW had an inverse correlation with SH-groups (r = -0.37; p = 0.003) and MDAs (r = -0.48; p = 0.004). An odds ratio of PD inadequacy was 3.6 times higher among overhydrated patients than in normovolemic one: OR = 3.6 (95% CI 1.3-10.3; p = 0.01). Conclusions. Extracellular fluid overload promotes intraperitoneal and systemic oxidative stress which could be one of the pathway explanations of technique survival failure and cardiovascular mortality in overhydrated PD patients.

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The Effect of Overhydration on Mortality and Technique Failure Among Peritoneal Dialysis Patients: A Systematic Review and Meta-Analysis

Cited by 46 publications

References 42 publications

Association between Dialysis Modality and Cardiovascular Diseases: A Comparison between Peritoneal Dialysis and Hemodialysis

Association between Dialysis Modality and Cardiovascular Diseases: A Comparison between Peritoneal Dialysis and Hemodialysis

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

The relationship between overhydration, increased oxidative stress and peritoneal dialysis adequacy

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