|
1
|
Mohamed M, Matthie J, Fan SL. Bioimpedance spectroscopy: Is a picture worth a thousand words? Semin Dial 2025; 38:71-81. [PMID: 35466475 PMCID: PMC11867155 DOI: 10.1111/sdi.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
Volume status can be difficult to assess in dialysis patients. Peripheral edema, elevated venous pressure, lung crackles, and hypertension are taught as signs of fluid overload, but sensitivity and specificity are poor. Bioimpedance technology has evolved from early single frequency to multifrequency machines which apply spectroscopic analysis (BIS), modeling data to physics-based mixture theory. Bioimpedance plots can aid the evaluation of hydration status and body composition. The challenge remains how to use this information to manage dialysis populations, particularly as interventions to improve over hydration, sarcopenia, and adiposity are not without side effects. It is therefore of no surprise that validation studies for BIS use in peritoneal dialysis patients are limited, and results from clinical trials are inconsistent and conflicting. Despite these limitations, BIS has clinical utility with potential to accurately evaluate small changes in body tissue components. This article explains the information a BIS plot ("picture") can provide and how it can contribute to the overall clinical assessment of a patient. However, it remains the role of the clinician to integrate information and devise treatment strategies to optimize competing patient risks, fluid and nutrition status, effects of high glucose PD fluids on membrane function, and quality of life issues.
Collapse
Affiliation(s)
- Maha Mohamed
- Department of Renal Medicine and TransplantationBarts Health NHS TrustLondonUK
| | | | - Stanley L. Fan
- Department of Renal Medicine and TransplantationBarts Health NHS TrustLondonUK
| |
Collapse
|
|
2
|
Dan L, Jiamei X, Ning W, Yanxiang G, Mengli T. Predictors and prognostic significance of the volume load trajectory: a longitudinal study in patients on peritoneal dialysis. Ren Fail 2024; 46:2405561. [PMID: 39301865 PMCID: PMC11418055 DOI: 10.1080/0886022x.2024.2405561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 08/27/2024] [Accepted: 09/12/2024] [Indexed: 09/22/2024] Open
Abstract
Volume overload in peritoneal dialysis patients is a common issue that can lead to poor prognosis. We employed a group trajectory model to categorize volume load trajectories and examined the factors associated with each trajectory class to explore the impact of different trajectory groups on clinical prognosis and residual renal function (RRF). This single-center prospective cohort study included 214 patients on maintenance peritoneal dialysis within a tertiary hospital. The ratio of extracellular water to total body water was measured using Bioimpedance analysis. The SAS 9.4 PROC Traj procedure was used to examine the group-based trajectory of the patients. A multivariate logistic regression model was used to calculate the adjusted odds ratios (aOR) of the associated factors to predict the trajectory class of participants. The average age of the included patients was 53.56 (SD: 11.77) years, with a male proportion of 46.7% and a median follow-up time of 6 months. The normal stable group accounted for 35.05% of the total population and maintained a normal and stable level, the moderate stable group accounted for 52.8% of the total population and showed a slightly higher and stable level, and the high fluctuation group accounted for 12.15% of the total population and showed a high and fluctuating level. A multivariate logistic regression analysis revealed that age, diabetes, and albumin levels are significant factors influencing the categorization of volume load trajectories. There were statistically significant differences in both the technical survival rate and the loss of residual renal function among the three trajectory groups.
Collapse
Affiliation(s)
- Liu Dan
- Nephrology Department, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Xu Jiamei
- Nephrology Department, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Weng Ning
- Nephrology Department, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Guo Yanxiang
- Nephrology Department, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Tong Mengli
- Nephrology Department, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
|
3
|
Uchiyama K, Yamada S, Ofuji N, Fukagawa S, Sato S, Chigusa N, Kimura T, Kasai T, Hosoya K, Ito J, Kakuda W, Washida N. Impact of home-based exercise on residual kidney function in patients initiating peritoneal dialysis: A feasibility multicenter randomized controlled trial. Perit Dial Int 2024:8968608241290362. [PMID: 39415658 DOI: 10.1177/08968608241290362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Although the impact of aerobic exercise (AE) and resistance training (RT) on peritoneal dialysis (PD) patients is well established, the impact of exercise programs on residual kidney function (RKF) has not been elucidated. METHODS Patients were randomly assigned to either the exercise (n = 25) or control groups (n = 30). Patients in the exercise group performed AE three times a week and RT twice a week at home for 24 weeks. The control group did not receive any specific intervention. The primary outcome was RKF, assessed by residual glomerular filtration rate (rGFR). Secondary outcomes included urinary protein levels, distance covered in the incremental shuttle walking test (ISWT), and glycated hemoglobin (HbA1c) percentages. RESULTS Linear mixed-effects models showed no significant changes in mean rGFR between the exercise and control groups at 12 weeks (-0.40; 95% confidence interval (CI): -2.17, 1.36; p = 0.65) and at 24 weeks (0.65; 95% CI: -1.15, 2.45; p = 0.48). There was a trend toward improvement in mean urinary protein level and ISWT results, and a significant decrease in mean HbA1c percentage at 24 weeks in the exercise group (-1.07, 95% CI: -2.29, 0.15, p = 0.09; 37.7, 95% CI: -10.1, 85.5, p = 0.12; -0.57, 95% CI: -0.97, -0.18, p = 0.005, respectively) compared to the control group. CONCLUSION The 24-week home-based exercise program did not demonstrate beneficial effects on RKF in incident PD patients. Nonetheless, it may have an impact on reducing urinary protein levels and HbA1c percentages.
Collapse
Affiliation(s)
- Kiyotaka Uchiyama
- Department of Nephrology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Seiki Yamada
- Department of Nephrology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Noriyuki Ofuji
- Department of Rehabilitation Medicine, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Shohei Fukagawa
- Department of Rehabilitation Medicine, International University of Health and Welfare Atami Hospital, Shizuoka, Japan
| | - Shin Sato
- Department of Rehabilitation Medicine, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Naoki Chigusa
- Department of Nephrology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Takahide Kimura
- Department of Nephrology, Mishima General Hospital, Shizuoka, Japan
| | - Takahiro Kasai
- Department of Nephrology, International University of Health and Welfare Atami Hospital, Shizuoka, Japan
| | - Koji Hosoya
- Department of Nephrology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Jun Ito
- Department of Nephrology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Wataru Kakuda
- Department of Rehabilitation Medicine, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Naoki Washida
- Department of Nephrology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| |
Collapse
|
|
4
|
Mafra D, Kemp JA, Borges NA, Wong M, Stenvinkel P. Gut Microbiota Interventions to Retain Residual Kidney Function. Toxins (Basel) 2023; 15:499. [PMID: 37624256 PMCID: PMC10467110 DOI: 10.3390/toxins15080499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
Residual kidney function for patients with chronic kidney disease (CKD) is associated with better quality of life and outcome; thus, strategies should be implemented to preserve kidney function. Among the multiple causes that promote kidney damage, gut dysbiosis due to increased uremic toxin production and endotoxemia need attention. Several strategies have been proposed to modulate the gut microbiota in these patients, and diet has gained increasing attention in recent years since it is the primary driver of gut dysbiosis. In addition, medications and faecal transplantation may be valid strategies. Modifying gut microbiota composition may mitigate chronic kidney damage and preserve residual kidney function. Although various studies have shown the influential role of diet in modulating gut microbiota composition, the effects of this modulation on residual kidney function remain limited. This review discusses the role of gut microbiota metabolism on residual kidney function and vice versa and how we could preserve the residual kidney function by modulating the gut microbiota balance.
Collapse
Affiliation(s)
- Denise Mafra
- Graduate Program in Nutrition Sciences, Fluminense Federal University (UFF), Niteroi 24020-140, Brazil;
- Graduate Program in Biological Sciences—Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-902, Brazil
| | - Julie A. Kemp
- Graduate Program in Nutrition Sciences, Fluminense Federal University (UFF), Niteroi 24020-140, Brazil;
| | - Natalia A. Borges
- Institute of Nutrition, Rio de Janeiro State University (UERJ), Rio de Janeiro 20550-170, Brazil;
| | - Michelle Wong
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z1, Canada;
| | | |
Collapse
|
|
5
|
Iwatani H, Yamato M, Bessho S, Mori Y, Notsu S, Asahina Y, Koizumi S, Kimura Y, Shimomura A. Tolvaptan Reduces Extracellular Fluid per Amount of Body Fluid Reduction Less Markedly than Conventional Diuretics. Intern Med 2022; 61:2561-2565. [PMID: 35110480 PMCID: PMC9492492 DOI: 10.2169/internalmedicine.8533-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective Tolvaptan, a vasopressin V2 receptor antagonist, is a water diuretic, removing electrolyte-free water from the kidneys and affecting the water balance between the intracellular and extracellular fluid. We previously reported that tolvaptan efficiently reduced the intracellular fluid volume, suggesting its utility for treating cellular edema. Furthermore, tolvaptan is known for its low incidence of worsening the renal function, with conventional diuretics use associated with worsening of the renal function Methods In this retrospective observational study, five chronic kidney disease (CKD) patients with fluid retention were assessed by the bioelectrical impedance (BIA) method twice (before and after tolvaptan therapy). Tolvaptan was used with conventional diuretics. The post/pre ratio of extracellular water (ECW)/total body water (TBW) in the tolvaptan group was compared with that in 18 CKD patients undergoing body fluid reduction with conventional diuretics alone (conventional diuretics groups), taking the reduced amount of body fluid into consideration. Results Removing body fluid, either by tolvaptan or by conventional diuretics alone, decreased the ECW/TBW ratio. Of note, the reduction in extracellular fluid was milder in the tolvaptan group than in the conventional diuretics group. Conclusion Tolvaptan reduces the extracellular fluid per amount of body fluid reduction less markedly than conventional diuretics.
Collapse
Affiliation(s)
- Hirotsugu Iwatani
- Department of Nephrology, National Hospital Organization Osaka National Hospital, Japan
| | - Masafumi Yamato
- Department of Nephrology, National Hospital Organization Osaka National Hospital, Japan
| | - Saki Bessho
- Department of Nephrology, National Hospital Organization Osaka National Hospital, Japan
| | - Yuki Mori
- Department of Nephrology, National Hospital Organization Osaka National Hospital, Japan
| | - Shoki Notsu
- Department of Nephrology, National Hospital Organization Osaka National Hospital, Japan
| | - Yuta Asahina
- Department of Nephrology, National Hospital Organization Osaka National Hospital, Japan
| | - Shintaro Koizumi
- Department of Nephrology, National Hospital Organization Osaka National Hospital, Japan
| | - Yoshiki Kimura
- Department of Nephrology, National Hospital Organization Osaka National Hospital, Japan
| | - Akihiro Shimomura
- Department of Nephrology, National Hospital Organization Osaka National Hospital, Japan
| |
Collapse
|
|
6
|
Wang LC, Raimann JG, Tao X, Preciado P, Thwin O, Rosales L, Thijssen S, Kotanko P, Zhu F. Estimation of fluid status using three multifrequency bioimpedance methods in hemodialysis patients. Hemodial Int 2022; 26:575-587. [PMID: 35719044 DOI: 10.1111/hdi.13034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 05/02/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Segmental eight-point bioimpedance has been increasingly used in practice. However, whether changes in bioimpedance analysis components before and after hemodialysis (HD) using this technique in a standing position is comparable to traditional whole-body wrist-to-ankle method is still unclear. We aimed to investigate the differences between two eight-point devices (InBody 770 and Seca mBCA 514) and one wrist-to-ankle (Hydra 4200) in HD patients and healthy subjects in a standing position. METHODS Thirteen HD patients were studied pre- and post-HD, and 12 healthy subjects once. Four measurements were performed in the following order: InBody; Seca; Hydra; and InBody again. Electrical equivalent models by each bioimpedance method and the fluid volume estimates by each device were also compared. FINDINGS Overall, total body water (TBW) was not different between the three devices, but InBody showed lower extracellular water (ECW) and higher intracellular water (ICW) compared to the other two devices. When intradialytic weight loss was used as a surrogate for changes in ECW (∆ECW) and changes in TBW (∆TBW), ∆ECW was underestimated by Hydra (-0.79 ± 0.89 L, p < 0.01), InBody (-1.44 ± 0.65 L, p < 0.0001), and Seca (-0.32 ± 1.34, n.s.). ∆TBW was underestimated by Hydra (-1.14 ± 2.81 L, n.s.) and InBody (-0.52 ± 0.85 L, p < 0.05) but overestimated by Seca (+0.93 ± 3.55 L, n.s.). DISCUSSION Although segmental eight-point bioimpedance techniques provided comparable TBW measurements not affected by standing over a period of 10-15 min, the ECW/TBW ratio appeared to be significantly lower in InBody compared with Seca and Hydra. Results from our study showed lack of agreement between different bioimpedance devices; direct comparison of ECW, ICW, and ECW/TBW between different devices should be avoided and clinicians should use the same device to track the fluid status in their HD population in a longitudinal direction.
Collapse
Affiliation(s)
| | | | - Xia Tao
- Renal Research Institute, New York, New York, USA
| | | | - Ohnmar Thwin
- Renal Research Institute, New York, New York, USA
| | | | | | - Peter Kotanko
- Renal Research Institute, New York, New York, USA.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fansan Zhu
- Renal Research Institute, New York, New York, USA
| |
Collapse
|
|
7
|
Chen CH, Teitelbaum I. Peritoneal dialysis adequacy: a paradigm shift. Kidney Res Clin Pract 2022; 41:150-155. [PMID: 35286794 PMCID: PMC8995486 DOI: 10.23876/j.krcp.21.208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/05/2021] [Indexed: 11/21/2022] Open
Abstract
For the past 30 years, nephrologists have focused on a single minimal threshold of Kt/Vurea to determine the adequacy of peritoneal dialysis (PD). To date, there is no evidence that shows Kt/Vurea to be a good surrogate measure of uremic symptom control or nutritional state in patients on PD. Volume of distribution (Vurea) generally is considered equivalent to total body water (TBW). Yet, accurate determination of TBW is difficult. The most recent International Society for Peritoneal Dialysis practice recommendations on prescribing high-quality PD emphasized incorporation of multiple measures rather than the single value of Kt/Vurea. These measures include shared decision-making between the patient and the care team and assessment of health-related quality of life, burden of uremic symptoms, presence of residual kidney function, volume status, and biochemical measures including serum potassium and bicarbonate levels. In some cases, PD prescriptions can be tailored to the patient priorities and goals of care, such as in frail and pediatric patients. Overall, there has been a paradigm shift in providing high-quality care to PD patients. Instead of focusing on small solute clearance in the form of Kt/Vurea, nephrologists are encouraged to use a more comprehensive assessment of the patient as a whole.
Collapse
Affiliation(s)
- Chang Huei Chen
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Isaac Teitelbaum
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
|
8
|
Li SY, Chuang CL, Lin CC, Tsai SH, Chen JY. Peritoneal-Membrane Characteristics and Hypervolemia Management in Peritoneal Dialysis: A Randomized Control Trial. MEMBRANES 2021; 11:membranes11100768. [PMID: 34677534 PMCID: PMC8541348 DOI: 10.3390/membranes11100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/25/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Abstract
Excessive bodily-fluid retention is the major cause of hypertension and congestive heart failure in patients with end-stage renal disease. Compared to hemodialysis, peritoneal dialysis (PD) uses the abdominal peritoneum as a semipermeable dialysis membrane, providing continuous therapy as natural kidneys, and having fewer hemodynamic changes. One major challenge of PD treatment is to determine the dry weight, especially considering that the speed of small solutes and fluid across the peritoneal membrane varies among individuals; considerable between-patient variability is expected in both solute transportation and ultrafiltration capacity. This study explores the influence of peritoneal-membrane characteristics in the hydration status in patients on PD. A randomized control trial compares the bioimpedance-assessed dry weight with clinical judgment alone. A high peritoneal membrane D/P ratio was associated with the extracellular/total body water ratio, dialysate protein loss, and poor nutritional status in patients on PD. After a six-month intervention, patients with monthly bioimpedance analysis (BIA) assistance had better fluid (−1.2 ± 0.4 vs. 0.1 ± 0.4 kg, p = 0.014) and blood-pressure (124.7 ± 2.7 vs. 136.8 ± 2.8 mmHg, p < 0.001) control; however, hydration status and blood pressure returned to the baseline after we prolonged BIA assistance to a 3-month interval. The dry-weight reduction process had no negative effect on residual renal function or peritoneal-membrane function. We concluded that peritoneal-membrane characteristics affect fluid and nutritional status in patients on PD, and BIA is a helpful objective technique for fluid assessment for PD.
Collapse
Affiliation(s)
- Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan; (S.-Y.L.); (C.-C.L.)
| | - Chiao-Lin Chuang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan;
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan; (S.-Y.L.); (C.-C.L.)
| | - Shin-Hung Tsai
- Division of Nephrology, Department of Medicine, Cheng Hsin General Hospital, Taipei 112201, Taiwan;
| | - Jinn-Yang Chen
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan; (S.-Y.L.); (C.-C.L.)
- Correspondence:
| |
Collapse
|
|
9
|
Tangwonglert T, Davenport A. Changes in extracellular water and left ventricular mass in peritoneal dialysis patients. Kidney Res Clin Pract 2021; 40:135-142. [PMID: 33789386 PMCID: PMC8041629 DOI: 10.23876/j.krcp.20.153] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/08/2020] [Indexed: 12/14/2022] Open
Abstract
Background Increasing number of peritoneal dialysis (PD) patients are reported to have increased left ventricular hypertrophy (LVH), a major risk factor for cardiovascular mortality. We wished to determine which factors were most associated with changes in left ventricular mass index (LVMI). Methods We reviewed patient and treatment factors in prevalent PD patients with repeat echocardiograms 18 to 24 months apart, with corresponding bioimpedance measurements of extracellular water (ECW) and serum N-terminal pro-brain natriuretic peptide (NT-proBNP). Results We studied 60 patients (34 males, 35 with diabetes) who were treated with PD for a median of 14 months (2.5–26.3 months). All but one had LVH; on repeat echocardiography, there was no overall change in LVMI (106 [84–127] g/m2 vs. 108 [91–122] g/m2) despite a loss of residual renal function. Left ventricular mass increased in 34 (56.7%), and the percent change in LVMI was associated with percent change in NT-proBNP (r = 0.51, p = 0.017) and ECW/height (r = 0.32, p = 0.029), but not with ECW/total body water or changes in systolic or mean arterial pressure, urine output, 24-hour PD ultrafiltration, or net sodium balance. Only ECW/height remained independently associated with the percent change in LVMI in a multivariable model (odds ratio, 1.25; 95% confidence interval, 1.08–1.36; p = 0.007). Conclusion In this observational longitudinal report, a reduction in ECW/height was associated with regression of LVMI, whereas an increased ECW/height was associated with increased LVMI. As there was no corresponding association with systolic or mean arterial pressure, then volume expansion would appear to be a more significant factor in determining LVH than blood pressure.
Collapse
Affiliation(s)
- Theerasak Tangwonglert
- Nephrology Division, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Andrew Davenport
- UCL Department of Nephrology, Royal Free Hospital, University College London Medical School, London, United Kingdom
| |
Collapse
|
|
10
|
Do JY. Effect of volume indices of bioimpedance analysis on clinical outcomes, including left ventricular hypertrophy, in patients undergoing peritoneal dialysis. Kidney Res Clin Pract 2021; 40:6-8. [PMID: 33789380 PMCID: PMC8041625 DOI: 10.23876/j.krcp.21.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jun Young Do
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| |
Collapse
|
|
11
|
Comparison of Body Composition Monitor and InBody 720 Bioimpedance Devices for Body Composition Estimation in Hemodialysis Patients and Healthy Controls. Symmetry (Basel) 2021. [DOI: 10.3390/sym13010150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bioelectric impedance devices have become a standard of care not only for peritoneal dialysis but also for hemodialysis patients. We compared the most important body composition variables (extracellular water, intracellular water, total body water and fat mass) measured with the multifrequency bioelectric impedance device InBody 720 (MF-BIA) and bioimpedance spectroscopy body composition monitor Fresenius (BIS BCM) in hemodialysis patients (n = 51, 175.1 + 7.8 cm, 82.2 + 15.2 kg) and healthy controls (n = 51, 175.1 + 7.6 cm, 82.3 + 15.3 kg). The MF-BIA InBody 720 device compared to the BIS BCM device showed significantly larger total body water and intracellular water estimates and significantly smaller extracellular water and body fat estimates in hemodialysis patients (p < 0.001). These differences (p < 0.001) were similar in the cohort of healthy controls; moreover, we observed high correlations in all variables between the hemodialysis patients and the healthy controls (0.80–0.95, p < 0.001). The mean relative differences in the order of 8% were lower for extracellular water and total body fat, but the limits of agreement were still wide enough to be clinically significant. We conclude that the results of the measurements with InBody 720 and BCM Fresenius cannot be used interchangeably. Physicians and nutritionists involved in the care of hemodialysis patients should be aware of this discrepancy between the two devices and should try to use the same device to track the body in their hemodialysis population in a longitudinal direction.
Collapse
|
|
12
|
Tangwonglert T, Davenport A. Peritoneal sodium removal compared to glucose absorption in peritoneal dialysis patients treated by continuous ambulatory peritoneal dialysis and automated peritoneal dialysis with and without a daytime exchange. Ther Apher Dial 2021; 25:654-662. [PMID: 33403730 DOI: 10.1111/1744-9987.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/18/2020] [Accepted: 01/02/2021] [Indexed: 11/28/2022]
Abstract
Sodium removal in peritoneal dialysis (PD) depends on convective clearance, typically generated by a glucose gradient, but this can result in glucose absorption. We wished to determine which factors determine peritoneal sodium losses to glucose absorption (PD Na/Gluc). Peritoneal sodium losses and glucose absorption were calculated from measured 24-h collections of PD effluent, in patients attending for assessment of peritoneal membrane function. Five hundred and fifty eight patients; 317 (56.8%) males, mean age 56.1 ± 16.0 years, were studied, 281 treated by automated peritoneal dialysis (APD) with a daytime exchange (50.4%); 179 (32.1%) by APD and 98 (17.6%) by continuous ambulatory peritoneal dialysis (CAPD). All patients used glucose containing dialysates, with 352 (63.1%) using icodextrin and 210 (37.6%) hypertonic (22.7 g/L glucose) dialysates. The ratio of PD Na/Gluc was 0.14 (0.02-0.29). Patients using icodextrin had a higher ratio (0.16 (0.03-0.32) versus 0.11 (-0.02-0.26), P < .001), as did those using 22.7 g/L glucose versus 13.6 g/L (0.16 (0.06-0.32) versus 0.13 (-0.01-0.19), P < .01), and CAPD versus APD (0.18 (0.05-0.36) versus 0.11 (0.0-0.27), P < .05), respectively. A multivariable model showed that 24-h ultrafiltration (odds ratio [OR] 7.6 (95% confidence interval [3.9-14.8]), P < .001 was associated with increased PD Na/Gluc, whereas APD (OR 0.19 (0.06-0.62), P < .01 and increased extracellular water to total body water (OR 0.001 [0-0.08], P = .03) were associated with lower ratios. Twenty four-hour peritoneal ultrafiltration was strongly associated with PD Na/Gluc, whereas patients treated with APD cyclers without a daytime icodextrin exchange and those with an increased extracellular water to total body water had lower peritoneal sodium losses but with greater peritoneal glucose absorption.
Collapse
Affiliation(s)
- Theerasak Tangwonglert
- Nephrology Division, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Andrew Davenport
- UCL Department of Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| |
Collapse
|
|
13
|
Vareesangthip K, Vongsanim S, Fan S, Davenport A. Comparison between standard single chamber versus dual chamber low glucose degradation product peritoneal dialysis fluids. Artif Organs 2020; 45:88-94. [PMID: 32645750 DOI: 10.1111/aor.13768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
Dual chamber (DC) peritoneal dialysis (PD) dialysates contain fewer glucose degradation products (GDPs), so potentially reducing advanced glycosylation end products (AGEs), which have been reported to increase inflammation and cardiovascular risk. We wished to determine whether use of DC dialysates resulted in demonstrable patient benefits. Biochemical profiles, body composition, muscle strength, and skin autofluorescence measurements of tissue AGEs (SAF) were compared in patients using DC and standard single chamber dialysates. We studied 263 prevalent PD patients from 2 units, 62.4% male, mean age 61.8 ± 16.1 years, 78 (29.7%) used DC dialysates. DC patients were younger (55.9 ± 16.4 vs. 64.2 ± 15.4 years), and more had lower Davies comorbidity score (median 1 (0-1) vs. 1 (0, 2)), slower peritoneal transport (D/P creatinine 0.67 ± 0.12 vs. 0.73 ± 0.13), greater extracellular water-to-total body water (ECW/TBW) ratio (0.46 ± 0.05 vs. 0.42 ± 0.06), all P < .001, whereas there were no differences in the duration of PD (median (IQR) 19 (8-32) vs. 14 (8-23) months), residual renal function (Kt/Vurea 0.71 ± 0.71 vs. 0.87 ± 0.82), urine volume (642 (175-1200) vs. 648 (300-1200) mL/day), hand grip strength (26.9 ± 10.5 vs. 24.9 ± 10.7 kg), C-reactive protein (4(1-10) vs. 4(2-12) mg/L), and SAF (median 3.60 (3.02, 4.40) vs. 3.50 (3.00, 4.23)) AU. In our cross-sectional observational study, we were not able to show a demonstrable advantage for using low GDP dialysates over conventional glucose dialysates, in terms of biochemical profiles, residual renal function, muscle strength, or tissue AGE deposition. More patients using low GDP dialysates were slower peritoneal transporters with higher ECW/TBW ratios.
Collapse
Affiliation(s)
- Kornchanok Vareesangthip
- Renal Division, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Surachet Vongsanim
- Renal Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Stanley Fan
- Department of Renal Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Andrew Davenport
- UCL Department of Nephrology, Royal Free Hospital, University College London, London, UK
| |
Collapse
|
|
14
|
Alexandrou ME, Balafa O, Sarafidis P. Assessment of Hydration Status in Peritoneal Dialysis Patients: Validity, Prognostic Value, Strengths, and Limitations of Available Techniques. Am J Nephrol 2020; 51:589-612. [PMID: 32721969 DOI: 10.1159/000509115] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The majority of patients undergoing peritoneal dialysis (PD) suffer from volume overload and this overhydration is associated with increased mortality. Thus, optimal assessment of volume status in PD is an issue of paramount importance. Patient symptoms and physical signs are often unreliable indexes of true hydration status. SUMMARY Over the past decades, a quest for a valid, reproducible, and easily applicable technique to assess hydration status is taking place. Among existing techniques, inferior vena cava diameter measurements with echocardiography and natriuretic peptides such as brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were not extensively examined in PD populations; while having certain advantages, their interpretation are complicated by the underlying cardiac status and are not widely available. Bioelectrical impedance analysis (BIA) techniques are the most studied tool assessing volume overload in PD. Volume overload assessed with BIA has been associated with technique failure and increased mortality in observational studies, but the results of randomized trials on the value of BIA-based strategies to improve volume-related outcomes are contradictory. Lung ultrasound (US) is a recent technique with the ability to identify volume excess in the critical lung area. Preliminary evidence in PD showed that B-lines from lung US correlate with echocardiographic parameters but not with BIA measurements. This review presents the methods currently used to assess fluid status in PD patients and discusses existing data on their validity, applicability, limitations, and associations with intermediate and hard outcomes in this population. Key Message: No method has proved its value as an intervening tool affecting cardiovascular events, technique, and overall survival in PD patients. As BIA and lung US estimate fluid overload in different compartments of the body, they can be complementary tools for volume status assessment.
Collapse
Affiliation(s)
- Maria-Eleni Alexandrou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Olga Balafa
- Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece,
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
|
15
|
Wang AYM, Dong J, Xu X, Davies S. Volume management as a key dimension of a high-quality PD prescription. Perit Dial Int 2020; 40:282-292. [PMID: 32063208 DOI: 10.1177/0896860819895365] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Appropriate volume control is one of the key goals in a peritoneal dialysis (PD) prescription. As such it is an important component of the International Society of Peritoneal Dialysis (ISPD) guideline for "High-quality PD prescription" necessitating a review of the literature on volume management. The workgroup recognized the importance of including within its scope measures of volume status and blood pressure in prescribing high-quality PD therapy. METHODS A Medline and PubMed search for publications addressing volume status and its management in PD since the publication of the 2015 ISPD Adult Cardiovascular and Metabolic Guidelines, from October 2014 through to July 2019, was conducted. RESULTS There were no randomized controlled trials on blood pressure intervention and six randomized trials of bioimpedance-guided volume management. Generally, all studies were of small sample size, short duration, and used surrogate markers as primary outcomes. As a consequence, only "practice points" were drawn. High-quality goal-directed PD prescription should aim to achieve and maintain clinical euvolemia taking residual kidney function and its preservation into account, so that both fluid removal from peritoneal ultrafiltration and urine output are considered and residual kidney function is not compromised. Blood pressure should be included as a key objective parameter in assessing the quality of PD prescription but there is currently no evidence for a specific target in PD. Clinical examination remains the keystone of routine clinical care. CONCLUSIONS High-quality goal-directed PD prescription should include volume management as one of the key dimensions.
Collapse
Affiliation(s)
- Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, China
| | - Xiao Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, China
| | - Simon Davies
- Faculty of Medicine and Health Sciences, Keele University and University Hospitals of North Midlands, Stoke-on-Trent, UK
| |
Collapse
|
|
16
|
Chen CH, Perl J, Teitelbaum I. Prescribing high-quality peritoneal dialysis: The role of preserving residual kidney function. Perit Dial Int 2020; 40:274-281. [DOI: 10.1177/0896860819893821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Maintenance of residual kidney function (RKF) is independently associated with increased survival in patients with end-stage renal disease. Presence of RKF is also associated with improved volume status, better nutritional status, reduced erythropoietin requirement, and decreased rate of peritonitis in patients on peritoneal dialysis (PD). Thus, the preservation of RKF is an important therapeutic end point in the management of patients on PD. Measurement of RKF in PD patients should be based on the mean of 24-h urinary creatinine and urea clearances, and ideally, this should be done quarterly. Compared to those started on hemodialysis, patients initiated on PD appear to have slower decline in RKF. The choice of PD modality should be based on patient preference, as there is no clear evidence to date showing one modality is superior than the other in preserving RKF. Peritoneal dialysates with neutral pH and low glucose degradation products seem to have a favorable effect on RKF. An angiotensin-converting enzyme inhibitor or angiotensin receptor blocker should be used whenever possible to preserve RKF and reduce cardiac mortality. Both loop diuretics and icodextrin can be utilized to maintain fluid balance in PD patients. However, caution should be taken to avoid volume depletion which could accelerate RKF decline. Short-term use of aminoglycosides does not have a detrimental impact on RKF, but prolonged use (>3 weeks) should be avoided to minimize the risk of ototoxicity. Lastly, potential nephrotoxic agents such as intravenous contrast should be used judiciously.
Collapse
Affiliation(s)
- Chang Huei Chen
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jeff Perl
- Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Isaac Teitelbaum
- Department of Medicine, University of Colorado Health Sciences Center, Aurora, CO, USA
| |
Collapse
|
|
17
|
van der Sande FM, van de Wal-Visscher ER, Stuard S, Moissl U, Kooman JP. Using Bioimpedance Spectroscopy to Assess Volume Status in Dialysis Patients. Blood Purif 2019; 49:178-184. [PMID: 31851988 DOI: 10.1159/000504079] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022]
Abstract
The aim of the paper is to reflect on the current status of bioimpedance spectroscopy (BIS) in fluid management in dialysis patients. BIS identifies fluid overload (FO) as a virtual (overhydration) compartment, which is calculated from the difference between the measured extracellular volume and the predicted values based on a fixed hydration of lean and adipose tissue mass. FO is highly prevalent in both hemodialysis (HD) and peritoneal dialysis (PD) patients, while levels of FO are at a population level comparable between PD patients and HD patients when measured before the dialysis treatment. Even mild levels of FO are independently related to outcome in patients on HD, PD as well as in nondialysis patients with advanced chronic kidney disease. FO is not only related to left ventricular hypertrophy (LVH) but also forms part of a multidimensional spectrum with noncardiovascular risk factors such as malnutrition and inflammation. Even after multiple adjustments, FO remains an independent predictor of mortality. BIS-assisted adjustment of dry weight in HD patients has been shown to improve hypertension control and LVH and has resulted in a decline in intradialytic symptomatology. On the other hand, with increased fluid removal, target weight may not always be reached due to an increase in intradialytic symptomatology, and care should be applied in target weight adjustment in fluid overloaded patients with severe malnutrition and/or inflammation. Although a reduction in hospitalization rate was suggested, the effect of BIS-guided dry weight adjustment on mortality has not yet been shown, however, although available studies are underpowered. In PD patients, results have been more equivocal, which may be partly related to differences in treatment protocols or study populations. Future large-scale studies are needed to assess the full potential of BIS.
Collapse
Affiliation(s)
- Frank M van der Sande
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Esther R van de Wal-Visscher
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stefano Stuard
- Clinical and Therapeutical Governance-Care Value Management, Fresenius Medical Care Deutschland, Bad Homburg, Germany
| | - Ulrich Moissl
- Global Research and Development, Fresenius Medical Care Deutschland, Bad Homburg, Germany
| | - Jeroen P Kooman
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands,
| |
Collapse
|
|
18
|
Feasibility of Assessing Sodium-Associated Body Fluid Composition in End-Stage Renal Disease. Nurs Res 2019; 68:246-252. [PMID: 31033867 DOI: 10.1097/nnr.0000000000000320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cardiovascular disease accounts for more than half of all deaths in the hemodialysis (HD) population. Although much of this mortality is associated with fluid overload (FO), FO is difficult to measure, and many HD patients have significant pulmonary congestion despite the absence of clinical presentation. Cohort studies have observed that FO, as measured by bioimpedance spectroscopy (BIS), correlates with mortality. Other studies have observed that lower sodium intake is associated with less fluid-related weight gain, improved hypertension, and survival. Whether sodium intake influences FO in HD patients as measured by BIS is not known. OBJECTIVE The aims of the study were to determine the feasibility of assessing the impact of sodium restriction on body fluid composition as measured by BIS among patients with three levels of sodium intake and to determine if there are statistical and/or clinical differences in BIS measures across sodium intake groups. METHODS We used a double-blinded randomized controlled trial design with three levels of sodium restriction, 2,400 mg per day, 1,500 mg per day, and unrestricted (control group), to test our aims. Forty-two HD patients from a tertiary acute care academic institution associated with three urban DaVita dialysis centers were enrolled. Participants remained in the inpatient center for 5 days and 4 nights and were randomly assigned to sodium intake groups. Body fluid composition was measured with BIS. RESULTS Recruitment, enrollment, and retention statistics supported the feasibility of the study design. Regression analyses showed that there were no statistically significant differences among sodium intake groups on any of the outcomes. DISCUSSION Our data suggest the need for additional research into the effects of sodium restriction on body fluid composition.
Collapse
|
|
19
|
Tangvoraphonkchai K, Davenport A. Aortic Pulse Wave Velocity in Peritoneal Dialysis Patients Is Not Simply Associated with Extracellular Water Expansion. Kidney Blood Press Res 2019; 44:1423-1431. [PMID: 31715600 DOI: 10.1159/000503424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiac death is increased in peritoneal dialysis (PD) patients. Pulse wave velocity (PWV) is a measurement of arterial stiffness, and previous reports linked PWV to increased extracellular water (ECW). As cyclers and icodextrin are increasingly used, we wished to determine whether this association between PWV and ECW remains. METHODS We measured aortic PWV (aPWV) and bioimpedance (InBody, Seoul, South Korea) in consecutive PD patients attending for peritoneal membrane testing. RESULTS 189 patients were included, 62.4% male, mean age 63.1 ± 15.2 years, 45.3% diabetic, median dialysis duration 12.3 (6.5-25.1) months, 71.4% using cyclers, weight 73.0 ± 16.1 kg, systolic blood pressure 142 ± 21 mm Hg, aPWV 10.4 ± 5.1 m/s. aPWV was associated with pulse pressure (r = 0.26, p = 0.001), Davies comorbidity score (r = 0.18, p = 0.013), and N-terminal pro-brain-type natriuretic peptide (NTproBNP; r = 0.18, p = 0.011). Patients with aPWV ≥10 m/s were older (65.9 ± 13.6 vs. 60.1 ± 16.3 years, p < 0.01) with a higher ECW-to-total body water ratio (0.400 ± 0.012 vs. 0.396 ± 0.013, p < 0.05), but ECW/height was not different (8.52 ± 2.32 vs. 8.75 ± 1.78 L/m), as was NTproBNP (2,472 [788-5,422] vs. 1,234 [410-6,230] ng/L). On multivariable testing, aPWV was positively associated with β-blocker prescription (standardised β coefficient [Stβ] 0.3, 95% confidence limits [95% CL] 0.7-2.6, p = 0.001) and negatively with icodextrin prescription (Stβ 0.19, 95% CL -0.2 to -2.1, p = 0.04). CONCLUSIONS Compared to previous studies, we did not find an independent association between aPWV and ECW and estimates of ECW excess, using the InBody bioimpedance device, suggesting that vascular stiffness in PD patients is more complex than simple ECW volume expansion in PD patients.
Collapse
Affiliation(s)
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London, London, United Kingdom,
| |
Collapse
|
|
20
|
Masuda T, Ohara K, Nagayama I, Matsuoka R, Murakami T, Nakagawa S, Oka K, Asakura M, Igarashi Y, Fukaya Y, Miyazawa Y, Maeshima A, Akimoto T, Saito O, Nagata D. Impact of serum albumin levels on the body fluid response to tolvaptan in chronic kidney disease patients. Int Urol Nephrol 2019; 51:1623-1629. [PMID: 31161520 DOI: 10.1007/s11255-019-02180-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/21/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Tolvaptan exerts an aquaretic effect by blocking vasopressin V2 receptor. Although tolvaptan ameliorates body fluid retention even in patients with chronic kidney disease (CKD), predictors of body fluid reduction induced by tolvaptan remain unclear. We, therefore, examined the clinical parameters associated with the effect of tolvaptan on fluid volume in CKD patients. METHODS Twelve CKD patients (stage 3-5) with fluid retention were treated with tolvaptan in addition to conventional diuretic treatment. Patients were divided into low and high responders by the median change in total body water (TBW) for 1 week measured by a bioimpedance analysis (BIA) device, and clinical parameters were compared between the groups. RESULTS The body weight significantly decreased by 2.0 ± 2.3 kg (p = 0.005), but the estimated glomerular filtration rate (eGFR) was not significantly changed (16.9 ± 11.9 vs. 17.4 ± 12.4 mL/min/1.73 m2, p = 0.139) after 1 week. The BIA showed that the intracellular water (ICW) decreased by 6.0% ± 4.7% (p < 0.001), the extracellular water (ECW) decreased by 6.7% ± 5.4% (p = 0.001), and the TBW decreased by 6.3% ± 4.9% (median value - 6.02%, p < 0.001). The serum albumin level in the high responders was significantly lower than in the low responders (2.3 ± 0.5 vs. 3.3 ± 0.8 g/dL, p = 0.013). Significant partial correlations adjusted for the eGFR were observed between the baseline serum albumin level and changes in the ICW (r = 0.440, p = 0.048), ECW (r = 0.593, p = 0.009) and TBW (r = 0.520, p = 0.020). CONCLUSIONS Serum albumin levels predict the body fluid response to tolvaptan in CKD patients. Tolvaptan may be a promising therapeutic option for ameliorating body fluid retention, especially in patients with hypoalbuminemia.
Collapse
Affiliation(s)
- Takahiro Masuda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Ken Ohara
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Izumi Nagayama
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Ryo Matsuoka
- Department of Clinical Engineering, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takuya Murakami
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Saki Nakagawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kentanro Oka
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Maki Asakura
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yusuke Igarashi
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yukimura Fukaya
- Department of Internal Medicine, Nasu Minami Hospital, Nasukarasuyama, Tochigi, Japan
| | - Yasuharu Miyazawa
- Department of Internal Medicine, Nasu Minami Hospital, Nasukarasuyama, Tochigi, Japan
| | - Akito Maeshima
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Osamu Saito
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| |
Collapse
|
|
21
|
Ohara K, Masuda T, Murakami T, Imai T, Yoshizawa H, Nakagawa S, Okada M, Miki A, Myoga A, Sugase T, Sekiguchi C, Miyazawa Y, Maeshima A, Akimoto T, Saito O, Muto S, Nagata D. Effects of the sodium-glucose cotransporter 2 inhibitor dapagliflozin on fluid distribution: A comparison study with furosemide and tolvaptan. Nephrology (Carlton) 2019; 24:904-911. [PMID: 30578654 DOI: 10.1111/nep.13552] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2018] [Indexed: 01/08/2023]
Abstract
AIM Sodium-glucose cotransporter 2 (SGLT2) inhibitors are an antihyperglycemic drug with diuretic properties. We recently reported that an SGLT2 inhibitor ameliorated extracellular fluid expansion with a transient increase in urinary Na+ excretion. However, the effects of SGLT2 inhibitors on fluid distribution in comparison to conventional diuretics remain unclear. METHODS Forty chronic kidney disease patients with fluid retention (average estimated glomerular filtration rate 29.2 ± 3.2 mL/min per 1.73 m2 ) were divided into the SGLT2 inhibitor dapagliflozin (DAPA), loop diuretic furosemide (FR) and vasopressin V2 receptor antagonist tolvaptan (TLV). The body fluid volume was measured on days 0 and 7 using a bioimpedance analysis device. RESULTS In all three groups, body weight was significantly and similarly decreased, and urine volume numerically increased for 7 days. Bioimpedance analysis showed that the changes in intracellular water were similar, but that there were significant changes in the extracellular water (ECW) (DAPA -8.4 ± 1.7, FR -12.5 ± 1.3, TLV -7.4 ± 1.5%, P = 0.048). As a result, the change in the ratio of ECW to total body water in the DAPA group was significantly smaller than that in the FR group, but numerically larger than that in the TLV group (DAPA -1.5 ± 0.5, FR -3.6 ± 0.5, TLV -0.5 ± 0.4%, P < 0.001). CONCLUSION Sodium-glucose cotransporter 2 inhibitor DAPA predominantly decreased the ECW with a mild increase in urine volume, but the change in the ECW/total body water was smaller than that in patients treated with FR, and larger than that in patients treated with TLV, suggesting that the effects of SGLT2 inhibitors on fluid distribution may differ from those of conventional diuretics.
Collapse
Affiliation(s)
- Ken Ohara
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Takahiro Masuda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Takuya Murakami
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Toshimi Imai
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Hiromichi Yoshizawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Saki Nakagawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Mari Okada
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Atsushi Miki
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Akihiro Myoga
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Taro Sugase
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | | | - Yasuharu Miyazawa
- Department of Internal Medicine, Nasu Minami Hospital, Tochigi, Japan
| | - Akito Maeshima
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Osamu Saito
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Shigeaki Muto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| |
Collapse
|
|
22
|
Yoon HE, Kwon YJ, Shin SJ, Lee SY, Lee S, Kim SH, Lee EY, Shin SK, Kim YS. Bioimpedance spectroscopy-guided fluid management in peritoneal dialysis patients with residual kidney function: A randomized controlled trial. Nephrology (Carlton) 2019; 24:1279-1289. [PMID: 30706575 DOI: 10.1111/nep.13571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2019] [Indexed: 01/26/2023]
Abstract
AIM Bioimpedance spectroscopy (BIS) allows volume status to be assessed objectively. This study evaluated the effect of BIS-guided fluid management on residual kidney function (RKF), volume status, and cardiovascular events in peritoneal dialysis (PD) patients. METHODS A multicenter, prospective, randomized, controlled trial was conducted over 12 months in 2013-2017. Non-anuric PD patients (urine volume ≥ 500 mL/day) were randomized to clinical method-guided management (n = 98) or BIS-guided management (n = 103). The volume in the BIS group was controlled with BIS, with the aim of achieving the target overhydration (OH) goal of -2.0 to +2.0 L. The volume in the control group was controlled by clinical assessment alone. The groups were compared in terms of change in RKF and volume status at 12 months relative to baseline and in terms of cardiovascular event rates during a median follow-up period of 36 months. RESULTS Compared with the controls, the BIS group did not show a significant improvement in change in OH, after adjustments were made for covariates (P = 0.191). The two groups did not differ in terms of delta OH, renal creatinine and urea clearance, and 24 h urine volume. The control and BIS groups also did not differ significantly in terms of change in peritoneal ultrafiltration volume, blood pressure, body weight and echocardiographic variables or in cardiovascular event rates (10.2% vs 11.3%; P = 0.953). CONCLUSION Bioimpedance spectroscopy-guided fluid management did not show an additional benefit to achieve euvolemia, and did not affect the decline in RKF in non-anuric PD patients.
Collapse
Affiliation(s)
- Hye Eun Yoon
- Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Young Joo Kwon
- Department of Internal Medicine, Guro Hospital, Korea University, Seoul, South Korea
| | - Seok Joon Shin
- Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - So-Young Lee
- Department of Internal Medicine, Eulji Medical Center, Eulji University, Daejeon, South Korea
| | - Sangho Lee
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Su-Hyun Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Eun Young Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Sug Kyun Shin
- Department of Internal Medicine, National Health Insurance Serviced Ilsan Hospital, Goyang, South Korea
| | - Yong-Soo Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
|
23
|
Kawabata H, Iwatani H, Yamamichi Y, Shirahase K, Nagai N, Isaka Y. Tolvaptan Efficiently Reduces Intracellular Fluid: Working Toward a Potential Treatment Option for Cellular Edema. Intern Med 2019; 58:639-642. [PMID: 30449775 PMCID: PMC6443539 DOI: 10.2169/internalmedicine.0993-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective Tolvaptan is a class of diuretics that reduce body water through aquaresis. One of the most prominent characteristics of these agents is that worsening of the renal function is less likely to occur. We investigated the underlying mechanism concerning the change in the intracellular fluid (ICF) when the body fluid is reduced. Methods In this retrospective observational study, five overhydrated chronic kidney disease (CKD) patients with edema or pleural effusion treated with tolvaptan were assessed by the bioelectrical impedance method twice: once before and once after tolvaptan therapy. The changes in the ICF rate were compared with those in 11 hemodialysis patients undergoing body fluid reduction by hemodialysis. Results Removal of the body fluid either by tolvaptan or by hemodialysis increased the post/pre-ratio of ICW/total body water (TBW). Tolvaptan reduced the ICF more efficiently than hemodialysis. Conclusion Tolvaptan treatment lessens body fluid by the efficient reduction of the ICF.
Collapse
Affiliation(s)
- Hiroaki Kawabata
- Department of Nephrology, Higashiosaka City Medical Center, Japan
| | - Hirotsugu Iwatani
- Department of Nephrology, National Hospital Organization, Osaka National Hospital, Japan
| | - Yuko Yamamichi
- Division of Nutritional Management, Osaka University Hospital, Japan
| | - Keiko Shirahase
- Division of Nutritional Management, Osaka University Hospital, Japan
| | - Naoko Nagai
- Division of Nutritional Management, Osaka University Hospital, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Japan
| |
Collapse
|
|
24
|
Is the peritoneal dialysis biocompatibility hypothesis dead? Kidney Int 2019; 94:246-248. [PMID: 30031446 DOI: 10.1016/j.kint.2018.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/16/2018] [Accepted: 04/19/2018] [Indexed: 11/24/2022]
Abstract
The peritoneal dialysis (PD) biocompatibility hypothesis is that conventional PD solutions with high levels of glucose degradation products (GDPs), glucose and lactate, and low pH cause morphological and functional damage to the peritoneal membrane and that this damage may be attenuated by biocompatible solutions. Functional findings from randomized trials have not supported this hypothesis, and now new data from a large European pediatric peritoneal biopsy study provide a morphologic correlate for this. The implications are discussed.
Collapse
|
|
25
|
Yoowannakul S, Kotecha T, Fontana M, Davenport A. Do Pre‐Hemodialysis Estimates of Extracellular Volume Excess Using Bioimpedance and N‐Terminal Brain Natriuretic Peptide Correlate With Cardiac Chamber Size Measured by Magnetic Resonance Imaging? Ther Apher Dial 2018; 23:362-368. [DOI: 10.1111/1744-9987.12779] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 01/01/2023]
Affiliation(s)
| | - Tushar Kotecha
- National Amyloid Centre, Royal Free Hospital, Department of MedicineUniversity College London London UK
- Department of CardiologyRoyal Free Hospital London UK
| | - Marianna Fontana
- National Amyloid Centre, Royal Free Hospital, Department of MedicineUniversity College London London UK
| | | |
Collapse
|
|
26
|
Kong J, Davies M, Mount P. The importance of residual kidney function in haemodialysis patients. Nephrology (Carlton) 2018; 23:1073-1080. [DOI: 10.1111/nep.13427] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Jessica Kong
- Department of Nephrology; Austin Health; Melbourne Victoria Australia
| | - Matthew Davies
- Department of Nephrology; Austin Health; Melbourne Victoria Australia
| | - Peter Mount
- Department of Nephrology; Austin Health; Melbourne Victoria Australia
- Department of Medicine (Austin Health), Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Institute of Breathing and Sleep (Kidney Laboratory); Austin Health; Melbourne Victoria Australia
| |
Collapse
|
|
27
|
Abstract
PURPOSE OF REVIEW Maintaining euvolaemia is an essential yet challenging objective in management of patients on peritoneal dialysis. Optimal method to assess volume status remains to be determined. In this review, we will discuss the risk factors and clinical outcomes of fluid overload in PD patients, and examine the role of bioimpedance study in fluid management. RECENT FINDINGS Applying bioimpedance study to measure body composition has attracted increasing attention because it is noninvasive and provides point-of-care assessment of fluid status. Observational studies suggested that presence of residual renal function did not necessarily protect peritoneal dialysis patients from developing fluid overload. This reinforces the importance of fluid restriction in peritoneal dialysis patients, in whom the thirst sensation could be exacerbated by hyperglycaemia. Notably, fluid overload is present in significant portion of asymptomatic patients. Moreover, bioimpedance-defined fluid overload is associated with increase in all-cause mortality, technique failure and possibly excess peritonitis rate. SUMMARY Although future studies should investigate the clinical benefit of bioimpedance-guided fluid management in high-risk subgroup, raising awareness among clinicians, together with structured clinical assessment and dietary counselling are the cornerstone to maintain stable fluid status.
Collapse
|
|
28
|
Panorchan K, Davenport A. Increase in Extracellular Hydration Status After Initiating Peritoneal Dialysis Electively. Perit Dial Int 2018; 37:338-340. [PMID: 28512162 DOI: 10.3747/pdi.2016.00213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Renal replacement therapy is designed to treat uremic symptoms and correct hypervolemia. We hypothesized that starting peritoneal dialysis (PD) should reduce overhydration, and we measured body composition and hydration status using bioimpedance in PD patients prior to training and then at the first assessment of peritoneal membrane function. We studied 100 consecutive patients with a planned start to PD, without peritoneal infections or mechanical catheter problems, mean age 54.7 ± 17.1 years, 57% male and 25% diabetic. Extracellular water (ECW) overhydration increased from -0.06 (-1.21 to 0.97) L to 0.96 (0.50 to 3.01) L, p < 0.001. Fat mass increased from 22.7 ± 11.1 to 23.7 ± 11.3 kg, p = 0.007). The change in ECW/total body water (TBW) was associated with age (β 0.065, p < 0.001), increasing comorbidity (β 1.107, p = 0.005), faster peritoneal protein transport (β 1.84, p < 0.04), and negatively with serum albumin (β -0.208, p < 0.001), and residual renal function (β -0.725, p = 0.026). Patients who had an increase in ECW/TBW had higher C-reactive protein (CRP) both before starting (16.8 ± 24.1 vs 7.7 ± 18.9 mg/L), and when established on PD (15.0 ± 31.8 vs 4.6 ± 5.1 mg/L), p < 0.05. Rather than a reduction in ECW hydration status, overhydration increased after starting PD. This was greater for older more comorbid patients and those with an inflammatory milieu and lower residual renal function. These factors should be considered when deciding upon initial PD prescriptions to limit ECW overhydration before information on peritoneal membrane function becomes available.
Collapse
Affiliation(s)
- Kwanpeemai Panorchan
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| |
Collapse
|
|
29
|
Ohashi Y, Joki N, Yamazaki K, Kawamura T, Tai R, Oguchi H, Yuasa R, Sakai K. Changes in the fluid volume balance between intra- and extracellular water in a sample of Japanese adults aged 15–88 yr old: a cross-sectional study. Am J Physiol Renal Physiol 2018; 314:F614-F622. [DOI: 10.1152/ajprenal.00477.2017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The fluid volume balance between intracellular water (ICW) and extracellular water (ECW) gradually changes with age and various medical conditions. Comprehension of these physiological changes would aid in clinical decision-making related to body fluid assessments. A total of 1,992 individuals (753 men and 1,239 women) aged ≥15 yr included in this study had their body composition measurements performed at training gyms in 2014. We developed a regression formula to assess the association of age with the ratio of ECW to ICW in these subjects. The mean ages of male and female subjects were 51.2 ± 15.2 and 57.4 ± 15.2 yr, and their mean body mass indexes were 23.4 ± 3.3 and 21.1 ± 2.8 kg/m2, respectively. The total fluid volumes of male and female subjects were 39.6 ± 4.9 and 27.7 ± 3.0 liters, whereas the percent body fat mass per kilogram of body weight were 19 and 26%, respectively. The ECW-to-ICW ratio increased with age because of the steeper decrease in the ICW content than in the ECW content, especially after the age of 70 yr. The regression formulas used for calculating the age-adjusted ECW/ICW ratio were as follows: 0.5857 + 7.4334 × 10−6 × (age)2 in men and 0.6062 + 5.5775 × 10−6 × (age)2 in women. In conclusion, the fluid imbalance between ICW and ECW contents is driven by decreased cell volume associated with aging and muscle attenuation. Therefore, our proposed formula may serve as a useful assessment tool for the calculation of body fluid composition.
Collapse
Affiliation(s)
- Yasushi Ohashi
- Department of Nephrology, Sakura Medical Center, Toho University, Chiba, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Keisuke Yamazaki
- Department of Nephrology, Sakura Medical Center, Toho University, Chiba, Japan
| | - Takeshi Kawamura
- Department of Nephrology, Sakura Medical Center, Toho University, Chiba, Japan
| | - Reibin Tai
- School of Medicine, Department of Nephrology, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Hideyo Oguchi
- School of Medicine, Department of Nephrology, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Rena Yuasa
- School of Medicine, Department of Nephrology, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Ken Sakai
- School of Medicine, Department of Nephrology, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| |
Collapse
|
|
30
|
El-Kateb S, Sridharan S, Farrington K, Fan S, Davenport A. Comparison of equations of resting and total energy expenditure in peritoneal dialysis patients using body composition measurements determined by multi-frequency bioimpedance. Clin Nutr 2018; 37:646-650. [DOI: 10.1016/j.clnu.2017.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/31/2017] [Accepted: 02/03/2017] [Indexed: 11/27/2022]
|
|
31
|
Davenport A. Measuring residual renal function for hemodialysis adequacy: Is there an easier option? Hemodial Int 2018; 21 Suppl 2:S41-S46. [PMID: 29064172 DOI: 10.1111/hdi.12592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/01/2017] [Indexed: 02/04/2023]
Abstract
Most patients starting hemodialysis (HD) have residual renal function. As such, there has been increased interest in starting patients with less frequent and shorter dialysis session times. However, for this incremental approach to be successful, patients require regular monitoring of residual renal function, so that as residual renal function declines, the amount of HD is appropriately increased. Currently most dialysis centers rely on interdialytic urine collections. However, many patients find these inconvenient and there may be marked intrapatient variability due to compliance issues. Thus, alternative markers of residual renal function are required for routine clinical practice. Currently three middle sized molecules; cystatin C, β2 microglobulin, and βtrace protein have been investigated as potential endogenous markers of glomerular filtration. Although none is ideal, combinations of these markers have been proposed to provide a more accurate estimation of glomerular clearance, and in particular cut offs for minimal residual renal function. However, in patients with low levels of residual renal function it remains unclear as to whether the benefits of residual renal function equally apply to glomerular filtration or tubular function.
Collapse
Affiliation(s)
- Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London, Rowland Hill Street, London, NW3 2PF
| |
Collapse
|
|
32
|
Kim JK, Song YR, Lee HS, Kim HJ, Kim SG. Repeated Bioimpedance Measurements Predict Prognosis of Peritoneal Dialysis Patients. Am J Nephrol 2018; 47:120-129. [PMID: 29471301 DOI: 10.1159/000486901] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/15/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Fluid overload is a major risk factor for mortality in patients undergoing peritoneal dialysis (PD). However, few studies have investigated the effect of chronic exposure to sustained fluid overload on long-term outcomes. METHOD A total of 284 prevalent PD patients were included in this prospective study. Repeated multifrequency body composition analysis was performed 12 months apart, and 1-year cumulative chronic fluid overload were used to predict all-cause mortality and the risk for transfer to hemodialysis (HD) during the ensuing 15.6 ± 9.1 months. RESULTS The prevalence of fluid overload was approximately 27%. Interestingly, a substantial number of hypervolemic patients at first test were persistently hypervolemic at their second test. With this, chronic fluid overload was observed in 18.3% (n = 52). Notably, most of chronic fluid overload patients had diabetes (86.5%), and it was accompanied by concomitant changes in peritoneal membrane characteristics, a higher progression rate to high transporter. The risk of transfer to HD increased 2.8 times in patients with chronic fluid overload than in those without. Also, it significantly increased the risk of mortality (p = 0.038). Surprisingly, subgroup analysis found that patients with euvolemic status at follow-up experienced no mortality despite being in a fluid overload state at baseline. CONCLUSIONS One-year chronic exposure to fluid overload is a strong independent risk factor for transfer to HD and death in prevalent PD patients. Although the fluid status of most PD patients is not easily changed over time, becoming euvolemic during the entire PD treatment period seems to be very important.
Collapse
|
|
33
|
Yoowannakul S, Harris LS, Davenport A. Peritoneal Protein Losses Depend on More Than Just Peritoneal Dialysis Modality and Peritoneal Membrane Transporter Status. Ther Apher Dial 2018; 22:171-177. [PMID: 29314721 DOI: 10.1111/1744-9987.12647] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 11/30/2022]
Abstract
Peritoneal protein clearance (PPCl) depends upon vascular supply and size selective permeability. Some previous reports suggested PPCl can distinguish fast peritoneal membrane transport due to local or systemic inflammation. However, as studies have been discordant, we wished to determine factors associated with an increased PPCl. Consecutive patients starting peritoneal dialysis (PD) who were peritonitis-free were studied. Data included a baseline peritoneal equilibration test (PET), measurement of dialysis adequacy, 24-h dialysate PPCl and body composition measured by multifrequency bioimpedance. 411 patients, mean age 57.2 ± 16.6 years, 60.8% male, 39.4% diabetic, 20.2% treated by continuous ambulatory peritoneal dialysis (CAPD) were studied. Mean PET 4-h Dialysate/Serum creatinine was 0.73 ± 0.13, with daily peritoneal protein loss 4.6 (3.3-6.4) g, and median PPCl 69.6 (49.1-99.6) mL/day. On multivariate analysis, PPCl was most strongly associated with CAPD (β 0.25, P < 0.001), extracellular water (ECW)/total body water (TBW) ratio (β 0.21, P < 0.001), skeletal muscle mass index (β 0.21, P < 0.001), log N-terminal brain natriuretic peptide (NT-proBNP) (β 0.17, P = 0.001), faster PET transport (β 0.15, P = 0.005), and normalized nitrogen appearance rate (β 0.13, P = 0.008). In addition to the longer dwell times of CAPD, greater peritoneal creatinine clearance and faster PET transporter status, we observed an association between increased PPCl and ECW expansion, increased NT-proBNP, estimated dietary protein intake and muscle mass, suggesting a link to sodium intake and sodium balance, increasing both ECW and conduit artery hydrostatic pressure resulting in greater vascular protein permeability. This latter association may explain reports linking PPCl to patient mortality.
Collapse
Affiliation(s)
- Suree Yoowannakul
- UCL Center for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Lauren S Harris
- UCL Center for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Andrew Davenport
- UCL Center for Nephrology, Royal Free Hospital, University College London, London, UK
| |
Collapse
|
|
34
|
Abstract
Inflammation is one of the well-recognized nontraditional risk factors that contributes to the excessive cardiovascular mortality in peritoneal dialysis (PD) patients. Serum C-reactive protein and interleukin-6 levels are common surrogate markers used to measure inflammatory burden and predict adverse clinical outcomes in PD patients. Causes of inflammation are complex and can be categorized into factors related to a decrease in renal function and factors related to dialysis. They interact with each other and finally result in systemic and intraperitoneal inflammation. This review discusses the various causes and clinical implications of inflammation in PD patients. More importantly, potential therapeutic options that target the underlying pathogenic mechanisms are explored.
Collapse
Affiliation(s)
- Philip Kam-Tao Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Jack Kit-Chung Ng
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Christopher William Mcintyre
- Division of Nephrology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
|
35
|
Uchiyama K, Yanai A, Maeda K, Ono K, Honda K, Tsujimoto R, Kamijo Y, Yanagi M, Ishibashi Y. Baseline and Time-Averaged Values Predicting Residual Renal Function Decline Rate in Japanese Peritoneal Dialysis Patients. Ther Apher Dial 2017; 21:599-605. [PMID: 29047213 DOI: 10.1111/1744-9987.12589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/26/2017] [Accepted: 06/07/2017] [Indexed: 11/28/2022]
Abstract
Residual renal function (RRF) is a strong prognostic factor of morbidity and mortality in patients undergoing peritoneal dialysis (PD). We determined predictors of the RRF rate of decline using both baseline values and time-averaged ones. We retrospectively analyzed 94 patients being treated with PD at the Japanese Red Cross Medical Center. The decline rate of RRF was calculated by a diminution in the weekly renal Kt/V between the first and last follow up divided by follow-up years. The mean follow-up period was 2.28 years, and the mean decline rate of weekly renal Kt/V was 0.25 per year. A multivariate analysis using baseline parameters identified dialysis-to-plasma ratios of creatinine at 4 h (P = 0.02), urinary protein (P = 0.02), and mean blood pressure (MBP) (P < 0.01) as being positively associated with the RRF rate of decline, while the use of angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) had a negative correlation (P = 0.03). When using time-averaged values as independent variables, a lower weekly total renal Kt/V (P < 0.0001), higher urinary protein (P < 0.0001), and higher MBP (P = 0.04) independently predicted a faster RRF rate of decline. We demonstrated that PD patients with a lower MBP and lower urinary protein both at baseline and throughout their PD duration had a slower RRF rate of decline. We recommend strict control of blood pressure and anti-proteinuric therapy for PD patients.
Collapse
Affiliation(s)
- Kiyotaka Uchiyama
- Division of Nephrology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Akane Yanai
- Division of Nephrology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Keizo Maeda
- Division of Nephrology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Keisuke Ono
- Division of Nephrology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kazuya Honda
- Division of Nephrology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Ryuji Tsujimoto
- Division of Nephrology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yuka Kamijo
- Division of Nephrology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Mai Yanagi
- Division of Nephrology, Japanese Red Cross Medical Center, Tokyo, Japan
| | | |
Collapse
|
|
36
|
Tangvoraphonkchai K, Davenport A. Increasing Haemodialytic Clearances as Residual Renal Function Declines: An Incremental Approach. Blood Purif 2017; 44:217-226. [DOI: 10.1159/000475458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/02/2017] [Indexed: 11/19/2022]
Abstract
Many patients with chronic kidney disease start undergoing thrice-weekly haemodialysis (HD), aiming for an HD sessional dialyzer urea clearance target, irrespective of whether they have residual renal function (RRF). While increasing sessional dialyzer urea clearance above a target of 1.2 has not been shown to improve patient survival, it has been shown that the preservation of RRF improves patient self-reported outcomes and survival. Observational studies have suggested that initiating twice-weekly HD schedules leads to greater preservation of RRF. This has led to the concept of following an incremental approach to initiating HD, steadily increasing the amount of weekly dialyzer clearance as RRF decreases. Incremental dialysis practice requires the regular assessment of RRF to prevent inadequate delivery of dialysis treatment. Once RRF is lost, then the dialysis schedule and modality need to be adjusted to try to increase the middle-sized solute clearance and protein-bound toxins.
Collapse
|
|
37
|
Kazory A. Fluid overload as a major target in management of cardiorenal syndrome: Implications for the practice of peritoneal dialysis. World J Nephrol 2017; 6:168-175. [PMID: 28729965 PMCID: PMC5500454 DOI: 10.5527/wjn.v6.i4.168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/23/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
Congestion is an integral component of cardiorenal syndrome and portends an adverse impact on the outcomes. Recent studies suggest that congestion has the ability of modulating the interactions between the kidney and the heart in this setting. Peritoneal dialysis (PD) is a home-based therapeutic modality that is not only offered to patients with end-stage renal disease to provide solute clearance and ultrafiltration, but it has also been used in patients with refractory heart failure and fluid overload to help optimize volume status. Several uncontrolled studies and case series have so far evaluated the role of PD in management of hypervolemia for patients with heart failure. They have generally reported favorable results in this setting. However, the data on the outcomes of patients with end-stage renal disease and concomitant heart failure is mixed, and the proposed theoretical advantages of PD might not translate into improved clinical endpoints. Congestion is prevalent in this patient population and has a significant effect on their survival. As studies suggest that a significant subset of patients with end-stage renal disease who receive PD therapy are hypervolemic, suboptimal management of congestion could at least in part explain these conflicting results. PD is a highly flexible therapeutic modality and the choice of techniques, regimens, and solutions can affect its ability for optimization of fluid status. This article provides an overview of the currently available data on the role and clinical relevance of congestion in patients with cardiorenal syndrome and reviews potential options to enhance decongestion in these patients.
Collapse
|
|
38
|
Ok E, Levin NW, Asci G, Chazot C, Toz H, Ozkahya M. Interplay of volume, blood pressure, organ ischemia, residual renal function, and diet: certainties and uncertainties with dialytic management. Semin Dial 2017; 30:420-429. [PMID: 28581677 DOI: 10.1111/sdi.12612] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Extracellular fluid volume overload and its inevitable consequence, hypertension, increases cardiovascular mortality in the long term by leading to left ventricular hypertrophy, heart failure, and ischemic heart disease in dialysis patients. Unlike antihypertensive medications, a strict volume control strategy provides optimal blood pressure control without need for antihypertensive drugs. However, utilization of this strategy has remained limited because of several factors, including the absence of a gold standard method to assess volume status, difficulties in reducing extracellular fluid volume, and safety concerns associated with reduction of extracellular volume. These include intradialytic hypotension; ischemia of heart, brain, and gut; loss of residual renal function; and vascular access thrombosis. Comprehensibly, physicians are hesitant to follow strict volume control policy because of these safety concerns. Current data, however, suggest that a high ultrafiltration rate rather than the reduction in excess volume is related to these complications. Restriction of dietary salt intake, increased frequency, and/or duration of hemodialysis sessions or addition of temporary extra sessions during the process of gradually reducing postdialysis body weight in conventional hemodialysis and discontinuation of antihypertensive medications may prevent these complications. We believe that even if an unwanted effect occurs while gradually reaching euvolemia, this is likely to be counterbalanced by favorable cardiovascular outcomes such as regression of left ventricular hypertrophy, prevention of heart failure, and, ultimately, cardiovascular mortality as a result of the eventual achievement of normal extracellular fluid volume and blood pressure over the long term.
Collapse
Affiliation(s)
- Ercan Ok
- Ege University Medical School, Izmir, Turkey
| | - Nathan W Levin
- Icahn School of Medicine at Mount Sinai Health System, New York, USA
| | - Gulay Asci
- Ege University Medical School, Izmir, Turkey
| | | | - Huseyin Toz
- Ege University Medical School, Izmir, Turkey
| | | |
Collapse
|
|
39
|
Udo A, Goodlad C, Davenport A. Impact of Diabetes on Extracellular Volume Status in Patients Initiating Peritoneal Dialysis. Am J Nephrol 2017; 46:18-25. [PMID: 28564640 DOI: 10.1159/000477326] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/31/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Recent reports have highlighted that diabetic patients with kidney failure are at increased risk of technique failure and transfer to haemodialysis within 90 days of initiating peritoneal dialysis (PD). We wished to determine whether there were differences between diabetic and non-diabetic patients within the first 3 months of starting PD. METHODS We reviewed results of corresponding bioimpedance and the 1st test of peritoneal membrane function (PET) in consecutive patients, 6-10 weeks after initiating PD electively. RESULTS Adult patients numbering 386 - 230 males (59.6%), 152 (39.4%) diabetic, 188 (48.7%) white, mean age 57.3 ±16.9 years - were studied. Although weight, residual renal function and peritoneal clearances were not different, diabetic patients had greater extracellular water to total body water (ECW/TBW; 40.4 ± 1.1 vs. 39.2 ± 1.4) and % ECW excess (9.6 [6.3-12.3] vs. 4.9 [0.7-8.9]), lower serum albumin (35.2 ± 4.7 vs. 37.8 ± 4.9 g/L), greater fat mass index (9.5 ± 4.2 vs. 7.7 ± 4.2), and although mean arterial blood pressure was similar, arterial pulse pressure was greater (66.9 ± 10.8 vs. 54.3 ± 17.3 mm Hg, all p < 0.001). On multivariate analysis, glycated haemoglobin was associated with pulse pressure (standardised β 0.24, p < 0.001), N terminal brain natriuretic peptide (β 0.24, p < 0.001), ECW/TBW (β 0.19, p = 0.012) and negatively with serum albumin (β -0.14, p = 0.033) and creatinine (β -0.18, p = 0.02). CONCLUSION Diabetic patients electively starting PD were found to have greater ECW/TBW ratios and ECW excess 6-10 weeks after starting PD compared to non-diabetics, despite similar PET. Increased ECW could predispose diabetic patients to be at greater risk of volume overload.
Collapse
Affiliation(s)
- Aniema Udo
- Dialysis Unit, University of Uyo Teaching Hospital, Akwa Ibom State, Nigeria
| | | | | |
Collapse
|
|
40
|
Tangvoraphonkchai K, Davenport A. Incremental Hemodialysis - A European Perspective. Semin Dial 2017; 30:270-276. [PMID: 28185299 DOI: 10.1111/sdi.12583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Most patients initiating hemodialysis have residual renal function (RRF). Whereas RRF is monitored prior to commencing hemodialysis, once dialysis is started most centres simply rely on dialyzer urea clearance to determine adequate uremic toxin clearance and disregard the effect of RRF. However sustaining RRF is important for the dialysis patient, as RRF reduces inter-dialytic weight gains, increases middle molecule and protein bound toxin clearances and is associated with better quality of life assessments. Paradoxically, more frequent dialysis and longer dialysis sessions appear to be associated with more rapid loss of RRF. As such, starting patients with less frequent or shorter dialysis sessions, depending upon individual patient comorbidity, may lead to better preservation of RRF. However to prevent inadequate uremic toxin clearance or volume overload, RRF needs to be regularly monitored. Unfortunately, the 24-hour urine collection for urea and creatinine clearance remains the mainstay for RRF assessment. This measurement chiefly represents glomerular clearance rather than tubular function, but the latter may be also important for the dialysis patients. Incremental dialysis with less initial dialysis treatment may lower costs and will allow others to dialyze more frequently. The key to start a successful incremental hemodialysis approach is the regular monitoring of the patient, so that as RRF is lost an appropriate decision can be made regarding increasing dialysis session duration and frequency on an individual patient basis or consider switching modalities to hemodiafiltration.
Collapse
Affiliation(s)
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, United Kingdom
| |
Collapse
|
|
41
|
Vrtovsnik F, Fartoux L. Les enjeux de la surcharge hydro-sodée. Nephrol Ther 2017; 12:S10-S11. [PMID: 28132669 DOI: 10.1016/s1769-7255(17)30020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- F Vrtovsnik
- Hôpital Bichat-Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, 75018 Paris, France
| | - L Fartoux
- 18, avenue Foch, 94160 Saint-Mandé, France.
| |
Collapse
|
|
42
|
Goodlad C, Davenport A. Does Peritoneal Protein Transport Increase with Peritoneal Dialysis Therapy Duration and Lead to Extracellular Water Overload in Peritoneal Dialysis Patients? Ther Apher Dial 2017; 21:79-87. [PMID: 28105770 DOI: 10.1111/1744-9987.12484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 01/10/2023]
Abstract
Faster peritoneal transport status has been associated with adverse outcomes for peritoneal dialysis (PD) patients. Peritoneal protein clearance, through large pores, may be a surrogate marker of local inflammation. We wished to determine whether peritoneal protein transport increased with PD duration or was associated with extracellular water (ECW) expansion. We studied the relationships between 4 h Dialysate (D)/Serum (S) protein and ECW excess, using multifrequency bioelectrical impedance assessments, in 103 PD patients with up to 4 years of prospectively collected peritoneal equilibrium test (PET) results. 4 h PET D/S total protein and creatinine ratios were stable over time (K-W test, P = 0.063 and P = 0.3357, respectively). The initial PET 4 h D/S creatinine and D/S total protein correlated with ECW excess (r = 0.33, P = 0.003, and r = 0.27, P = 0.019, respectively), but thereafter there was no association. CRP and albumin did not correlate with 4 h D/S creatinine or total protein. Serial 4 h D/S total protein and 4 h D/S creatinine correlated all time points (P < 0.001). At the start of PD therapy, over-hydration (ECW excess) was observed with higher 4 h D/S creatinine and 4 h D/S total protein ratios, suggesting initial exposure to PD fluids causes faster transport. Thereafter changes in peritoneal creatinine and total protein transport mirrored each other suggesting that similar factors lead to changes in both small and large pore transport, and there was no sustained increase in larger pore transport with therapy time.
Collapse
Affiliation(s)
- Cate Goodlad
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| |
Collapse
|
|
43
|
Tan BK, Yu Z, Fang W, Lin A, Ni Z, Qian J, Woodrow G, Jenkins SB, Wilkie ME, Davies SJ. Longitudinal bioimpedance vector plots add little value to fluid management of peritoneal dialysis patients. Kidney Int 2017; 89:487-97. [PMID: 26466321 DOI: 10.1038/ki.2015.294] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 08/07/2015] [Accepted: 08/13/2015] [Indexed: 01/30/2023]
Abstract
Bioimpedance (BI) has the potential to enable better management of fluid balance, which can worsen over time on peritoneal dialysis (PD) due to loss of residual kidney function and progressive muscle wasting. We undertook a prospective, randomized, open-label, blinded end-point controlled trial to determine whether availability of longitudinal BI measures as vector plots helped clinicians maintain stable fluid status over 12 months in 308 peritoneal dialysis patients from the United Kingdom and Shanghai, China. Patients were recruited into 4 groups nested within a single trial design according to country and residual kidney function. Nonanuric subjects from both countries demonstrated stable fluid volumes irrespective of randomization. Hydration worsened in control anuric patients in Shanghai with increased extracellular/total body water (ECW/TBW) ratio (0.04; 95% CI: 0.01, 0.06) and reduced TBW (-1.76 L 95% CI: -2.70, -0.82), but was stable in the BI intervention group whose dialysate glucose prescription was increased. However, multilevel analysis incorporating data from both countries showed worsening ECW/TBW in active and control anuric patients. Clinicians in the United Kingdom reduced target weight in the nonanuric BI intervention group causing a reduction in TBW without beneficial effects on ECW or blood pressure. Thus, routine use of longitudinal BI vector plots to improve clinical management of fluid status is not supported.
Collapse
|
|
44
|
|
|
45
|
Kooman JP, Cornelis T, van der Sande FM, Leunissen KML. Is the Effect of Low-GDP Solutions on Residual Renal Function Mediated by Fluid State? An Enigmatic Question which Still Needs to be Solved. Perit Dial Int 2016; 36:239-42. [PMID: 27230598 DOI: 10.3747/pdi.2015.00149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Jeroen P Kooman
- Department of Internal Medicine, division of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Tom Cornelis
- Department of Internal Medicine, division of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Frank M van der Sande
- Department of Internal Medicine, division of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Karel M L Leunissen
- Department of Internal Medicine, division of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands
| |
Collapse
|
|
46
|
El-Kateb S, Sridharan S, Farrington K, Fan S, Davenport A. A single weekly Kt/Vurea target for peritoneal dialysis patients does not provide an equal dialysis dose for all. Kidney Int 2016; 90:1342-1347. [DOI: 10.1016/j.kint.2016.07.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/11/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
|
|
47
|
Greenhall GHB, Davenport A. Screening for muscle loss in patients established on peritoneal dialysis using bioimpedance. Eur J Clin Nutr 2016; 71:70-75. [DOI: 10.1038/ejcn.2016.202] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 07/13/2016] [Accepted: 08/12/2016] [Indexed: 12/27/2022]
|
|
48
|
Oei E, Paudel K, Visser A, Finney H, Fan SL. Is overhydration in peritoneal dialysis patients associated with cardiac mortality that might be reversible? World J Nephrol 2016; 5:448-454. [PMID: 27648408 PMCID: PMC5011251 DOI: 10.5527/wjn.v5.i5.448] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/02/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To study the relationship between overhydration (OH) in peritoneal dialysis (PD) patients and cardiac mortality.
METHODS OH, as measured by body composition monitor (BCM), is associated with increased mortality in dialysis patients. BCM has been used to guide treatment on the assumption that correcting OH will improve cardiac morbidity and mortality although data demonstrating causality that is reversible is limited. We wished to determine if OH in PD patients predicted cardiac mortality, and if there was a correlation between OH and cardiac troponin-T (cTnT) levels. Finally, we wished to determine if improving OH values would lead to a decrement in cTnT. All prevalent PD patients over the study period of 57 mo who had contemporaneous BCM and cTnT measurements were followed irrespective of transplantation or PD technique failure. We also studied a cohort of patients with who had severe OH (> +2L). The Fresenius Body Composition Monitor was used to obtain hydration parameters. cTnT levels were done as part of routine clinical care. Data was analysed using SPSS version 20.0.
RESULTS There were 48 deaths in the 336 patients. The patients that died from cardiac or non-cardiac causes were similar with respect to their age, incidence of diabetes mellitus, gender, ethnicity and cause of renal failure. However, the patients with cardiac causes of death had significantly shorter dialysis vintage (10.3 mo vs 37.0 mo, P < 0.0001) and were significantly more overhydrated by BCM measurement (2.95 L vs 1.35 L, P < 0.05). The mean (standard error of the means) hydration status of the 336 patients was +1.15 (0.12) L and the median [interquartile range (IQR)] cTnT level was 43.5 (20-90) ng/L. The cTnT results were not normally distributed and were therefore transformed logarithmically. There was a statistically significant correlation between Log (cTnT) with the OH value (Spearman r value 0.425, P < 0.0001). We identified a sub-group of patients that were severely overhydrated; median (IQR) hydration at baseline was +2.7 (2.3 to 3.7) L. They were followed up for a minimum of 6 mo. Reduction in OH values in these patients over 6 mo correlated with lowering of cTnT levels (Spearman r value 0.29, P < 0.02).
CONCLUSION Patients that were overhydrated had higher cTnT, and had deaths that were more likely to be cardiac related. Reduction in OH correlated with lowering of cTnT.
Collapse
|
|
49
|
Lui SL, Zhu D, Cheng SW, Ng F, Hui PC, Yip T, Lo WK. Effects of Astragalus membranaceus-based Chinese Medicine Formulae on Residual Renal Function in Patients on Peritoneal Dialysis. Perit Dial Int 2016; 35:595-7. [PMID: 26450483 DOI: 10.3747/pdi.2014.00039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sing Leung Lui
- Dr. Lee Iu Cheung Memorial Renal Research Center, Tung Wah Hospital, Hong Kong SAR, People's Republic of China
| | - Dan Zhu
- Department of Medicine, The University of Hong Kong Clinical Center for Teaching and Research in Chinese Medicine, Tung Wah Hospital, Hong Kong SAR, People's Republic of China
| | - Suk Wai Cheng
- Dr. Lee Iu Cheung Memorial Renal Research Center, Tung Wah Hospital, Hong Kong SAR, People's Republic of China
| | - Flora Ng
- Dr. Lee Iu Cheung Memorial Renal Research Center, Tung Wah Hospital, Hong Kong SAR, People's Republic of China
| | - Pui Chi Hui
- Dr. Lee Iu Cheung Memorial Renal Research Center, Tung Wah Hospital, Hong Kong SAR, People's Republic of China
| | - Terence Yip
- Dr. Lee Iu Cheung Memorial Renal Research Center, Tung Wah Hospital, Hong Kong SAR, People's Republic of China
| | - Wai Kei Lo
- Dr. Lee Iu Cheung Memorial Renal Research Center, Tung Wah Hospital, Hong Kong SAR, People's Republic of China
| |
Collapse
|
|
50
|
Sikaneta T, Wu G, Abdolell M, Ng A, Mahdavi S, Svendrovski A, Tu T, Mercer T, Tong M, Oreopoulos D, Tam P. The Trio Trial - A Randomized Controlled Clinical Trial Evaluating the Effect of a Biocompatible Peritoneal Dialysis Solution on Residual Renal Function. Perit Dial Int 2016; 36:526-32. [PMID: 27282852 DOI: 10.3747/pdi.2015.00090] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 02/19/2016] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND AND OBJECTIVE Residual renal function (RRF) correlates with mortality and morbidity rates in patients receiving peritoneal dialysis (PD). We examined the effect of a biocompatible PD solution (Gambrosol Trio; Gambro Lundia AB, Lund, Sweden) with lower concentrations of glucose degradation products on rates of decline in RRF. ♦ DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Incident patients at 2 centers in Canada and 1 in Hong Kong were randomized (by minimization) in an open-label parallel group trial to receive Gambrosol Trio or standard PD solution (Dianeal; Baxter Healthcare, Mississauga, Canada) for 2 years. Primary outcome was slope of RRF. Secondary outcomes were urine volumes, fluid and nutrition indices, PD and membrane characteristics, peritonitis rates, adverse events, and PD technique survival. ♦ RESULTS Residual renal function declined by 0.132 mL/minute/1.73 m(2)/month in 51 patients allocated to biocompatible, and 0.174 mL/minute/1.73 m(2)/month in 50 patients allocated to standard PD solution (difference 0.042 mL/minute/1.73 m(2)/month, p = 0.001). Urine volume, body mass index, normalized protein catabolic rates, and fat mass were higher; total body water, peritoneal ultrafiltration, and D/P creatinine did not differ; and serum phosphate, rates of icodextrin, and automated cycler use were lower with Gambrosol Trio use. There were more peritonitis events with Gambrosol Trio use, while PD technique survival did not differ between groups. ♦ CONCLUSIONS The use of the biocompatible PD solution Gambrosol Trio was associated with slower rates of decline in RRF, fluid and nutrition benefits, and increased peritonitis rates. TRIAL NUMBER ISRCTN26252543.
Collapse
Affiliation(s)
- Tabo Sikaneta
- Department of Nephrology, The Scarborough Hospital, Scarborough, ON, Canada
| | - George Wu
- Department of Medicine, Credit Valley Hospital, Mississauga, ON, Canada
| | - Mohamed Abdolell
- Division of Radiology, Dalhousie University, Halifax, NS, Canada
| | - Anita Ng
- Research Department, Kidney Life Sciences Institute, Scarborough, ON, Canada
| | - Sara Mahdavi
- Department of Nephrology, The Scarborough Hospital, Scarborough, ON, Canada
| | | | - Tony Tu
- Research Department, Kidney Life Sciences Institute, Scarborough, ON, Canada
| | - Trish Mercer
- Department of Medicine, Credit Valley Hospital, Mississauga, ON, Canada
| | - Matthew Tong
- Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong
| | | | - Paul Tam
- Department of Nephrology, The Scarborough Hospital, Scarborough, ON, Canada
| |
Collapse
|