1
|
Koh S, Kim SJ, Lee S. Associations between central pulse pressure, microvascular endothelial function, and fluid overload in peritoneal dialysis patients. Clin Exp Hypertens 2023; 45:2267192. [PMID: 37842909 DOI: 10.1080/10641963.2023.2267192] [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: 07/23/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Microcirculatory endothelial dysfunction is a complex phenomenon that contributes to the development of cardiovascular disease. However, the relationship between microcirculatory endothelial dysfunction and macrovascular disease remains incompletely understood. Fluid overload is a risk factor for cardiovascular mortality in patients undergoing peritoneal dialysis. Therefore, we investigated the effects of chronic fluid overload on both the microcirculation and macrocirculation in these patients. METHODS Thirty patients undergoing peritoneal dialysis were included in this cross-sectional study. We measured their central blood pressure and pulse wave velocity, assessed their microvascular endothelial function using drug-induced iontophoresis with laser Doppler flowmetry, and determined the amount of fluid overload using bioimpedance. We conducted a Spearman correlation analysis, univariate analysis, and stepwise multivariate regression models to determine the associations among the hemodynamic parameters. RESULTS Acetylcholine-induced iontophoresis with laser Doppler flowmetry showed a correlation with both brachial and central pulse pressure (PP), but not with pulse wave velocity. Fluid overload was associated with both central and brachial PP and remained an independent predictor of central PP even after adjusting for multiple factors. However, fluid overload was not associated with microcirculatory endothelial function. CONCLUSION In peritoneal dialysis patients, we observed a significant association between central PP and microvascular endothelial function, indicating a connection between macrocirculation and microcirculation. However, conclusive evidence regarding fluid overload as a mediator between these circulatory systems is lacking. Further research is needed to investigate this relationship.
Collapse
Affiliation(s)
- Seoyon Koh
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Seung-Jung Kim
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Shina Lee
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| |
Collapse
|
2
|
Yang K, Pan S, Yang N, Wu J, Liu Y, He Q. Effect of bioelectrical impedance technology on the prognosis of dialysis patients: a meta-analysis of randomized controlled trials. Ren Fail 2023; 45:2203247. [PMID: 37133857 PMCID: PMC10158555 DOI: 10.1080/0886022x.2023.2203247] [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: 05/04/2023] Open
Abstract
Managing patient 'dry weight' according to clinical standards has deficiencies. Research has focused on the effectiveness of using bioelectrical impedance technology for fluid management in dialysis patients. Whether bioelectrical impedance monitoring can improve dialysis patients prognoses remain controversial. We performed a meta-analysis of randomized controlled trials to determine whether bioelectrical impedance was effective in improving dialysis patients prognoses. The primary outcome was all-cause mortality (13.6 ± 9.1 months). Secondary outcomes were left ventricular mass index (LVMI), arterial stiffness assessed using Pulse Wave Velocity (PWV), and N-terminal brain natriuretic peptide precursor (NT-proBNP). Of 4,641 citations retrieved, we identified 15 eligible trials involving 2763 patients divided into experimental (n = 1386) and control (n = 1377) groups. In 14 studies with mortality data, the meta-analysis showed that bioelectrical impedance intervention reduced the risk of all-cause mortality (rate ratios [RR]: 0.71; 95% confidence interval [CI]: 0.51, 0.99; p = .05; I2 = 1%). Subgroup analysis of patients on hemodialysis (RR: 0.72; 95% CI: 0.42, 1.22; p = .22) and peritoneal dialysis (RR: 0.62; 95% CI: 0.35, 1.07; p = .08) showed no significant mortality difference between intervention and control groups. It reduced the risk of all-cause mortality in the Asian population (RR: 0.52; p = .02), and reduced NT-proBNP (mean difference [MD]: -1495.73; p = 0.002; I2=0%) and PWV (MD: -1.55; p = .01; I2=89%). Bioelectrical impedance intervention reduced the LVMI in hemodialysis patients (MD: -12.69; p < .0001; I2=0%). Our analysis shows that in dialysis patients, bioelectrical impedance technology intervention could reduce, but not eliminate, the risk of all-cause mortality. Overall, this technology can improve the prognosis of dialysis patients.
Collapse
Affiliation(s)
- Kaibi Yang
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Shujun Pan
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Nan Yang
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Juan Wu
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Yueming Liu
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Qiang He
- Department of Nephrology, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| |
Collapse
|
3
|
Costa FL, Reis NSDC, Reis FM, de Oliveira RC, Zanati Bazan SG, Canedo da Silva MZ, Martin LC, Barretti P. Multifrequency bioimpedance by spectroscopy vs. routine methods in the management of hydration status in peritoneal dialysis patients: A randomized control trial. Front Med (Lausanne) 2022; 9:911047. [PMID: 36160161 PMCID: PMC9492968 DOI: 10.3389/fmed.2022.911047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Overhydration (OH) is common in peritoneal dialysis (PD) and increases the cardiovascular risk. Multifrequency bioimpedance spectroscopy (BIS) has been proposed to estimate the hydration in dialysis. Our objective was to evaluate if BIS is superior than control based on clinical assessment plus single-frequency bioimpedance (SF-BIA) on the fluid control and intermediate cardiovascular outcomes. Methods Randomized controlled study in adult PD patients, with a 9-month follow-up, allocated into two groups: control and BIS. Data were collected from medical records. SF-BIA and BIS, laboratory exams, ambulatory blood pressure monitoring, echocardiography (ECHO), and pulse wave velocity (PWV) were evaluated. The BIS data were available to the medical team only in BIS group. Results 34 patients completed the study, 17 in each group. At the endpoint the BIS group had a significant (p < 0.05) greater proportion of patients with OH/extracellular water (OH/ECW%) ≤ 15% than the control (94.1% vs. 52.9%), and a lower OH mean (2.1 ± 1.6 vs. 0.9 ± 1.1 L). The control group has a significant increase in the tumor necrosis factor alpha median concentration from baseline to six [11.9 (6.0–24.1) vs. 44.7 (9.4–70.6) pg/ml] and 9 months [11.9 (6.0–24.1) vs. 39.4 (27.9–62.6) pg/ml], and in the N-terminal fragment of pro-B-type natriuretic peptide median [239 (171.5–360.5) vs. 356 (219–1,555) pg/ml]. For cardiovascular parameters, BIS group presented a significant reduction in radial PWV [7.7 (6.9–9.2) vs. 6.5 (5.5–8.4) m/s] at 9 month, while in the control presented a significant increase in mean central systolic blood pressure (BP) (106.8 ± 11.2 vs. 117.6 ± 16.5 mmHg) and in central diastolic BP (90.4 ± 9.8 vs. 103.3 ± 12.5 mmHg) at 9 months. The left ventricular mass (LVM)/body surface presented a significant reduction in the control (109.6 ± 30.8 vs. 101.2 ± 28.9 g/m2) and BIS group (107.7 ± 24.9 vs. 96.1 ± 27.0 g/m2) at 9 months. Conclusion The results suggest BIS is superior than the clinical evaluation plus SF-BIA for the fluid control of PD patients. Clinical trial registration [https://www.ClinicalTrials.gov], identifier [RBR-10k8j3bx].
Collapse
|
4
|
Zhang L, Zhang X, Xue S. Left Heart Failure Caused by Capacity Overload in Peritoneal Dialysis Patients. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5422333. [PMID: 35607309 PMCID: PMC9124112 DOI: 10.1155/2022/5422333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
Background This study sets out to investigate the incidence of acute left ventricular failure in peritoneal dialysis patients with different volume loads and to analyze the related risk factors for LVF in these patients. Methods This study involved patients who received peritoneal dialysis in our hospital between September 2018 and January 2021. The demographic data and biochemical indicators of the patients were collected. The bioimpedance analysis method was used to determine the volume overload [overhydration (OH)] level of patients, and cardiac color Doppler ultrasound was used to detect changes in their cardiac structure. According to the LVF diagnostic criteria of symptoms and laboratory tests, the patients were divided into the LVF and non-LVF groups and then divided according to their OH level into the normal volume (OH ≤1.1 L) and volume overload (OH >1.1 L) groups. The incidence of LVF in was analyzed in patients with different volume loads, and logistic regression was used to identify the risk factors for LVF. Results Among the 226 peritoneal dialysis patients enrolled in this study, 125 patients (55.3%) had LVF. The normal volume group (n = 68, 30.1%) included 22 patients (32.4%) with LVF, and the volume overload group (n = 158, 69.9%) included 84 patients (53.2%) with LVF. In the volume overload group, 74 patients (46.8%) had subclinical volume overload, including 35 patients (47.3%) with LVF, and 84 patients (53.2%) had clinical volume overload, including 65 patients (77.4%) LVF. Multivariate logistic regression analysis revealed a high OH level (OR = 1.862, 95% CI: 1.353-2.668, P < 0.001) and low hemoglobin level (OR = 0.845, 95% CI: 0.721-0.980, P = 0.008) to be independent risk factors for LVF. Conclusions LVF has a high incidence in peritoneal dialysis patients, especially those with volume overload. A high OH level and low hemoglobin level are independent risk factors for LVF.
Collapse
Affiliation(s)
- Lin Zhang
- Department of Nephrology, Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou, China
| | - Xiaocui Zhang
- Department of Pediatrics, East Hospital of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Song Xue
- Department of Cardiology, Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, China
| |
Collapse
|
5
|
Slabbert A, Chothia MY. The association between office blood pressure and fluid status using bioimpedance spectroscopy in stable continuous ambulatory peritoneal dialysis patients. Clin Hypertens 2022; 28:8. [PMID: 35287755 PMCID: PMC8922746 DOI: 10.1186/s40885-021-00192-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hypertension is common in continuous ambulatory peritoneal dialysis (CAPD) patients. It remains to be determined the extent to which fluid overload contributes to uncontrolled blood pressure (BP) in this population. The aim was to determine the association between fluid status as measured using bioimpedance spectroscopy (BIS) and BP in CAPD patients.
Methods
A cross-sectional study was performed involving 50 stable CAPD patients at a single center in Cape Town, South Africa. All participants were known to have hypertension and were divided into two groups based on office BP measurements: an uncontrolled BP group (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) and a controlled BP group. Fluid status was determined using BIS (Body Composition Monitor®, Fresenius Medical Care, Bad Homburg, Germany).
Results
There was a statistically significant difference in overhydration (OH) between the uncontrolled BP group and the controlled BP group (3.0 ± 2.3 L vs. 1.4 ± 1.6 L, respectively, P = 0.01). The uncontrolled BP group was older (37.7 ± 9.5 years vs. 32.0 ± 8.0 years, P = 0.04) and had a shorter dialysis vintage (15 [IQR, 7–22] months vs. 31 [IQR, 12–39] months, P = 0.02). Significant correlations were found between OH and the extracellular water (ECW) (r = 0.557, P < 0.01) and ECW to total body water (TBW) ratio (r = 0.474, P < 0.01). Mixed ancestry, presence of residual kidney function, ECW, and ECW to TBW ratio were identified as predictors of OH on multivariable linear regression.
Conclusions
We found that stable CAPD patients with uncontrolled BP had higher OH compared to patients whose BP was controlled.
Collapse
|
6
|
Kim JC, Do JY, Kang SH. Clinical Significance of Volume Status in Body Composition and Physical Performance Measurements in Hemodialysis Patients. Front Nutr 2022; 9:754329. [PMID: 35299757 PMCID: PMC8922218 DOI: 10.3389/fnut.2022.754329] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction This study aimed to evaluate the association between volume status and body composition or physical performance measurements in hemodialysis patients. Methods A total of 84 patients were enrolled in this study. The participants were divided into tertiles based on the edema index (extracellular water/total body water): low, middle, and high tertiles. Serum albumin and serum high-sensitivity C-reactive protein levels were measured. The appendicular lean mass index (ALM/Ht2, kg/m2) was measured using dual-energy X-ray absorptiometry. The thigh muscle area index (TMA/Ht2, cm2/m2) was measured using CT. Extracellular and total body water and phase angles were obtained using bioimpedance analysis. The results of the subjective global assessment (SGA), hand-grip strength (HGS), gait speed (GS), short physical performance battery (SPPB), sit-to-stand for 30-second (STS30) test, timed up and go (TUG), sit-to-stand test performed five times (STS5), and 6-minute walk (6-MW) tests were also evaluated. Results On the univariate analysis, the SGA score and phase angle in the high tertile group were the lowest among the three groups. On multivariate analysis, TMA/Ht2 and phase angle in the high tertile were the lowest among the three groups. Inverse correlations were observed between edema index and TMA/Ht2, SGA score, phase angle, HGS, GS, SPPB, STS30, or 6-MW. Positive correlations were observed between the edema index and the STS5 or TUG test. The sensitivity and specificity for predicting low GS were 34.5 and 89.7%, respectively. The values for predicting low SPPB were 68.0 and 79.7%, respectively. Conclusion This study demonstrates that high volume status may be associated with decreased muscle mass and physical performance regardless of inflammatory or nutritional status.
Collapse
Affiliation(s)
- Jun Chul Kim
- Division of Nephrology, Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi, South Korea
| | - Jun Young Do
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, South Korea
- *Correspondence: Seok Hui Kang
| |
Collapse
|
7
|
The effect of sodium exchange and dialytic biochemical parameters on blood pressure, arterial stiffness, and endothelial functions in patients with peritoneal dialysis. Int Urol Nephrol 2020; 52:2197-2203. [PMID: 32948926 DOI: 10.1007/s11255-020-02541-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to investigate the relationship between fluid and sodium excretion and blood pressure, echocardiographic parameters, and arterial stiffness in peritoneal dialysis (PD) patients and to evaluate the effect of sodium excretion on patients' survival. METHOD This study was conducted as a single-centered, prospective study in the Department of Nephrology in Erciyes University. The patients included in the study were followed up for 3 years. Seventy PD patients were included in the study. We recorded demographic characteristics, biochemical parameters, urine and peritoneal ultrafiltration volumes, peritoneal equalization tests, ambulatory blood pressure measurements, and echocardiographic measurements. We measured the amount of total sodium excretion of the patients and arterial stiffness using pulse wave velocity (PWV). Patients were divided into two groups based on the amount of total sodium excretion: low group and high group. We compared these groups in terms of cardiac and biochemical parameters. RESULTS When demographic data and biochemical values were compared, there was no significant difference between the two groups. NT-proBNP level, systolic blood pressure, and mean arterial pressure were significantly higher in the low group (p: 0.02, p: 0.031, p: 0.05, respectively). Net ultrafiltration was significantly higher in the high group (p: 0.03), was also found to be high in patients with high sodium excretion (p: 0.001). Negative correlations were found between sodium excretion and net ultrafiltration, NT-Pro BNP, and PWV. At the end of the 3-year follow-up, the survival rate was shorter and the mortality rate was higher in the low group (p: 0.042). DISCUSSION AND CONCLUSION Fluid status in PD patients can affect arterial stiffness both directly and through hypertension. Correction of hypervolemia has the potential to not only prevent hypertension and left ventricular hypertrophy, but also to improve arterial stiffness, a well-known cardiovascular risk factor. The mortality rate was higher in PD patients with low total sodium excretion. Therefore, these patients should be followed more closely to ensure volume control.
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
A comparative study of ambulatory central hemodynamics and arterial stiffness parameters in peritoneal dialysis and hemodialysis patients. J Hypertens 2020; 38:2393-2403. [PMID: 32694339 DOI: 10.1097/hjh.0000000000002574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ambulatory pulse-wave velocity (PWV), augmentation pressure, and augmentation index (AIx) are associated with increased cardiovascular events and death in hemodialysis. The intermittent nature of hemodialysis generates a distinct ambulatory pattern, with a progressive increase of augmentation pressure and AIx during the interdialytic interval. No study so far has compared the ambulatory course of central hemodynamics and PWV between peritoneal dialysis and hemodialysis patients. METHODS Thirty-eight patients under peritoneal dialysis and 76 patients under hemodialysis matched in a 1 : 2 ratio for age, sex and dialysis vintage underwent 48-h ambulatory blood pressure (BP) monitoring with the oscillometric Mobil-O-Graph device. Parameters of central hemodynamics [central SBP, DBP and pulse pressure (PP)], wave reflection [AIx, heart rate-adjusted AIx; AIx(75) and augmentation pressure] and PWV were estimated from the 48-h recordings. RESULTS Over the total 48-h period, no significant differences were observed between peritoneal dialysis and hemodialysis patients in mean levels of central SBP, DBP, PP, augmentation pressure, AIx, AIx(75) and PWV. However, patients under peritoneal dialysis and hemodialysis displayed different trajectories in all the above parameters over the course of the recording: in peritoneal dialysis patients no differences were noted in central SBP (125.0 ± 19.2 vs. 126.0 ± 17.8 mmHg, P = 0.25), DBP, PP, augmentation pressure (13.0 ± 6.8 vs. 13.7 ± 7. mmHg, P = 0.15), AIx(75) (25.9 ± 6.9 vs. 26.3 ± 7.8%, P = 0.54) and PWV (9.5 ± 2.1 vs. 9.6 ± 2.1 m/s, P = 0.27) from the first to the second 24-h period of the recording. In contrast, hemodialysis patients showed significant increases in all these parameters from the first to second 24 h (SBP: 119.5 ± 14.4 vs. 124.6 ± 15.0 mmHg, P < 0.001; augmentation pressure: 10.9 ± 5.3 vs. 13.1 ± 6.3 mmHg, P < 0.001; AIx(75): 24.7 ± 7.6 vs. 27.4 ± 7.9%, P < 0.001; PWV: 9.1 ± 1.8 vs. 9.3 ± 1.8 m/s, P < 0.001). Peritoneal dialysis patients had numerically higher levels than hemodialysis patients in all the above parameters during all periods studied and especially during the first 24-h. CONCLUSION Central BP, wave reflection indices and PWV during a 48-h recording are steady in peritoneal dialysis but gradually increase in hemodialysis patients. During all studied periods, peritoneal dialysis patients have numerically higher levels of all studied parameters, a fact that could relate to higher cardiovascular risk.
Collapse
|
10
|
Yeter HH, Karacalik C, Eraslan E, Akcay OF, Derici U, Ronco C. Effect of remote patient management in peritoneal dialysis on haemodynamic and volume control. Nephrology (Carlton) 2020; 25:856-864. [PMID: 32621370 DOI: 10.1111/nep.13751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 11/28/2022]
Abstract
AIM Reduced treatment compliance in patients with peritoneal dialysis facilitates the development of fluid overload and as a result increased blood pressure and vascular stiffness in the long term. We aimed to evaluate blood pressure change and anti-hypertensive needs of patients within 1 year after the changeover to remote monitoring automated peritoneal dialysis (RM-APD) and compare the effect of RM-APD and continuous ambulatory peritoneal dialysis (CAPD) on peripheral and central haemodynamic parameters, volume status of patients and anti-hypertensive drug needs. METHODS This was an observational and cross-sectional study. We enrolled 15 patients performing CAPD, 20 patients performing RM-APD, and 38 age, and gender-matched healthy control. We measured pulse wave velocity to assess arterial stiffness, peripheral and central haemodynamic parameters. We measured the volume status of participants via bioimpedance spectroscopy. RESULTS The mean excess hydration of patients who underwent CAPD were higher than those who performed RM-APD and healthy control (P = .02). We found that mean diastolic blood pressure, heart rate, central systolic and diastolic blood pressure, and central pulse pressure were significantly different between the RM-APD, CAPD and healthy control (P = .02, P = .05, P = .007, P = .05 and P = .005, respectively). Post hoc analysis of these results showed that the differences between the groups were caused by the healthy control group and the patients with underwent CAPD. Daily anti-hypertensive drug count in patients with performing RM-APD was reduced over time (P < .001). CONCLUSION The RM-APD provides better control of peripheral blood pressure and decrease of central haemodynamic parameters via controlling the excess body water.
Collapse
Affiliation(s)
- Hasan H Yeter
- Department of Nephrology Dialysis and Transplantation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ceren Karacalik
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Esra Eraslan
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Omer F Akcay
- Department of Nephrology Dialysis and Transplantation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ulver Derici
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Claudio Ronco
- Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| |
Collapse
|
11
|
Tangvoraphonkchai K, Davenport A. Changes in aortic pulse wave velocity in peritoneal dialysis do not mirror changes in extracellular water measured by bioimpedance. Int J Artif Organs 2020; 44:85-91. [PMID: 32552371 DOI: 10.1177/0391398820931109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pulse wave velocity is a measurement of arterial stiffness and associated with increased cardiovascular mortality. Previous reports in peritoneal dialysis have linked increased pulse wave velocity with an expansion in extracellular water. As cardiovascular mortality is increased in peritoneal dialysis patient, we wished to determine whether changes in pulse wave velocity mirrored changes in extracellular water. METHODS We repeated aortic pulse wave velocity and bioimpedance-derived extracellular water measurements in peritoneal dialysis patients attending for assessment of peritoneal membrane function. RESULTS Sixty-six patients, 41 males (62.1%), mean age of 66.2 ± 13.9 years, median duration of peritoneal dialysis treatment (14.3 (3.1-31.9) months) had repeated measurement 6.4 (5.8-10.2) months apart, with no significant change in aortic pulse wave velocity (10.1 ± 3.2 to 9.9 ± 2.8 m/s). In univariate analysis, the initial aortic pulse wave velocity was associated with extracellular water (r = 0.26, p = 0.034) and serum N-terminal pro brain-type natriuretic peptide (r = 0.25, p = 0.04), and on follow-up, aortic pulse wave velocity with N-terminal pro brain-type natriuretic peptide (r = 0.31, p = 0.01). Aortic pulse wave velocity increased in 50% of patients, and these patients had greater serum C-reactive protein 3(2-10) versus 2(1-4) mg/L, and ferritin (778(444-1099) versus 585(313-811), p < 0.05), but there were no differences in either absolute or adjusted extracellular water. Both log C-reactive protein (odds ratio 4.7 (95% confidence limits 1.3-17.1), p = 0.019) and prescription of calcium channel blockers (odds ratio 4.9 (95% confidence limits 1.2-19.1), p = 0.024) were independently associated with an increase in aortic pulse wave velocity. CONCLUSION We did not find an independent association between a change in aortic pulse wave velocity and extracellular water, suggesting that changes in aortic stiffness in peritoneal dialysis patients are more complex than simply following changes in extracellular water.
Collapse
Affiliation(s)
| | - Andrew Davenport
- UCL Department for Nephrology, University College London, London, UK
| |
Collapse
|
12
|
Yang WL, Fahim M, Johnson DW. Pathophysiology and significance of natriuretic peptides in patients with end-stage kidney disease. Clin Biochem 2020; 83:1-11. [PMID: 32511964 DOI: 10.1016/j.clinbiochem.2020.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 12/30/2022]
Abstract
Natriuretic peptides (NP), especially B type (BNP) and its N-terminal pro-B type natriuretic peptide (NT-proBNP), have long been regarded as biomarkers of volume overload and tools to exclude heart failure in the general population. However, their role in end-stage kidney disease (ESKD) is less certain given that BNP and NT-proBNP are excreted by the kidney and so serum concentrations of NPs are nearly universally elevated compared to controls. Nevertheless, the accumulated evidence suggests thatserum concentrations of NPs in patients with ESKD show moderate or strong positive relationships with underlying heart disease, abnormal cardiac structure or function and mortality. Limited evidence also supports the role of BNP including NT-proBNP, ANP in some studies, rather than CNP or DNP in risk stratification among ESKD patients as well as the utility of BNP samplings pre- and post- hemodialysis. However, studies of the cut-off values of NPs have yielded inconsistent results, such that further large-scale studies are needed to clarify these issues. This review summarizes the pathophysiology and significance of NPs in ESKD patients, especially their potential role as risk stratification biomarkers in clinical management.
Collapse
Affiliation(s)
- Wen-Ling Yang
- Department of Nephrology, Peking University Third Hospital, Beijing, China; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Kidney Disease Research, The University of Queensland, Queensland, Australia
| | - Magid Fahim
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Kidney Disease Research, The University of Queensland, Queensland, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Kidney Disease Research, The University of Queensland, Queensland, Australia; Translational Research Institute, Brisbane, Australia.
| |
Collapse
|
13
|
Arterial Stiffness Assessed by Oscillometric Method in Kidney Transplant, Predialysis, and Dialysis Patients. Transplant Proc 2020; 52:2337-2340. [PMID: 32359829 DOI: 10.1016/j.transproceed.2020.01.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/26/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is strongly associated with a higher risk of cardiovascular disease (CV). An important nontraditional risk factor of cardiovascular disease in renal patients is vascular stiffness, which currently can be evaluated by oscillometric measuring of pulse wave velocity (PWV) and heart rate-corrected augmentation index (AIx@75). AIM The aim of our study was to compare vascular stiffness between kidney transplant (KTx) recipients, patients on dialysis maintenance, and those in the predialysis period. MATERIALS AND METHODS A cross-sectional study of 140 patients (52 in CKD stage 3-4; 37 in CKD stage 5 on hemodialysis maintenance [HD]; and 51 KTx recipients) had their PWV and AIx@75 measured with Mobil-O-Graph (IEM Gmbh, Stolberg, Germany) blood and pulse pressure monitor. RESULTS KTx, HD, and CKD G3-4 were comparable in term of age, sex, body mass index, and diagnoses of diabetes mellitus and hypertension. The PWV was higher in the HD group than in the KTx and CKD G3-4 (9.4 m/s vs 8.4 m/s vs 7.9 m/s respectively; P < .05 for HD vs other groups), while the difference between the KTx and CKD G3-4 was not significant. AIx@75 values were similar in the HD and KTx groups (27.1 and 25.6; P > .05) and significantly lower in CDK G3-4 (17.8; P < .05). CONCLUSIONS According to our results, the highest CV risk expressed by PWV (vascular stiffness) was found in hemodialysis patients. Although patients with CKD 3-4 and after KTx showed comparable large artery stiffness, transplant recipients additionally showed higher stiffness in smaller arteries as measured by heart rate-corrected AIx.
Collapse
|
14
|
Hong YA, Yoon HE, Choi BS, Shin SJ, Kim YS, Lee SY, Lee SH, Kim SH, Lee EY, Shin SK, Kwon YJ, Kim JH, Chang YK, Kim SY, Kim JE, Ahn SY, Ko GJ. The Effect of Strict Volume Control Assessed by Repeated Bioimpedance Spectroscopy on Cardiac Function in Peritoneal Dialysis Patients. Sci Rep 2019; 9:17679. [PMID: 31776362 PMCID: PMC6881363 DOI: 10.1038/s41598-019-53792-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 10/31/2019] [Indexed: 01/08/2023] Open
Abstract
Adequate fluid management plays an important role in decreasing cardiovascular risk in peritoneal dialysis (PD) patients. We evaluated whether strict volume control monitored by bioimpedance spectroscopy (BIS) affects cardiac function in PD patients. This study is a secondary analysis of a multicentre, prospective, randomized, controlled trial. Fluid overload was assessed by the average overhydration/extracellular water (OH/ECW) at baseline, 6 months and 12 months. Patients were categorized as time-averaged overhydrated (TA-OH/ECW ≥15%) or normohydrated (TA-OH/ECW <15%), and echocardiographic parameters were compared between groups. Among a total of 151 patients, 120 patients exhibited time-averaged normohydration. Time-averaged overhydrated patients had a significantly higher left atrial (LA) diameter and E/e′ ratio and a lower left ventricular (LV) ejection fraction at 12 months than time-averaged normohydrated patients. LA diameter, end-systolic volume and end-diastolic volume were decreased at 12 months compared to baseline in time-averaged normohydrated patients only. TA-OH/ECW was independently associated with ejection fraction at 12 months (β = −0.190; p = 0.010). TA-OH/ECW, but not OH/ECW at 12 months, was an independent risk factor for LV dysfunction (odds ratio 4.020 [95% confidence interval 1.285–12.573]). Overhydration status based on repeated BIS measurements is an independent predictor of LV systolic function in PD patients.
Collapse
Affiliation(s)
- Yu Ah Hong
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Eun Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bum Soon Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Joon Shin
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Soo Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So Young Lee
- Department of Internal Medicine, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Lee
- Department of Internal Medicine, Kyung Hee University Medical School, Seoul, Republic of Korea
| | - Su Hyun Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Eun Young Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Sug Kyun Shin
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Young Joo Kwon
- Department of Internal Medicine, Korea University School of Medicine, Seoul, Republic of Korea
| | - Jeong Ho Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoon Kyung Chang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Suk Young Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Eun Kim
- Department of Internal Medicine, Korea University School of Medicine, Seoul, Republic of Korea
| | - Shin Young Ahn
- Department of Internal Medicine, Korea University School of Medicine, Seoul, Republic of Korea
| | - Gang Jee Ko
- Department of Internal Medicine, Korea University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
15
|
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: 0.4] [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
|
16
|
Poon PYK, Ng JKC, Fung WWS, Chow KM, Kwan BCH, Li PKT, Szeto CC. Relationship between Plasma Endocan Level and Clinical Outcome of Chinese Peritoneal Dialysis Patients. Kidney Blood Press Res 2019; 44:1259-1270. [PMID: 31587005 DOI: 10.1159/000502961] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/23/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endocan is associated with endothelial dysfunction. In peritoneal dialysis (PD) patients, cardiovascular disease is a common cause of mortality. We examined the relationship between serum endocan level and clinical outcome of PD patients. METHODS We recruited 193 new PD patients (118 males, mean age 58.8 ± 11.6 years). Serum endocan levels were determined and stratified into tertile 1 (lowest) to 3 (highest). Nutritional status, arterial pulse wave velocity (PWV) and serum C-reactive protein (CRP) levels were measured. The patients were followed for at least 4 years for clinical outcomes. RESULTS For the whole cohort, patients with higher serum endocan levels had lower serum albumin and subjective global assessment score, higher carotid-femoral PWV, and higher serum CRP. For patients with suboptimal blood pressure (BP) control, cardiovascular event-free survival was 95.0, 95.5, and 78.5% for tertiles 1, 2, and 3 at 60 months respectively (p = 0.019). Multivariate Cox regression analysis showed that serum endocan level was an independent predictor of cardiovascular event-free survival. No association with cardiovascular event-free survival was found for patients with adequate BP control (95.0, 92.3, and 100% for tertile 1, 2, and 3 at 60 months, respectively, p = 0.6). CONCLUSIONS Higher serum endocan level is associated with unfavourable nutritional, arterial and inflammatory conditions in PD patients. In patients with suboptimal BP control, higher serum endocan is also associated with worse cardiovascular outcome.
Collapse
Affiliation(s)
- Peter Yam-Kau Poon
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Departments of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jack Kit-Chung Ng
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Departments of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Winston Wing-Shing Fung
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Departments of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Kai-Ming Chow
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Departments of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Bonnie Ching-Ha Kwan
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Departments of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Philip Kam-Tao Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Departments of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Cheuk-Chun Szeto
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Departments of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China, .,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China,
| |
Collapse
|
17
|
Rodriguez RA, Hae R, Spence M, Shea B, Agharazii M, Burns KD. A Systematic Review and Meta-analysis of Nonpharmacologic-based Interventions for Aortic Stiffness in End-Stage Renal Disease. Kidney Int Rep 2019; 4:1109-1121. [PMID: 31440701 PMCID: PMC6698308 DOI: 10.1016/j.ekir.2019.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/08/2019] [Accepted: 05/13/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Increased carotid-femoral pulse wave velocity (cf-PWV) in end-stage renal disease (ESRD) indicates enhanced aortic stiffness and mortality risk. We conducted a systematic review and meta-analysis of nonpharmacologic interventions in adults with ESRD to determine their effects on cf-PWV, systolic blood pressure (SBP), and intervention-associated adverse events. Methods MEDLINE, EMBASE, and EBM databases were searched. Study screening, selection, data collection, and methodological quality assessments were performed by 2 independent reviewers. Pooled-effect estimates from mean differences and 95% confidence intervals (CIs) were calculated using random effect models. Results A total of 2166 subjects with ESRD from 33 studies (17 randomized; 16 nonrandomized) were included. Four intervention-comparator pairs were meta-analyzed. Quality of evidence ranged from very low to moderate. Kidney transplantation decreased cf-PWV (−0.70 m/s; CI: –1.3 to −0.11; P = 0.02) and SBP (−8.3 mm Hg; CI: −13.2 to −3.3; P < 0.001) over pretransplantation. In randomized trials, control of fluid overload by bio-impedance reduced cf-PWV (−1.90 m/s; CI: −3.3 to −0.5); P = 0.02) and SBP (−4.3 mm Hg; CI: −7.7 to −0.93); P = 0.01) compared with clinical assessment alone. Cross-sectional studies also demonstrated significantly lower cf-PWV and SBP in normovolemia compared with hypervolemia (P ≤ 0.01). Low calcium dialysate decreased cf-PWV (−1.70 m/s; CI: −2.4 to −1.0; P < 0.00001) without affecting SBP (−1.6 mm Hg; CI: −8.9 to 5.8; P = 0.61). Intradialytic exercise compared with no exercise reduced cf-PWV (−1.13 m/s; CI: −2.2 to −0.03; P = 0.04), but not SBP (+0.5 mm Hg; CI: −9.5 to 10.4); P = 0.93). Conclusions Several nonpharmacologic interventions effectively decrease aortic stiffness in ESRD. The impact of these interventions on cardiovascular outcomes and mortality risk reduction in ESRD requires further study.
Collapse
Affiliation(s)
- Rosendo A Rodriguez
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Richard Hae
- Division of Nephrology, Kidney Research Centre, University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew Spence
- Division of Nephrology, Kidney Research Centre, University of Ottawa, Ottawa, Ontario, Canada
| | - Beverley Shea
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Kevin D Burns
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.,Division of Nephrology, Kidney Research Centre, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
18
|
N-Terminal Pro-Brain Natriuretic Peptide Predicts Long-Term Technique Failure in Patients Undergoing Peritoneal Dialysis. J Clin Med 2018; 7:jcm7120557. [PMID: 30558385 PMCID: PMC6306793 DOI: 10.3390/jcm7120557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 12/06/2018] [Accepted: 12/13/2018] [Indexed: 12/29/2022] Open
Abstract
It is unclear whether N-terminal pro-brain type natriuretic peptide (NT-proBNP) level can be a biomarker for technique failure among long-term peritoneal dialysis (PD) patients. We prospectively included end-stage renal disease patients undergoing PD from a single center between December 2011 and December 2017. We divided the cohort into high or low NT-proBNP groups and analyzed the risk factors associated with the incidence of technique failure using Cox proportional hazard regression analysis. A total of 258 chronic PD patients (serum NT-proBNP, 582 ± 1216 ng/mL) were included. After a mean follow-up of 3.6 years, 49.6% of PD patients developed technique failure and switched to hemodialysis, while 15.5% died. Cox proportional hazard regression analyses accounting for age, gender, diabetes, renal clearance, C-reactive protein, and hydration status, showed that higher natural log transformed NT-proBNP levels (hazard ratio [HR] 1.13, p < 0.01) were predictive of an increased risk of technique failure, and were also predictive of an increased risk of mortality (HR 1.56, p < 0.01). Consequently, NT-proBNP might be an under-recognized biomarker for estimating the risk of technique failure, and regular monitoring NT-proBNP levels among PD patients may assist in their care.
Collapse
|
19
|
Differential effects of arterial stiffness and fluid overload on blood pressure according to renal function in patients at risk for cardiovascular disease. Hypertens Res 2018; 42:341-353. [DOI: 10.1038/s41440-018-0151-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 12/30/2022]
|
20
|
Oh KH, Baek SH, Joo KW, Kim DK, Kim YS, Kim S, Oh YK, Han BG, Chang JH, Chung W, Na KY. Does Routine Bioimpedance-Guided Fluid Management Provide Additional Benefit to Non-Anuric Peritoneal Dialysis Patients? Results from COMPASS Clinical Trial. Perit Dial Int 2018; 38:131-138. [PMID: 29386302 DOI: 10.3747/pdi.2016.00241] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/22/2017] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION In peritoneal dialysis (PD) patients, volume overload is related to cardiac dysfunction and mortality, while intravascular volume depletion is associated with a rapid decline in the residual renal function (RRF). This study sought to determine the clinical usefulness of bioimpedance spectroscopy (BIS)-guided fluid management for preserving RRF and cardiac function in PD patients. SUBJECTS AND METHODS This is a multicenter, prospective, open-label study that was conducted over a 1-year period (NCT01887262). Non-anuric (urine volume > 500 mL/day) subjects on PD were enrolled. Subjects in the control group received fluid management based on the clinical information alone. Those in the BIS group received BIS-guided fluid management along with clinical information. RESULTS The subjects (N = 137, mean age 51.3 ± 12.8 years, 54% male) were randomly assigned to the BIS group (n = 67) or to the control group (n = 70). There were no significant differences between the 2 groups with regard to age, sex ratio, cause of kidney failure, duration of PD, baseline comorbidity, RRF, PD method, or peritoneal transport type. At baseline, the 2 groups were not different in terms of RRF (glomerular filtration rate [GFR], 5.1 ± 2.9 vs 5.5 ± 3.7 mL/min/1.73 m2). After follow-up, changes in the GFR between the 2 groups were not different (-1.5 ± 2.4 vs -1.3 ± 2.6 mL/min/1.73 m2, p = 0.593). Over the 1-year study period, both groups maintained stability of various fluid status parameters. Between the 2 groups, there were no differences in the net change of various fluid status parameters such as overhydration (OH) and extracellular water/total body water (ECW/TBW). A net change in ECW over 1 year was slightly but significantly higher in the control group (net increase, 0.57 ± 1.27 vs 0.05 ± 1.63 L, p = 0.047). However, this difference was not translated into an improvement in RRF in the BIS group. There were no differences in echocardiographic parameters or arterial stiffness at the end of follow-up. CONCLUSION Routine BIS-guided fluid management in non-anuric PD patients did not provide additional benefit in volume control, RRF preservation, or cardiovascular (CV) parameters. However, our study cannot be generalized to the whole PD population. Further research is warranted in order to investigate the subpopulation of PD patients who may benefit from routine BIS-guided fluid management.
Collapse
Affiliation(s)
- Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seon Ha Baek
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi Do, Korea
| | - Kwon-Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi Do, Korea
| | - Yun Kyu Oh
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Byoung Geun Han
- Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Jae Hyun Chang
- Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Wookyung Chung
- Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi Do, Korea
| | | |
Collapse
|
21
|
Dekker MJE, van der Sande FM, van den Berghe F, Leunissen KML, Kooman JP. Fluid Overload and Inflammation Axis. Blood Purif 2018; 45:159-165. [PMID: 29478061 DOI: 10.1159/000485153] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Extracellular fluid overload (FO), which is assessed using bioimpedance technologies, is an important predictor of outcome in dialysis patients and in patients with early stages of chronic kidney disease. While traditional cardiovascular abnormalities are assumed to mediate this risk, recently also, the importance of noncardiovascular factors, such as systemic inflammation and malnutrition has been shown. While both FO and inflammation are independent risk factors for mortality, recent studies have shown that their combined presence can lead to a cumulative risk profile. From a pathophysiologic viewpoint, FO and inflammation can also be mutually reinforcing. Inflammation could contribute to FO by hypoalbuminemia, capillary leakage, and a (unnoticed) decline in lean and/or fat tissue mass resulting in incorrect estimation of dry weight. Reciprocally, FO could lead to inflammation by the translocation of endotoxins through a congested bowel wall or by a proinflammatory effect of tissue sodium. The relative importance of these putative factors is, however, not clear yet and epidemiological studies have shown no clear temporal direction regarding the relationship between FO and inflammation. FO and inflammation appear to be part of (dynamic) clusters of risk factors, including malnutrition and hyponatremia. Technology-guided fluid management of the often vulnerable dialysis patient with FO and inflammation cannot yet be based on evidence from randomized controlled trials, in which these specific patients were in general not included. In the absence of those trials, treatment should be based on identifying actionable causes of inflammation and on the judicious removal of excess volume based on frequent clinical reassessment.
Collapse
|
22
|
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: 5] [Impact Index Per Article: 0.8] [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
|
23
|
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: 1.7] [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
|
24
|
Niiranen TJ, Kalesan B, Larson MG, Hamburg NM, Benjamin EJ, Mitchell GF, Vasan RS. Aortic-Brachial Arterial Stiffness Gradient and Cardiovascular Risk in the Community: The Framingham Heart Study. Hypertension 2017; 69:1022-1028. [PMID: 28396534 DOI: 10.1161/hypertensionaha.116.08917] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/13/2017] [Accepted: 03/08/2017] [Indexed: 01/13/2023]
Abstract
A recent study reported that the aortic-brachial arterial stiffness gradient, defined as carotid-radial/carotid-femoral pulse wave velocity (PWV ratio), predicts all-cause mortality better than carotid-femoral pulse wave velocity (CFPWV) alone in dialysis patients. However, the prognostic significance of PWV ratio for cardiovascular disease (CVD) in the community remains unclear. Accordingly, we assessed the correlates and prognostic value of the PWV ratio in 2114 Framingham Heart Study participants (60±10 years; 56% women) free of overt CVD. Mean PWV ratio decreased from 1.36±0.19 in participants aged <40 years to 0.73±0.21 in those aged ≥80 years. In multivariable linear regression, older age, male sex, higher body mass index, diabetes mellitus, lower high-density lipoprotein cholesterol, higher mean arterial pressure, and higher heart rate were associated with lower PWV ratio (P<0.001 for all). During a median follow-up of 12.6 years, 248 first CVD events occurred. In Cox regression models adjusted for standard CVD risk factors, 1-SD changes in CFPWV (hazard ratio, 1.33; 95% confidence interval, 1.10-1.61) and PWV ratio (hazard ratio, 1.32; 95% confidence interval, 1.09-1.59) were associated with similar CVD risks. Models that included conventional CVD risk factors plus CFPWV or PWV ratio gave the same C statistics (C=0.783). Although PWV ratio has been reported to provide incremental predictive value over CFPWV in dialysis patients, we could not replicate these findings in our community-based sample. Our findings suggest that the prognostic significance of PWV ratio may vary based on baseline CVD risk, and CFPWV should remain the criterion standard for assessing vascular stiffness in the community.
Collapse
Affiliation(s)
- Teemu J Niiranen
- From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.).
| | - Bindu Kalesan
- From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.)
| | - Martin G Larson
- From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.)
| | - Naomi M Hamburg
- From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.)
| | - Emelia J Benjamin
- From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.)
| | - Gary F Mitchell
- From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.)
| | - Ramachandran S Vasan
- From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.)
| |
Collapse
|
25
|
Nakahigashi M, Tsukaguchi H, Morimoto S, Nakano C, Ueda H, Someya K, Kusabe M, Kikuchi S, Imada T, Shiojima I. Determinants of the Change in Arterial Stiffness in Peritoneal Dialysis Patients. Int Heart J 2017; 58:915-925. [DOI: 10.1536/ihj.16-624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Satoshi Morimoto
- Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University
| | | | - Hiroko Ueda
- Department of Medicine II, Kansai Medical University
| | | | - Makiko Kusabe
- Department of Medicine II, Kansai Medical University
| | - Sanae Kikuchi
- Department of Medicine II, Kansai Medical University
| | | | | |
Collapse
|
26
|
Yilmaz A, Yilmaz B, Küçükseymen S, Özpelit E, Pekel N. Association of overhydration and cardiac dysfunction in patients have chronic kidney disease but not yet dialysis. Nephrol Ther 2015; 12:94-7. [PMID: 26612488 DOI: 10.1016/j.nephro.2015.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/25/2015] [Accepted: 08/01/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND/AIM Fluid overload and cardiac dysfunction is well established in hemodialysis patients. But in predialysis chronic kidney disease, the association of fluid overload and cardiac dysfunction is relatively unknown. In this study, we aimed to investigate the relationship between fluid overload and cardiac dysfunction in predialysis chronic kidney disease patients. METHOD We enrolled 107 consecutive patients in our study. Fluid overload was assessed via body composition monitor. Patients were dichotomized according to the fluid overload status. The patients with FO < 1.1L were determined as normovolemic and those with FO ≥ 1.1L as hypervolemic according to the previously reported physiologic model. Left atrial volume index (LAVI), left ventricular end-diastolic-end-systolic index (LVEDVI, LVESVI), E/e', LVMI and global longitudinal left ventricular left ventricular strain (GLS-%) were evaluated in each patient as markers of cardiac dysfunction. Arterial stiffness was also assessed by Mobil-O-Graph(®) 24h pulse wave analysis monitor and pWV values were recorded. RESULTS Fifty-five patients were normovolemic and 52 patients were hypervolemic. LAVI, LVMI, LDEDVI, LVEDSVI, E/e' were increased in hypervolemic patients. Also in hypervolemic patients pulse wave velocity was increased and GLS was decreased. Multivariate analysis showed that FO was independently associated with GLS which is the most specific echo-parameter for left ventricular dysfunction. CONCLUSION FO was independently associated with cardiac dysfunction in patients with chronic kidney disease not ongoing dialysis. Effective treatment of hypervolemia may be important in these patients to avoid further cardiac damage.
Collapse
Affiliation(s)
- Akar Yilmaz
- Izmir University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey.
| | - Banu Yilmaz
- Tepecik Training and Research Hospital, Clinic of Nephrology, Izmir, Turkey
| | - Selçuk Küçükseymen
- Antalya Training and Research Hospital, Clinic of Cardiology, Izmir, Turkey
| | - Emre Özpelit
- Izmir University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - Nihat Pekel
- Izmir University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| |
Collapse
|
27
|
Szeto CC, Kwan BCH, Chow KM, Cheng PMS, Kwong VWK, Choy ASM, Law MC, Leung CB, Li PKT. The Effect of Neutral Peritoneal Dialysis Solution with Low Glucose-Degradation-Product on the Fluid Status and Body Composition--A Randomized Control Trial. PLoS One 2015; 10:e0141425. [PMID: 26510186 PMCID: PMC4625015 DOI: 10.1371/journal.pone.0141425] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/02/2015] [Indexed: 11/19/2022] Open
Abstract
Background Previous studies report conflicting results on the benefit of peritoneal dialysis (PD) patients treated with low glucose degradation product (GDP) solution. The effects of low GDP solution on body fluid status and arterial pulse wave velocity (PWV) have not been studied. Methods We randomly assigned 68 incident PD patients to low GDP (Intervention Group) or conventional solutions (Control Group); 4 dropped off before they received the assigned treatment. Patients were followed for 52 weeks for changes in ultrafiltration, residual renal function, body fluid status and arterial PWV. Result After 52 weeks, Intervention Group had higher overhydration (3.1 ± 2.6 vs 1.9 ± 2.2 L, p = 0.045) and extracellular water volume (17.7 ± 3.9 vs 15.8 ± 3.1 L, p = 0.034) than Control Group. There was no significant difference in PWV between groups. There was no significant difference in residual renal function between the Groups. Intervention Group had lower ultrafiltration volume than Control Group at 4 weeks (0.45 ± .0.61 vs 0.90 ± 0.79 L/day, p = 0.013), but the difference became insignificant at later time points. Intervention Group had lower serum CRP levels than Control Group (4.17 ± 0.77 vs 4.91 ± 0.95 mg/dL, p < 0.0001). Conclusion Incident PD patients treated with low GDP solution have less severe systemic inflammation but trends of less ultrafiltration, and more fluid accumulation. However, the effects on ultrafiltration and fluid accumulation disappear with time. The long term effect of low GDP solution requires further study. Trial Registration ClinicalTrials.gov NCT00966615
Collapse
Affiliation(s)
- Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- * E-mail:
| | - Bonnie C. H. Kwan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kai-Ming Chow
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Phyllis M. S. Cheng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Vickie W. K. Kwong
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnes S. M. Choy
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Man-Ching Law
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Chi-Bon Leung
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Philip K. T. Li
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| |
Collapse
|
28
|
Akonur A, Firanek CA, Gellens ME, Hutchcraft AM, Kathuria P, Sloand JA. Volume-Based Peritoneal Dialysis Prescription Guide to Achieve Adequacy Targets. Perit Dial Int 2015; 36:188-95. [PMID: 26293841 DOI: 10.3747/pdi.2014.00255] [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] [Received: 02/23/2015] [Accepted: 02/25/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND The use of automated and continuous ambulatory peritoneal dialysis (APD and CAPD) prescriptions (Rxs) to achieve adequate uremic toxin and fluid removal targets is important for attaining optimal patient outcomes. One approach for predicting such Rxs is the use of kinetic modeling. ♦ METHODS Demographic data and peritoneal membrane characteristics derived from a peritoneal equilibration test (PET) were available from 1,005 patients in North American centers who participated in a national adequacy initiative in 1999. Twelve patient subgroups were identified according to peritoneal membrane transport type and tertiles of total body water, assumed equal to urea distribution volume (Vurea). Each patient was then modeled using PD Adequest 2.0 to be treated by 12 CAPD and 34 APD Rxs using both glucose and icodextrin solutions to achieve adequacy targets of weekly urea Kt/V of 1.7 and 1 L of daily ultrafiltration (UF). Residual kidney function (RKF) was assumed to be 0, 2, 4, and 6 mL/min. Feasible peritoneal dialysis (PD) Rxs were identified where: 1) the 95% confidence limit achieved the goal of meeting the targets for urea Kt/V, daily UF, and both in 85%, 75%, and 70% of patients, respectively; 2) average PD solution dextrose concentration was < 2.5%; and 3) the number of daytime exchanges was minimized. ♦ RESULTS Feasible PD Rxs were similar when RKF was ≥ 2 mL/min, allowing condensed recommendations based on RKF ≥ 2 mL/min or < 2 mL/min. Individuals with lower or slower membrane transport required relatively greater 24-h solution volumes to achieve adequacy targets when RKF fell below 2 mL/min. With increasing Vurea, there was disproportionately greater dependence on RKF to achieve targets. While multiple Rxs achieving urea Kt/V and daily UF goals were identified for all membrane transport types, use of icodextrin in the long dwell reduced the need for a midday exchange in APD, glucose exposure, required fill and 24-h dwell volumes, irrespective of RKF and Vurea. While these benefits were most notable in high and high-average transporters, similar results were also seen in low and low-average transporters. ♦ CONCLUSIONS Kinetic modeling identified multiple APD and CAPD Rxs that achieved adequate uremic solute and fluid removal for patients, irrespective of RKF and Vurea. Use of icodextrin rather than glucose in the long dwell reduced the complexity of the PD regimen, total glucose exposure, and 24-h total treatment solution volumes. Irrespective of modeling, adequacy of any PD prescription should be based upon individual clinical evaluation both for volume and solute removal.
Collapse
|