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Overhydration Assessed Using Bioelectrical Impedance Vector Analysis Adversely Affects 90-Day Clinical Outcome among SARS-CoV2 Patients: A New Approach. Nutrients 2022; 14:nu14132726. [PMID: 35807907 PMCID: PMC9268688 DOI: 10.3390/nu14132726] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 12/04/2022] Open
Abstract
Background: COVID-19 has taken on pandemic proportions with growing interest in prognostic factors. Overhydration is a risk factor for mortality in several medical conditions with its role in COVID-19, assessed with bioelectrical impedance (BI), gaining research interest. COVID-19 affects hydration status. The aim was to determine the hydration predictive role on 90 d survival COVID-19 and to compare BI assessments with traditional measures of hydration. Methods: We studied 127 consecutive COVID-19 patients. Hydration status was estimated using a 50 kHz phase-sensitive BI and estimated, compared with clinical scores and laboratory markers to predict mortality. Results: Non-surviving COVID-19 patients had significantly higher hydration 85.2% (76.9−89.3) vs. 73.7% (73.2−82.1) and extracellular water/total body water (ECW/TBW) 0.67 (0.59−0.75) vs. 0.54 (0.48−0.61) (p = 0.001, respectively), compared to surviving. Patients in the highest hydration tertile had increased mortality (p = 0.012), Intensive Care Unit (ICU) admission (p = 0.027), COVID-19 SEIMC score (p = 0.003), and inflammation biomarkers [CRP/prealbumin (p = 0.011)]. Multivariate analysis revealed that hydration status was associated with increased mortality. HR was 2.967 (95%CI, 1.459−6.032, p < 0.001) for hydration and 2.528 (95%CI, 1.664−3.843, p < 0.001) for ECW/TBW, which were significantly greater than traditional measures: CRP/prealbumin 3.057(95%CI, 0.906−10.308, p = 0.072) or BUN/creatinine 1.861 (95%CI, 1.375−2.520, p < 0.001). Hydration > 76.15% or ECW/TBW > 0.58 were the cut-off values predicting COVID-19 mortality with 81.3% and 93.8% sensitivity and 64 and 67.6% specificity, respectively. Hydration status offers a sensitive and specific prognostic test at admission, compared to established poor prognosis parameters. Conclusions and Relevance: Overhydration, indicated as high hydration (>76.15%) and ECW/TBW (>0.58), were significant predictors of COVID-19 mortality. These findings suggest that hydration evaluation with 50 kHz phase-sensitive BI measurements should be routinely included in the clinical assessment of COVID-19 patients at hospital admission, to identify increased mortality risk patients and assist medical care.
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Abstract
Loss of sodium and water excretion with disruption of volume homeostasis is a crucial abnormality of end-stage renal failure. Fluid management is a fundamental function of dialysis therapy, but studies show frequent occult fluid overload, hypertension, and cardiac dysfunction in peritoneal dialysis. A rigorous approach to fluid management in PD can achieve excellent fluid, hypertension, and cardiovascular results in clinical practice. The present article explores the reasons for fluid overload and poor ultrafiltration in peritoneal dialysis patients and discusses optimal assessment and management of these problems.
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Karava V, Stabouli S, Dotis J, Liakopoulos V, Papachristou F, Printza N. Tracking hydration status changes by bioimpedance spectroscopy in children on peritoneal dialysis. Perit Dial Int 2020; 41:217-225. [PMID: 32783508 DOI: 10.1177/0896860820945813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This 6-month prospective longitudinal study investigates the association between hydration status changes using bioimpedance spectroscopy (BIS) and systolic blood pressure (SBP), pulse pressure (PP), and serum albumin (sAlb) changes in children on peritoneal dialysis (PD). METHODS Thirteen patients (median age: 12.58 years) were enrolled. Normal hydration, moderate hydration, severe overhydration, and dehydration were defined as -7% ≤ relative overhydration (Re-OH) < +7%, +7% ≤ Re-OH < +15%, Re-OH ≥ +15%, and Re-OH < -7%, respectively. Automated office blood pressure z-score, sAlb, and weight z-score were recorded. RESULTS Fifty-two Re-OH measurements were recorded: three in five, four in five, five in two, and seven in one patient, respectively. SBP was higher and sAlb lower in cases with severe overhydration (9 readings) (p < 0.001, p < 0.001), but distribution of these parameters did not differ between normal hydration/dehydration (28 readings) and moderate overhydration (15 readings) cases. In patients with hydration status change, SBP and PP were higher while sAlb lower in cases with higher hydration status level (p = 0.026, p = 0.05, and p = 0.109, respectively). In all patients, visit-to-visit SBP, PP, and sAlb changes were correlated to Re-OH changes (rs = 0.693, p < 0.001; rs = 0.643, p < 0.001; rs = -0.444, p = 0.008, respectively) but not to weight changes (rs = 0.052, p = 0.754; rs = 0.034, p = 0.838; rs = -0.156, p = 0.378, respectively). Visit-to-visit Re-OH changes, which were >+4% or <-4%, were linearly correlated to SBP (r = 0.858, p < 0.001), PP (r = 0.757, p < 0.001), and sAlb (r = -0.699, p = 0.002) changes. CONCLUSION In children on PD, longitudinal Re-OH changes are superior to weight changes in assessing volume-dependent variations of SBP, PP, and sAlb. Routine BIS application, rather than single BIS measurements, seems useful in the intra-patient monitoring of hydration status.
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Affiliation(s)
- Vasiliki Karava
- Pediatric Nephrology Unit, 1st Department of Pediatrics, 37782Aristotle University of Thessaloniki, Greece
| | - Stella Stabouli
- Pediatric Nephrology Unit, 1st Department of Pediatrics, 37782Aristotle University of Thessaloniki, Greece
| | - John Dotis
- Pediatric Nephrology Unit, 1st Department of Pediatrics, 37782Aristotle University of Thessaloniki, Greece
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, 37782Aristotle University of Thessaloniki, Greece
| | - Fotios Papachristou
- Pediatric Nephrology Unit, 1st Department of Pediatrics, 37782Aristotle University of Thessaloniki, Greece
| | - Nikoleta Printza
- Pediatric Nephrology Unit, 1st Department of Pediatrics, 37782Aristotle University of Thessaloniki, Greece
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Affiliation(s)
- Barbara Engel
- Faculty of Health & Medical Sciences, Staffordshire United Kingdom
| | - Simon J. Davies
- Surrey University Guildford, Surrey Institute for Science and Technology in Medicine, Staffordshire United Kingdom
- Keele University Keele, Staffordshire Department of Nephrology University Hospital of North Staffordshire Stoke-on-Trent, Staffordshire United Kingdom
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Woodrow G, Devine Y, Cullen M, Lindley E. Article Commentary: Application of Bioelectrical Impedance to Clinical Assessment of Body Composition in Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080702700504] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patients on peritoneal dialysis (PD) develop complex changes in body composition. These changes reflect hydration, nutrition, and body fat, all important elements reflecting patient well-being and efficacy of therapy that should be assessed and monitored as guides to patient management. They are all notoriously difficult to accurately measure in clinical practice and simultaneous abnormalities may obscure detection, as in the malnourished fluid-overloaded patient where body weight is misleadingly stable. Malnutrition is a serious complication in PD that carries an adverse prognosis. Assessment of hydration in PD is important in determining “dry weight” to allow adjustment of dialysis prescription to optimize fluid balance. A number of techniques have been investigated to measure body composition in clinical practice. Of these, bioelectrical impedance analysis (BIA) has attracted most interest and seems to be of greatest promise. Cases illustrating different aspects of the use of BIA in PD patients are described, and the background, possible uses, and limitations of BIA in PD patients are discussed. To be of clinical value, BIA must be used to distinguish between extracellular water (which reflects hydration) and body cell mass, or intracellular water (which declines in wasting and malnutrition). The high precision of BIA is ideally suited to detecting changes in body composition and its main role may be in longitudinal monitoring. However, inaccuracy of absolute measurements and variability of normal values in the general population make precise diagnosis of the degree of normality of body composition in an individual subject a more difficult task for body composition analysis.
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Affiliation(s)
- Graham Woodrow
- Renal Unit, St James's University Hospital, Leeds, United Kingdom
| | - Yvette Devine
- Renal Unit, St James's University Hospital, Leeds, United Kingdom
| | - Mary Cullen
- Renal Unit, St James's University Hospital, Leeds, United Kingdom
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Law MC, Kwan BCH, Fung JSF, Chow KM, Ng JKC, Pang WF, Cheng PMS, Leung CB, Szeto CC. The efficacy of managing fluid overload in chronic peritoneal dialysis patients by a structured nurse-led intervention protocol. BMC Nephrol 2019; 20:454. [PMID: 31815632 PMCID: PMC6902497 DOI: 10.1186/s12882-019-1596-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/23/2019] [Indexed: 11/19/2022] Open
Abstract
Background Extracellular volume overload is a common problem in peritoneal dialysis (PD) patients and is associated with excessive mortality. We determine the effectiveness of treating PD patients with extracellular volume overload by a structured nurse-led intervention program. Methods The hydration status of PD patients was screened by bioimpedance spectroscopy (BIS). Fluid overload was defined as overhydration volume ≥ 2 L. Patients were classified into Symptomatic and Asymptomatic Groups and were managed by a structured nurse-led intervention protocol that focused on education and motivation. Hypertonic cycles were given for short term symptom relief for the Symptomatic group. Patients were followed for 12 weeks for the change in volume status, blood pressure, knowledge and adherence as determined by standard questionnaires. Results We recruited 103 patients (53 Symptomatic, 50 Asymptomatic Group. There was a significant reduction in overhydration volume 4 weeks after intervention, which was sustained by week 12; the overall reduction in overhydration volume was 0.96 ± 1.43 L at 4 weeks, and 1.06 ± 1.70 L at 12 weeks (p < 0.001 for both). The improvement was significant for both Symptomatic and Asymptomatic Groups. There was a concomitant reduction in systolic blood pressure in the Asymptomatic (146.9 ± 20.7 to 136.9 ± 19.5 mmHg, p = 0.037) but not Symptomatic group. The scores of knowledge, adherence to dietary control and advices on daily habit at week 4 were all significantly increased, and the improvement was sustained at week 12. Conclusions The structured nurse-led intervention protocol has a lasting benefit on the volume status of PD patients with extracellular volume overload. BIS screening allows prompt identification of volume overload in asymptomatic patients, and facilitates a focused effort on this high risk group.
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Affiliation(s)
- Man Ching Law
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR, China
| | - Bonnie Ching-Ha Kwan
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR, China
| | - Janny Suk-Fun Fung
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR, China
| | - Kai Ming Chow
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR, China
| | - Jack K C 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, NT, Hong Kong, SAR, China
| | - Wing-Fai Pang
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR, China
| | - Phyllis Mei-Shan Cheng
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR, China
| | - Chi Bon Leung
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR, China
| | | | - Cheuk Chun Szeto
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR, China.
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Tian JP, Wang H, Du FH, Wang T. The standard deviation of extracellular water/intracellular water is associated with all-cause mortality and technique failure in peritoneal dialysis patients. Int Urol Nephrol 2016; 48:1547-54. [PMID: 27438601 DOI: 10.1007/s11255-016-1371-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The mortality rate of peritoneal dialysis (PD) patients is still high, and the predicting factors for PD patient mortality remain to be determined. This study aimed to explore the relationship between the standard deviation (SD) of extracellular water/intracellular water (E/I) and all-cause mortality and technique failure in continuous ambulatory PD (CAPD) patients. METHODS All 152 patients came from the PD Center between January 1st 2006 and December 31st 2007. Clinical data and at least five-visit E/I ratio defined by bioelectrical impedance analysis were collected. The patients were followed up till December 31st 2010. The primary outcomes were death from any cause and technique failure. Kaplan-Meier analysis and Cox proportional hazards models were used to identify risk factors for mortality and technique failure in CAPD patients. RESULTS All patients were followed up for 59.6 ± 23.0 months. The patients were divided into two groups according to their SD of E/I values: lower SD of E/I group (≤0.126) and higher SD of E/I group (>0.126). The patients with higher SD of E/I showed a higher all-cause mortality (log-rank χ (2) = 10.719, P = 0.001) and technique failure (log-rank χ (2) = 9.724, P = 0.002) than those with lower SD of E/I. Cox regression analysis found that SD of E/I independently predicted all-cause mortality (HR 3.551, 95 % CI 1.442-8.746, P = 0.006) and technique failure (HR 2.487, 95 % CI 1.093-5.659, P = 0.030) in CAPD patients after adjustment for confounders except when sensitive C-reactive protein was added into the model. CONCLUSION The SD of E/I was a strong independent predictor of all-cause mortality and technique failure in CAPD patients.
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Affiliation(s)
- Jun-Ping Tian
- Department of Cardiology, Beijing Tian Tan Hospital, Capital Medical University, No. 6, Tian Tan Xi Li, Dongcheng District, Beijing, 100050, People's Republic of China.
| | - Hong Wang
- Department of Endocrinology, Aerospace Center Hospital, Beijing, People's Republic of China
| | - Feng-He Du
- Department of Cardiology, Beijing Tian Tan Hospital, Capital Medical University, No. 6, Tian Tan Xi Li, Dongcheng District, Beijing, 100050, People's Republic of China
| | - Tao Wang
- Division of Nephrology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100083, People's Republic of China.
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Yap J, Rafii M, Azcue M, Pencharz P. Effect of Intravenous Infusion Solutions on Bioelectrical Impedance Spectroscopy. JPEN J Parenter Enteral Nutr 2015; 41:641-646. [PMID: 26637229 DOI: 10.1177/0148607115619598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Bioelectrical impedance (BIA) is often used to measure body fluid spaces and thereby body composition. However, in acute animal studies, we found that impedance was driven by the saline content of intravenous (IV) fluids and not by the volume. The aim of the study was to investigate the effect of 3 different fluids acutely administered on the change in impedance, specifically resistance (R). MATERIALS AND METHODS Nine healthy adults participated in 3 treatment (0.9% saline, 5% dextrose, and a mixture of 0.3% saline + 3.3% dextrose) experiments on nonconsecutive days. They all received 1 L of one of the treatments intravenously over a 1-hour period. Repeated BIA measurements were performed prior to IV infusion and then every 5 minutes for the 1-hour infusion period, plus 3 more measurements up to 15 minutes after the completion of the infusion. RESULTS The change in R in the 0.9% saline infusion experiment was significantly lower than that of the glucose and mixture treatment ( P < .001). CONCLUSION Bioelectrical impedance spectroscopy and BIA measure salt rather than the volume changes over the infusion period. Hence, in patients receiving IV fluids, BIA of any kind (single frequency or multifrequency) cannot be used to measure body fluid spaces or body composition.
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Affiliation(s)
- Jason Yap
- 1 Department of Paediatrics, University of Alberta, Edmonton, Canada.,2 The Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Mahroukh Rafii
- 2 The Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Maria Azcue
- 2 The Research Institute, The Hospital for Sick Children, Toronto, Canada.,3 Hospital CUF, Cascias, Portugal
| | - Paul Pencharz
- 1 Department of Paediatrics, University of Alberta, Edmonton, Canada.,2 The Research Institute, The Hospital for Sick Children, Toronto, Canada.,4 Department of Nutritional Science and Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Bernardo AP, Oliveira JC, Santos O, Carvalho MJ, Cabrita A, Rodrigues A. Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients: Associations with Body Composition, Peritoneal Transport, and Peritoneal Glucose Absorption. Clin J Am Soc Nephrol 2015; 10:2205-12. [PMID: 26507143 DOI: 10.2215/cjn.03170315] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/21/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Insulin resistance has been associated with cardiovascular disease in peritoneal dialysis patients. Few studies have addressed the impact of fast transport status or dialysis prescription on insulin resistance. The aim of this study was to test whether insulin resistance is associated with obesity parameters, peritoneal transport rate, and glucose absorption. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Insulin resistance was evaluated with homeostasis model assessment method (HOMA-IR), additionally corrected by adiponectin (HOMA-AD). Enrolled patients were prevalent nondiabetics attending at Santo António Hospital Peritoneal Dialysis Unit, who were free of hospitalization or infectious events in the previous 3 months (51 patients aged 50.4 ± 15.9 years, 59% women). Leptin, adiponectin, insulin-like growth factor-binding protein 1 (IGFBP-1), and daily glucose absorption were also measured. Lean tissue index, fat tissue index (FTI), and relative fat mass (rel.FM) were assessed using multifrequency bioimpedance. Patients were categorized according to dialysate to plasma creatinine ratio at 4 hours, 3.86% peritoneal equilibration test, and obesity parameters. RESULTS Obesity was present in 49% of patients according to rel.FM. HOMA-IR correlated better with FTI than with body mass index. Significant correlations were found in obese, but not in nonobese patients, between HOMA-IR and leptin, leptin/adiponectin ratio (LAR), and IGFBP-1. HOMA-IR correlated with HOMA-AD, but did not correlate with glucose absorption or transport rate. There were no significant differences in insulin resistance indices, glucose absorption, and body composition parameters between fast and nonfast transporters. A total of 18 patients (35.3%) who had insulin resistance presented with higher LAR and rel.FM (7.3 [12.3, interquartile range] versus 0.7 [1.4, interquartile range], P<0.001, and 39.4 ± 10.1% versus 27.2 ± 11.5%, P=0.002, respectively), lower IGFBP-1 (8.2 ± 7.2 versus 21.0 ± 16.3 ng/ml, P=0.002), but similar glucose absorption and small-solute transport compared with patients without insulin resistance. FTI and LAR were independent correlates of HOMA-IR in multivariate analysis adjusted for glucose absorption and small-solute transport (r=0.82, P<0.001). CONCLUSIONS Insulin resistance in nondiabetic peritoneal dialysis patients is associated with obesity and LAR independent of glucose absorption and small-solute transport status. Fast transport status was not associated with higher likelihood of obesity or insulin resistance.
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Affiliation(s)
- Ana Paula Bernardo
- Department of Nephrology and Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - Jose C Oliveira
- Department of Clinical Pathology, Santo António General Hospital(Hospital Center of Porto, EPE), Porto, Portugal; and
| | | | | | | | - Anabela Rodrigues
- Department of Nephrology and Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
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Lindley EJ, Lopot F. The use of bioimpedance to aid volume assessment in dialysis patients. Kidney Int 2015; 87:240. [PMID: 25549124 DOI: 10.1038/ki.2014.310] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Elizabeth J Lindley
- Renal Medicine, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - František Lopot
- Department of Medicine, General University Hospital, Prague-Strahov, Czech Republic
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Aguiar PV, Santos O, Teixeira L, Silva F, Azevedo P, Vidinha J, Ferrer F, Carvalho MJ, Cabrita A, Rodrigues A. Overhydration prevalence in peritoneal dialysis – A 2 year longitudinal analysis. Nefrologia 2015; 35:189-96. [DOI: 10.1016/j.nefro.2015.05.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 12/03/2014] [Indexed: 11/15/2022] Open
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Davies SJ, Davenport A. The authors reply. Kidney Int 2014; 87:240. [PMID: 25549125 DOI: 10.1038/ki.2014.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Simon J Davies
- Health Services Research Unit, Institute for Science and Technology in Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
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Bernardo AP, Fonseca I, Oliveira JC, Santos O, Carvalho MJ, Cabrita A, Rodrigues A. Adipokines in peritoneal dialysis: relevant clinical impact according to body composition. Ther Apher Dial 2014; 19:144-53. [PMID: 25363550 DOI: 10.1111/1744-9987.12239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Adipokines impact on clinical outcomes is not adequately addressed in peritoneal dialysis (PD). We investigated the impact of leptin/adiponectin ratio (L/A) as a predictor of cardiovascular events (CVE) in PD, taking into consideration patient's body composition and the potential role of glucose load. We prospectively followed 66 prevalent PD patients for 47.0 ± 28.2 months. New CVE were evaluated. Lean tissue index (LTI), relative fat mass (relFM) and relative overhydration (relOH) using multifrequency bioimpedance (BCM) were assessed; serum lipids, interleukin-6 (IL-6), leptin and adiponectin were measured. We established the determinants of L/A using multiple linear regression and the impact of L/A on CVE. Obesity was present in 47 (73.4%) patients according to relFM, and in seven (10.6%) according to body mass index (BMI). Leptin and L/A exhibited a stronger correlation with relFM (both r = 0.62, P < 0.0001) than with BMI (r = 0.46 and r = 0.51, respectively, both P < 0.0001). L/A showed a significant correlation with triglycerides (r = 0.41, P = 0.001) and HDL-cholesterol (r = -0.358, P = 0.003), better than isolated leptin or adiponectin. RelFM (RR = 0.130, 95%confidence interval [CI]:0.086-0.174, P < 0.0001) and LTI (RR = 0.194, 95%CI:0.037-0.351, P = 0.016) were independent predictors of L/A (R(2) = 0.67). Patients who suffered new CVE were older (59.12 ± 12.41 vs. 47.52 ± 13.84years, P = 0.003) and had a higher relOH (11.28 ± 7.29 vs. 6.60 ± 8.16%, P = 0.028). L/A was significantly higher in patients with CVE[2.29 (1.79) vs. 0.65 (1.73), P = 0.028] but this association was only put on evidence after excluding patients with wasting. BMI is an inaccurate method to classify obesity in PD since it underestimates its prevalence compared with body composition assessment using BCM. High adiponectin and low leptin are associated with a more favorable metabolic risk profile in peritoneal dialysis. The L/A is determined by relFM and by LTI. A higher L/A is associated with CVE in PD patients without wasting.
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Affiliation(s)
- Ana Paula Bernardo
- Nephrology Department, Santo António Hospital, Oporto Hospital Center, Oporto, Portugal; UMIB/ICBAS/Porto University, Oporto, Portugal
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Davies SJ, Davenport A. The role of bioimpedance and biomarkers in helping to aid clinical decision-making of volume assessments in dialysis patients. Kidney Int 2014; 86:489-96. [DOI: 10.1038/ki.2014.207] [Citation(s) in RCA: 198] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/21/2014] [Accepted: 04/17/2014] [Indexed: 11/09/2022]
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O'Lone EL, Visser A, Finney H, Fan SL. Clinical significance of multi-frequency bioimpedance spectroscopy in peritoneal dialysis patients: independent predictor of patient survival. Nephrol Dial Transplant 2014; 29:1430-7. [PMID: 24598280 DOI: 10.1093/ndt/gfu049] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND It is becoming increasingly evident that the accurate assessment of hydration status is critical to care of a dialysis patient. Using the Body Composition Monitor, different parameters (overhydration (OH), extra-cellular water/total body water (ECW/TBW) or OH/ECW) have been proposed to indicate hydration status. We wished to determine which parameter (if any) was most predictive of all-cause mortality, and if this was independent of nutritional indices. METHODS We performed a single-centre retrospective analysis of prospectively collected data of all peritoneal dialysis (PD) patients between 1 January 2008 and 30 March 2012. Record review was undertaken to establish patient survival, clinical and demographic data. Follow-up was continued even after PD technique failure (transfer to haemodialysis) and transplantation. RESULTS The study included 529 patients. OH index (OH and OH/ECW) was the independent predictor of mortality in multi-variate analysis. ECW/TBW as a continuous variable was not associated with increased risk of death. In contrast, patients that were severely overhydrated (highest 33%) had hazard ratios (HRs) that were statistically significant irrespective of the parameter used to define hydration. Using OH, severely overhydrated patients had an HR of 1.83 [95% confidence interval (CI) 1.19-2.82, P < 0.01], OH/ECW: 2.09 (95% CI 1.36-3.20, P < 0.001) and ECW/TBW: 2.05 (95% CI 1.31-3.22, P < 0.005). CONCLUSIONS Our results also indicated that there was no influence of body mass index (BMI) on the hydration parameter OH/ECW. OH/ECW remained an independent predictor of mortality when the BMI and lean tissue index were included in multivariate model. However, it remains to be determined if correcting the OH status of a patient will lead to improvement in mortality.
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Affiliation(s)
- Emma L O'Lone
- Department of Renal Medicine and Transplantation, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Annemarie Visser
- Department of Nutrition and Dietetics, Barts Health NHS Trust, London, UK
| | - Hazel Finney
- Department of Clinical Biochemistry, Barts Health NHS Trust, London, UK
| | - Stanley L Fan
- Department of Renal Medicine and Transplantation, The Royal London Hospital, Barts Health NHS Trust, London, UK
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Tai DJ, Ahmed SB, Palacios-Derflingher L, Hemmelgarn BR, MacRae JM. Pneumatic compression devices during hemodialysis: a randomized crossover trial. Nephrol Dial Transplant 2012; 28:982-90. [PMID: 23136215 DOI: 10.1093/ndt/gfs502] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Maintenance of central blood volume (CBV) is essential for hemodynamic stability during hemodialysis (HD), though preservation of CBV is poorly understood. Pneumatic compression devices (PCDs) during HD may help maintain CBV. METHODS We performed a randomized, crossover trial to determine the effect of PCDs on CBV during HD. Patients underwent two consecutive mid-week HD sessions, randomized to begin the first session either with or without PCDs [stratified by intradialytic hypotension (IDH)-prone status]. The primary outcome was change in CBV during HD. The secondary outcomes were change in other hemodynamic and volume status parameters. RESULTS Fifty-one patients (median age 65 years, 75% male, 22% IDH-prone) were randomized; forty-six completed the study. During HD, the median change in CBV for PCD and control sessions was -0.08 versus -0.05 L (P = 0.62). There was no difference in the change in cardiac output (CO) (-0.63 versus -0.49 L/min, P = 0.78) or systemic vascular resistance (SVR) (+1.30 versus +1.55 mmHg/L/min, P = 0.67) for PCDs versus control. Based on the bioimpedance measurements, patients were not volume overloaded pre-dialysis. There was a greater reduction in total body water (TBW) (-2.6 versus -2.3 L, P = 0.05) and intracellular fluid (ICF) volume (-1.3 versus -1.1 L, P = 0.03), and no difference in change in the extracellular fluid (ECF) volume (1.3 versus 1.2 L, P = 0.09) with PCDs versus control. Similar results were observed in IDH-prone patients. CONCLUSIONS Compared with standard of care, PCDs have no effect on intradialytic hemodynamic parameters, including CBV, although they may allow greater capacity for fluid removal. Further studies are required to better understand physiological and hemodynamic changes in patients during HD.
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Affiliation(s)
- Davina J Tai
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Utter AC, McAnulty SR, Riha BF, Pratt BA, Grose JM. The validity of multifrequency bioelectrical impedance measures to detect changes in the hydration status of wrestlers during acute dehydration and rehydration. J Strength Cond Res 2012; 26:9-15. [PMID: 21964427 DOI: 10.1519/jsc.0b013e318238ea51] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The objective of this study was to examine the validity of multifrequency direct segmental bioelectrical impedance analysis (DSM-BIA) measures to detect changes in the hydration status of wrestlers after they underwent 3% acute dehydration and a 2-hour rehydration period. Fifty-six National Collegiate Athletic Association wrestlers: (mean ± SEM); age 19.5 ± 0.2 years, height 1.73 ± 0.01 m, and body mass (BM) 82.5 ± 2.3 kg were tested in euhydrated, dehydrated (-3.5%), and 2-hour rehydration conditions using DSM-BIA to detect the changes in hydration status. The hydration status was quantified by measuring the changes in plasma osmolality (P(osm)), urine osmolality (Uosm), urine specific gravity (U(sg)), BM, and weighted segmental impedance at frequencies of 5, 20, 50, 100, and 500 kHz. Weighted segmental impedance significantly increased after a 3.5% reduction in the body weight for all the 5 frequencies evaluated, but it did not return to baseline at 2-hour rehydration. P(osm) (303 ± 0.6 mOsm·L(-1)), Uosm (617 ± 47 mOsm·L(-1)), and U(sg) (1.017 ± 0.001) all significantly increased at postdehydration and returned to baseline at 2-hour rehydration. Estimations of extracellular water were significantly different throughout the trial, but there were no significant changes in the estimations of the total body water or intracellular water. The results of this study demonstrate the potential use of DSM-BIA as a field measure to assess the hydration status of wrestlers for the purpose of minimal weight certification before the competitive season. When employing DSM-BIA to assess the hydration status, the results indicated that the changes in weighted segmental impedance at the frequencies evaluated (5, 20, 50, 100, and 500 kHz) are sensitive to acute changes in dehydration but lag behind changes in the standard physiological (plasma and urinary) markers of hydration status after a 2-hour rehydration period.
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Affiliation(s)
- Alan C Utter
- Department of Health, Leisure, and Exercise Science, Appalachian State University, Boone, North Carolina, USA.
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Abstract
Fluid homeostasis is one of the fundamental roles of the kidney and a crucial aspect in clinical management of patients on peritoneal dialysis (PD). Volume status has an important impact on the outcome of PD patients. Fluid excess leads to accelerated development of cardiovascular disease. Volume status may also impact on disorders and assessment of nutritional state. While ultrafiltration and residual urine volume have featured prominently in PD research, the importance of fluid intake and thirst in PD patients has received relatively little attention. Despite older studies suggesting that fluid overload is common in PD, current PD techniques can produce sufficient fluid removal to achieve good control of fluid, with associated cardiac benefits in PD patients. One of the major challenges is to apply these techniques to obtain ideal volume status in patients. Bioelectrical impedance analysis appears to be the most promising technique currently available to guide fluid management.
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Affiliation(s)
- Graham Woodrow
- Renal Unit, St James's University Hospital, Beckett Street, Leeds, United Kingdom.
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Body composition monitor measurement technique for the detection of volume status in peritoneal dialysis patients: the effect of abdominal fullness. Int Urol Nephrol 2011; 43:1195-9. [DOI: 10.1007/s11255-011-9977-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 04/19/2011] [Indexed: 10/18/2022]
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John B, Tan BK, Dainty S, Spanel P, Smith D, Davies SJ. Plasma volume, albumin, and fluid status in peritoneal dialysis patients. Clin J Am Soc Nephrol 2010; 5:1463-70. [PMID: 20538836 DOI: 10.2215/cjn.09411209] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Peritoneal dialysis (PD) patients may be overhydrated especially when inflammation is present. We hypothesized that patients with a plasma albumin below the median value would have measurable overhydration without a proportional increase in plasma volume (PV). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We investigated a cross-sectional sample of 46 prevalent PD patients powered to detect a proportional increase in PV associated with whole body overhydration and hypoalbuminemia. PV was determined from (125)I-labeled albumin dilution, absolute total body water from D dilution (TBW(D)), and relative hydration from multifrequency bioimpedance analysis (BIA; Xitron 4200) expressed as the extracellular water (ECW):TBW(BIA) ratio. RESULTS Whereas patients with plasma albumin below the median (31.4 g/dl) were overhydrated as determined both by BIA alone (ECW:TBW(BIA) 0.49 versus 0.47, P < 0.036) and the difference between estimated TBW(BIA) and measured TBW(D) (3.55 versus 0.94 L, P = 0.012), corrected PV was not different (1463 versus 1482 ml/m(2), NS). Mean PV was not different from predicted, and its variance did not correlate with any other clinical measures. Multivariate analysis showed that the only independent predictor of whole body overhydration was reduced plasma albumin. CONCLUSIONS Hypoalbuminemia is an important determinant of tissue overhydration in PD patients. This overhydration is not associated with an increased plasma volume. Attempts to normalize the ECW:TBW ratio in hypoalbuminemic, inflamed PD patients may lead to hypovolemia and loss of residual renal function.
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Affiliation(s)
- Biju John
- Department of Nephrology, University Hospital of North Staffordshire, Stoke on Trent, Staffordshire, United Kingdom
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Devolder I, Verleysen A, Vijt D, Vanholder R, Van Biesen W. Body composition, hydration, and related parameters in hemodialysis versus peritoneal dialysis patients. Perit Dial Int 2010; 30:208-14. [PMID: 20081049 DOI: 10.3747/pdi.2008.00284] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS Maintaining euvolemia is an important goal in patients on renal replacement therapy. However, adequate assessment of volume status in clinical practice is hampered by a lack of accurate measuring tools. A new multifrequency bioimpedance tool has recently been validated. This study compares volume status in peritoneal dialysis (PD) and hemodialysis (HD) patients in a single center. METHODS Body Composition Monitoring (BCM; Fresenius Medical Care, Bad Homburg, Germany) was performed in all patients on PD or HD without contraindication. PD patients were measured with a full abdomen; HD patients were measured at the midweek session, once immediately before and once 20 minutes after dialysis. Clinical overhydration was defined as an overhydration-to-extracellular water ratio of >0.15. RESULTS Total body water, extracellular water, and intracellular water were 33.7 +/- 6.9 L versus 31.8 +/- 8.1 L vs 33.9 +/- 6.7 L, 16.4 +/- 3.9 L vs 15.3 +/- 4.9 L vs 16.8 +/- 3.3 L, and 17.1 +/- 6.2 L vs 16.5 +/- 4.6 L vs 17.2 +/- 3.9 L in the pre-HD, post-HD, and PD patients, respectively (p = NS). In the pre-HD and the PD patients, overhydration was 1.9 +/- 1.7 L and 2.1 +/- 2.3 L, whereas post-HD this was only 0.6 +/- 1.7 L (p < 0.001). Clinical overhydration was more prevalent in pre-HD and PD patients compared to post-HD patients (24.1% vs 22.3% vs 10%, p < 0.001). In multivariate models, overhydration was related to age, male gender, and post-HD status. CONCLUSION Although much clinical attention is paid to volume status, 24% of patients still have clinically relevant volume overload. Implementation of a reliable and clinically applicable tool to assess volume status is therefore necessary. It is possible to obtain comparable volume status in PD and HD patients.
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Peixoto AJ. Guest Editor: Rajiv Agarwal: Can “Diagnostic Markers” Predict Blood Pressure Response in Hypertensive Dialysis Patients? Semin Dial 2007; 20:411-5. [PMID: 17897247 DOI: 10.1111/j.1525-139x.2007.00315.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Aldo J Peixoto
- Department of Medicine, Division of Nephrology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Connecticut, USA.
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