1
|
Kobayashi R, Kinugasa S, Kamano D, Sumura R, Kakiwaki H, Haze T, Ono K, Yanagi M, Tamura K, Ishibashi Y. Impact of compliance with salt management guidelines before dialysis introduction on peritoneal dialysis technique survival: The importance of pre-dialysis care and education. Ther Apher Dial 2024. [PMID: 38783565 DOI: 10.1111/1744-9987.14167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 05/04/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Peritoneal dialysis (PD) is a mode of therapy in which the patients themselves actively participate in the care of their own disease. We examined a possible association of salt reduction before starting dialysis with PD technique survival. METHODS This retrospective cohort study included 42 patients who started PD between April 2014 and March 2018. Participants were allocated to two groups based on their estimated daily salt intake before the initiation of dialysis: patients with an estimated daily salt intake <6 g/day were allocated to the appropriate salt intake group (AS group), while the rest were assigned to the high salt intake group (HS group). RESULTS During a median follow-up of 47 months, PD technique survival, defined by death or transition to hemodialysis, was significantly lower in the HS group compared to the AS group. CONCLUSION Successful salt reduction before dialysis introduction is associated with better PD technique survival.
Collapse
Affiliation(s)
- Ryu Kobayashi
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Satoshi Kinugasa
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Daisuke Kamano
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Rena Sumura
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hirotoshi Kakiwaki
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Tatsuya Haze
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Keisuke Ono
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Mai Yanagi
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoshitaka Ishibashi
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| |
Collapse
|
2
|
Nekooeian M, Roozbeh J, Ezzatzadegan Jahromi S, Moaref A, Masjedi F. The superiority of bioimpedance vs. echocardiography and pitting edema in predicting automated office blood pressure in continuous ambulatory peritoneal dialysis patients. Ther Apher Dial 2024; 28:272-283. [PMID: 37850431 DOI: 10.1111/1744-9987.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION To achieve optimal blood pressure control in continuous ambulatory peritoneal dialysis (CAPD) patients, identifying methods of volume assessment with the strongest correlation with blood pressure is essential. METHODS In this cross-sectional study, 52 CAPD patients were assigned to automated office blood pressure (AOBP) measurement, assessment of pedal pitting edema, bioimpedance analysis (BIA), and inferior vena cava collapsibility index (IVCCI%) measurement. Data were analyzed using STATA ver.17, and the significance level was p < 0.05. RESULTS Fifty-two patients were divided based on their AOBP readings. 29 (55.8%) of patients had uncontrolled AOBP. Overhydration (OH) and the grade of pitting edema were significantly higher in the uncontrolled AOBP group. OH was identified as the best variable for predicting blood pressure (p ≤ 0.001) and detecting uncontrolled blood pressure (AUC = 0.832) using multivariate linear regression and ROC analysis, respectively. CONCLUSION BIA-derived OH was the best variable for predicting systolic and diastolic AOBP, outperforming IVCCI% and pitting edema.
Collapse
Affiliation(s)
- Mohammad Nekooeian
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jamshid Roozbeh
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrokh Ezzatzadegan Jahromi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Alireza Moaref
- Department of Cardiology, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
- Cardiovascular Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Fatemeh Masjedi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
3
|
Heimbürger O, Hegbrant J, Martus G, Wilkie M, De Leon C, Carlsson O, Johansson AC. Effects of Steady Glucose Concentration Peritoneal Dialysis on Ultrafiltration Volume and Sodium Removal: A Pilot Crossover Trial. Clin J Am Soc Nephrol 2024; 19:224-232. [PMID: 37902732 PMCID: PMC10861104 DOI: 10.2215/cjn.0000000000000342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/23/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Volume overload is common in patients treated with peritoneal dialysis (PD) and is associated with poor clinical outcome. Steady concentration PD is where a continuous glucose infusion maintains the intraperitoneal glucose concentration and as a result provides continuous ultrafiltration throughout the dwell. The primary objective of this study was to investigate the ultrafiltration rate and glucose ultrafiltration efficiency for steady concentration PD in comparison with a standard continuous ambulatory PD (CAPD) dwell, using the novel Carry Life UF device. METHODS Eight stable patients treated with PD (six fast and two fast average transporters) were investigated four times: a standard 4-hour CAPD dwell with 2 L of 2.5% dextrose solution as control and three 5-hour steady concentration PD treatments (glucose dose 11, 14, 20 g/h, initial fill 1.5 L of 1.5% dextrose solution). All investigations were preceded by an overnight 2 L 7.5% icodextrin dwell. RESULTS Intraperitoneal glucose concentration increased during the first 1-2 hours of the steady concentration PD treatments and remained stable thereafter. Ultrafiltration rates were significantly higher with steady concentration PD treatments (124±49, 146±63, and 168±78 mL/h with 11, 14, and 20 g/h, respectively, versus 40±60 mL/h with the control dwell). Sodium removal and glucose ultrafiltration efficiency (ultrafiltration volume/gram glucose uptake) were significantly higher with steady concentration PD treatments versus the control dwell, where the 11 g/h glucose dose was most efficient. CONCLUSIONS Steady concentration PD performed with the Carry Life UF device resulted in higher ultrafiltration rates, more efficient use of glucose (increased ultrafiltration volume/gram glucose absorbed), and greater sodium removal compared with a standard 2.5% dextrose CAPD dwell. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER A Performance Analysis of the Peritoneal Ultrafiltration (PUF) Achieved With the Carry Life ® UF, NCT03724682 .
Collapse
Affiliation(s)
- Olof Heimbürger
- Medical Unit Renal Medicine, Karolinska University Hospital, and CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Jörgen Hegbrant
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Giedre Martus
- Department of Nephrology, Skåne University Hospital, Lund, Sweden
| | - Martin Wilkie
- Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | | | | | | |
Collapse
|
4
|
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
|
5
|
Than WH, Chan GCK, Kwan BCH, Lai KB, Chan RCK, Teoh JYC, Ng JKC, Fung WWS, Chow KM, Cheng PMS, Li PKT, Szeto CC. Plasma vaspin levels and clinical outcome in incident peritoneal dialysis patients. BMC Nephrol 2023; 24:206. [PMID: 37438733 DOI: 10.1186/s12882-023-03259-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/29/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Vaspin is an adipokine that regulates glucose and lipid metabolism. Plasma vaspin level is increased in chronic kidney disease but decreased in hemodialysis patients. However, plasma vaspin level in peritoneal dialysis (PD) patients, as well as its prognostic role, has not been studied. METHODS We recruited 146 incident PD patients. Their baseline plasma vaspin levels, body anthropometry, the profile of insulin resistance, bioimpedance spectroscopy parameters, dialysis adequacy, and nutritional indices were measured. They were followed for up to 5 years for survival analysis. RESULTS The average age was 58.4 ± 11.8 years; 96 patients (65.8%) were men, and 90 (61.6%) had diabetes. The median vaspin level was 0.18 ng/dL (interquartile range [IQR] 0.11 to 0.30 ng/dL). Plasma vaspin level did not have a significant correlation with adipose tissue mass or baseline insulin level. However, plasma vaspin level had a modest correlation with the change in insulin resistance, as represented by the HOMA-IR index, in non-diabetic patients (r = -0.358, p = 0.048). Although the plasma vaspin level quartile did not have a significant association with patient survival in the entire cohort, it had a significant interaction with diabetic status (p < 0.001). In nondiabetic patients, plasma vaspin level quartile was an independent predictor of patient survival after adjusting for confounding clinical factors (adjusted hazard ratio 2.038, 95% confidence interval 1.191-3.487, p = 0.009), while the result for diabetic patients was not significant. CONCLUSIONS Plasma vaspin level quartile had a significant association with patient survival in non-diabetic PD patients. Baseline plasma vaspin level also had a modest inverse correlation with the subsequent change in the severity of insulin resistance, but the exact biological role of vaspin deserves further studies.
Collapse
Affiliation(s)
- Win Hlaing Than
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Shatin, NT, China
| | - Gordon Chun-Kau Chan
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, Shatin, NT, China
| | - Bonnie Ching-Ha Kwan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Shatin, NT, China
| | - Ka-Bik Lai
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Shatin, NT, China
| | - Ronald Cheong-Kin Chan
- Department of Anatomical & Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Jack Kit-Chung Ng
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, Shatin, NT, China
| | - Winston Wing-Shing Fung
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, Shatin, NT, China
| | - Kai-Ming Chow
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, Shatin, NT, China
| | - Phyllis Mei-Shan Cheng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Shatin, NT, China
- Li Ka Shing Institute of Health Sciences (LiHS), The Chinese University of Hong Kong, Hong Kong, China
| | - Philip Kam-Tao Li
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, Shatin, NT, China
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Shatin, NT, China.
- Li Ka Shing Institute of Health Sciences (LiHS), The Chinese University of Hong Kong, Hong Kong, China.
| |
Collapse
|
6
|
Chan GCK, Fung WWS, Szeto CC, Ng JKC. From MIA to FIFA: The vicious matrix of frailty, inflammation, fluid overload and atherosclerosis in peritoneal dialysis. Nephrology (Carlton) 2023; 28:215-226. [PMID: 36807408 DOI: 10.1111/nep.14150] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/25/2023] [Accepted: 02/14/2023] [Indexed: 02/20/2023]
Abstract
Cardiovascular disease (CVD) is a major cause of mortality and morbidity in peritoneal dialysis (PD) patients. Two decades ago, the common co-existence of malnutrition and systemic inflammation PD patients with atherosclerosis and CVD led to the proposed terminology of 'malnutrition-inflammation-atherosclerosis (MIA) syndrome'. Although the importance of malnutrition is well accepted, frailty represents a more comprehensive assessment of the physical and functional capability of the patient and encompasses the contributions of sarcopenia (a key component of malnutrition), obesity, cardiopulmonary as well as neuropsychiatric impairment. In recent years, it is also increasingly recognized that fluid overload is not only the consequence but also play an important role in the pathogenesis of CVD. Moreover, fluid overload is closely linked with the systemic inflammatory status, presumably by gut oedema, gastrointestinal epithelial barrier dysfunction and leakage of bacterial fragments to the systemic circulation. There are now a wealth of published evidence to show intricate relations between frailty, inflammation, fluid overload and atherosclerotic disease in patients with chronic kidney disease (CKD) and those on PD, a phenomenon that we propose the term 'FIFA complex'. In this system, frailty and atherosclerotic disease may be regarded as two patient-oriented outcomes, while inflammation and fluid overload are two inter-connected pathogenic processes. However, there remain limited data on how the treatment of one component affect the others. It is also important to define how treatment of fluid overload affect the systemic inflammatory status and to develop effective anti-inflammatory strategies that could alleviate atherosclerotic disease and frailty.
Collapse
Affiliation(s)
- Gordon Chun-Kau Chan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Winston Wing-Shing Fung
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jack Kit-Chung Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
7
|
Omentin-1 Levels and Outcomes in Incident Peritoneal Dialysis Patients. Kidney Med 2023; 5:100598. [PMID: 36852091 PMCID: PMC9958401 DOI: 10.1016/j.xkme.2023.100598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Rationale & Objective Omentin-1 is an adipokine with anti-inflammatory and cardioprotective properties. The objective of this study was to determine the prognostic role of plasma omentin-1 levels in incident peritoneal dialysis (PD) patients. Study Design Retrospective analysis of prospective cohort. Setting & Participants 152 incident PD patients. Predictors Plasma omentin-1 level, adipose tissue omentin-1 messenger RNA (mRNA) expression. Outcomes Patient survival, technique survival, hospital admission, and duration of stay. Analytical Approach Time-to-event survival analyses; linear regression for hospitalization. Results The mean age was 58.4 ± 11.7 years; 102 were men, and 92 had diabetes. There was no significant correlation between plasma omentin-1 level and its adipose tissue mRNA expression. A higher plasma omentin-1 level quartile was not associated with patient survival (P = 0.92) or technique survival (P = 0.83) but had a modest correlation with a lower number of hospital admissions (P = 0.07) and shorter duration of hospital stay (P = 0.04). In adjusted models using multivariable linear regression, a higher plasma omentin-1 level quartile remained significantly associated with fewer hospital admissions (β, -0.13; 95% CI, -0.26 to -0.002; P = 0.05) and shorter hospitalization duration (β, -0.20; 95% CI, -0.38 to -0.02; P = 0.03). Limitations Observational study with baseline measures only. Conclusions Plasma omentin-1 level was not associated with patient survival, technique survival, or peritonitis, but higher plasma omentin-1 levels were associated with fewer hospital admissions and shorter duration of hospitalization among incident PD patients.
Collapse
|
8
|
Than WH, Chan GCK, Kwan BCH, Lai KB, Chan RCK, Teoh JYC, Ng JKC, Fung WWS, Chow KM, Cheng PMS, Law MC, Li PKT, Szeto CC. Circulating and Adipose Tissue Adiponectin Level and Outcomes in Incident Peritoneal Dialysis Patients. Kidney Med 2022; 5:100589. [PMID: 36793851 PMCID: PMC9922972 DOI: 10.1016/j.xkme.2022.100589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Rationale & Objective Cardiovascular disease is the major cause of mortality and morbidity in peritoneal dialysis (PD) patients. Adiponectin, a key adipokine, is related to obesity and insulin resistance. We determined the clinical and prognostic value of plasma adiponectin level and its adipose tissue messenger RNA (mRNA) expression in new PD patients. Study Design Retrospective analysis of a prospective observational study. Setting & Participants 152 new PD patients from a single center; 6 adults undergoing abdominal surgeries without kidney disease served as controls. Predictors Plasma adiponectin level and its adipose tissue mRNA expression. Outcomes Body build and composition, patient and technique survival. Analytical Approach Adiponectin level and mRNA expression were grouped in quartiles for correlation analysis for body build and Cox regression for survival analysis. Results The median plasma adiponectin level was 31.98 μg/mL (IQR, 16.81-49.49 μg/mL), and adiponectin mRNA expression in adipose tissue was 1.65 times higher than in controls (IQR, 0.98-2.63). There was a modest but statistically significant correlation between plasma adiponectin and its adipose tissue mRNA expression (r = 0.40, P < 0.001). Plasma adiponectin level inversely correlated with body mass index, waist-hip ratio, mid-arm circumference, adipose tissue mass, plasma triglyceride (r = -0.39, -0.38, -0.41, -0.38, and -0.30, respectively; P < 0.001 for all), as well as serum insulin level (r = -0.24, P = 0.005). Similar correlations were present but less marked with adipose tissue adiponectin mRNA level. Neither plasma adiponectin level nor adipose tissue adiponectin mRNA level predicted patient or technique survival. Limitations Observational study, single center, single baseline measurement. Conclusions Plasma adiponectin level correlated with the degree of adiposity in new PD patients. However, neither plasma adiponectin level nor its adipose tissue mRNA expression was an independent prognostic indicator in kidney failure patients newly started on PD.
Collapse
Affiliation(s)
- Win Hlaing Than
- 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,Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Gordon Chun-Kau Chan
- 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
| | - Bonnie Ching-Ha 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
| | - Ka-Bik Lai
- 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
| | - Ronald Cheong-Kin Chan
- Department of Anatomical & Cellular Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jeromy Yuen Chun Teoh
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jack Kit-Chung Ng
- 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
| | - Winston Wing-Shing Fung
- 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 Mei-Shan 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
| | - 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
| | - Philip Kam-Tao 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
| | - 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,Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China,Address for Correspondence: Cheuk-Chun Szeto, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China.
| |
Collapse
|
9
|
Ng JKC, Than WH, Szeto CC. Obesity, Weight Gain, and Fluid Overload in Peritoneal Dialysis. FRONTIERS IN NEPHROLOGY 2022; 2:880097. [PMID: 37675033 PMCID: PMC10479638 DOI: 10.3389/fneph.2022.880097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/02/2022] [Indexed: 09/08/2023]
Abstract
Obesity is a global epidemic that has a complicated pathogenesis as well as impact on the outcome of peritoneal dialysis (PD) patients. In this review, the prevalence of obesity in incident PD patients as well as the phenomenon of new-onset glucose intolerance after PD will be reviewed. Published literature on the effect of obesity on the survival and incidence of cardiovascular disease in PD patients will be discussed. Particular emphasis would be put on literature that compared the impact of obesity on the outcome of hemodialysis and PD, and the confounding effect of dialysis adequacy. Next, the complex concept of obesity and its relevance for PD will be explored. The focus would be put on the methods of assessment and clinical relevance of central versus general obesity, as well as visceral versus subcutaneous adipose tissue. The relation between obesity and systemic inflammation, as well as the biological role of several selected adipokines will be reviewed. The confounding effects of metabolic syndrome and insulin resistance will be discussed, followed by the prevalence and prognostic impact of weight gain during the first few years of PD. The differences between weight gain due to fluid overload and accumulation of adipose tissue will be discussed, followed by the current literature on the change in body composition after patients are put on chronic PD. The methods of body composition will be reviewed, and the clinical relevance of individual body component (fluid, fat, muscle, and bone) will be discussed. The review will conclude by highlighting current gaps of knowledge and further research directions in this area.
Collapse
Affiliation(s)
- Jack Kit-Chung Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Win Hlaing Than
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - 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 SAR, China
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| |
Collapse
|
10
|
Adipose and serum zinc alpha-2-glycoprotein (ZAG) expressions predict longitudinal change of adiposity, wasting and predict survival in dialysis patients. Sci Rep 2022; 12:9087. [PMID: 35641588 PMCID: PMC9158927 DOI: 10.1038/s41598-022-13149-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/18/2022] [Indexed: 11/29/2022] Open
Abstract
There were limited data on adipose and serum zinc alpha-2-glycoprotein (ZAG) expression and its association with body composition in patients with advanced chronic kidney disease (CKD). This study aimed to quantify adipose and serum ZAG expression and evaluate their association with body composition and its longitudinal change, together with mortality in incident dialysis patients. We performed a single-center prospective cohort study. Patients who were planned for peritoneal dialysis were recruited. ZAG levels were measured from serum sample, subcutaneous and pre-peritoneal fat tissue obtained during peritoneal dialysis catheter insertion. Body composition and functional state were evaluated by bioimpedance spectroscopy and Clinical Frailty Scale respectively at baseline and were repeated 1 year later. Primary outcome was 2-year survival. Secondary outcomes were longitudinal changes of body composition. At baseline, the average adipose and serum ZAG expression was 13.4 ± 130.0-fold and 74.7 ± 20.9 µg/ml respectively. Both adipose and serum ZAG expressions independently predicted adipose tissue mass (ATM) (p = 0.001, p = 0.008, respectively). At 1 year, ATM increased by 3.3 ± 7.4 kg (p < 0.001) while lean tissue mass (LTM) remained similar (p = 0.5). Adipose but not serum ZAG level predicted change in ATM (p = 0.007) and LTM (p = 0.01). Serum ZAG level predicted overall survival (p = 0.005) and risk of infection-related death (p = 0.045) after adjusting for confounders. In conclusion, adipose and serum ZAG levels negatively correlated with adiposity and predicted its longitudinal change of fat and lean tissue mass, whilst serum ZAG predicted survival independent of body mass in advanced CKD patient.
Collapse
|
11
|
Ng JKC, Chan GCK, Li PKT. Icodextrin in Peritoneal Dialysis: Implications on Clinical Practice and Survival Outcome. KIDNEY360 2022; 3:793-795. [PMID: 36128486 PMCID: PMC9438428 DOI: 10.34067/kid.0001902022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Jack Kit-Chung Ng
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - Gordon Chun-Kau Chan
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - Philip Kam-Tao Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| |
Collapse
|
12
|
Liu S, Zhang L, Ma S, Xiao J, Liu D, Ding R, Li Z, Zhao Z. Kt/V reach rate is associated with clinical outcome in incident peritoneal dialysis patients. Ren Fail 2022; 44:482-489. [PMID: 35285393 PMCID: PMC8928818 DOI: 10.1080/0886022x.2022.2048854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The urea clearance index (Kt/V) is an important index for predicting the clinical outcome of peritoneal dialysis (PD) patients, but it changes with time depending on the clinical condition. This study aimed to investigate the association between the Kt/V reach rate (defined as the percentage of Kt/V measurements that reached ≥ 1.70) and clinical outcome in incident PD patients. Methods In this retrospective cohort study, 210 patients were enrolled from the First Affiliated Hospital of Zhengzhou University from 1 January 2013 to 31 October 2019. The target Kt/V reach rate in the first year was applied as the predictor variable. Kaplan-Meier survival curves were drawn to evaluate differences in prognosis. The association between Kt/V reach rate and the composite clinical outcome (death or transfer to hemodialysis) was tested by Cox regression analysis. Results The dialysis adequacy group (Kt/V reach rate 3/3 times) and the dialysis intermittent adequacy group (1/3 or 2/3 times) had significantly better clinical outcomes than the dialysis inadequacy group (0/3 times). There was no difference in clinical outcome between the lower-rate group (reach rate 1/3 times) and the higher-rate group (2/3 times). Compared with the dialysis inadequacy group, the dialysis intermittent adequacy group and dialysis adequacy group had significantly lower risks of the composite outcome (HR 0.487, 95% CI 0.244–0.971, p = 0.041; HR 0.150, 95% CI 0.043–0.520, p = 0.003) in the fully adjusted analysis. Conclusion Higher Kt/V reach rates are associated with a better prognosis in incident PD patients.
Collapse
Affiliation(s)
- Shuang Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lijie Zhang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuang Ma
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Xiao
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dong Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui Ding
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhengyan Li
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
13
|
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
|
14
|
Than WH, Ng JKC, Chan GCK, Fung WWS, Chow KM, Szeto CC. The change in the prevalence of obesity and new-onset diabetes in Chinese peritoneal dialysis patients over 25 years. Clin Kidney J 2022; 15:70-78. [PMID: 35035938 PMCID: PMC8757419 DOI: 10.1093/ckj/sfab139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background The global prevalence of both obesity and end-stage kidney diseases (ESKDs) has increased in recent decades. Given the complicated interaction between obesity and ESKD, we examined the change in the prevalence of obesity in incident Chinese peritoneal dialysis (PD) patients over the past 25 years. Methods We reviewed the anthropometric measures of incident PD patients in a single Hong Kong center from 1995 to 2019. The results are reported in five 5-year periods. Patients with and without diabetes were analyzed separately, and the incidence of new-onset diabetes after PD was explored. Results We reviewed 1681 patients. Their mean age was 58.4 ± 12.5 years; 931 patients (55.4%) had pre-existing diabetes. From 1995–99 to 2015–19, the prevalence of obesity or overweight at the initiation of PD increased progressively for every 5-year period (from 21.9% to 26.2, 37.9, 42.7 and 47.3%, P < 0.001 for linearity). The increase in the prevalence of obesity or overweight was more pronounced in diabetic patients (from 33.7% to 59.6%) than non-diabetic ones (from 13.2% to 32.3%). Among nondiabetics patients, the incidence of new-onset diabetes after started on PD showed an insignificant rising trend during that period (from 18.0, 19.7, 17.8 and 22.4% to 23.3%, P = 0.106). The incidence of new-onset impaired fasting glucose or diabetes was significantly higher in obese or overweight patients than the others (56.9% versus 51.4%, P < 0.001). Conclusions The prevalence of obesity has increased substantially in both diabetic and nondiabetic new PD patients in Hong Kong over the past 25 years. The incidence of new-onset diabetes was significantly higher in new PD patients with pre-existing obesity or overweight than those without obesity. The prognostic implication and impacts on the healthcare system deserve further studies.
Collapse
Affiliation(s)
- Win Hlaing Than
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Jack Kit-Chung Ng
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Gordon Chun-Kau Chan
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Winston Wing-Shing Fung
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Kai-Ming Chow
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
| |
Collapse
|
15
|
Chan GCK, Ng JKC, Chow KM, Kwong VWK, Pang WF, Cheng PMS, Law MC, Leung CB, Li PKT, Szeto CC. Impact of frailty and its inter-relationship with lean tissue wasting and malnutrition on kidney transplant waitlist candidacy and delisting. Clin Nutr 2021; 40:5620-5629. [PMID: 34656960 DOI: 10.1016/j.clnu.2021.09.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/18/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND & AIMS Frailty and body composition contribute to adverse pre-transplant outcomes including hospitalization and waitlist mortality, but the interaction between frailty and body composition remains uncertain. METHODS Frailty was diagnosed by Clinical Frailty Scale (CFS) and a standard Frailty Questionnaire (FQ). Nutrition was evaluated by serum albumin level, subjective global assessment (SGA) and comprehensive malnutrition-inflammation score (MIS). Body composition was assessed by bioimpedance spectroscopy. All patients were followed up for three years. Primary outcome measure was a composite of death and permanent removal from waitlist. Secondary outcomes were emergency room attendance and hospitalization. RESULTS 432 prevalent peritoneal dialysis (PD) patients were recruited. 148 (34.3%) were listed on transplant waitlist. Frailty, age and comorbidity load predicted waitlisting. With time, 47 patients were delisted. Frailty by FQ (p = 0.028), serum albumin level (p = 0.005) and waist circumference (p = 0.010) predicted delisting after adjustment for confounders. Frailty significantly interacted with lean tissue wasting (FQ: p = 0.002, CFS: p = 0.048), and MIS (FQ: p = 0.004; CFS: p = 0.014) on delisting. Lean tissue wasting caused 2.56 times risk of delisting among frail individuals identified by FQ (p = 0.016), while serum albumin and the presence of diabetes mellitus predicted the risk of delisting among non-frail individuals. Lean tissue wasted and frail subjects had a higher all-cause and infection-related hospitalization. CONCLUSION Frailty predicted both kidney transplant waitlisting and subsequent delisting. Frailty interacted with body composition on transplant waitlist delisting. Lean tissue wasting and malnutrition independently predicted delisting in frail and non-frail listed subjects respectively.
Collapse
Affiliation(s)
- Gordon Chun-Kau Chan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Jack Kit-Chung Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kai-Ming Chow
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Vickie Wai-Ki Kwong
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Wing-Fai Pang
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Phyllis Mei-Shan Cheng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Man-Ching Law
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Chi-Bon Leung
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Philip Kam-Tao Li
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| |
Collapse
|
16
|
Brimble KS, Ganame J, Margetts P, Jain A, Perl J, Walsh M, Bosch J, Yusuf S, Beshay S, Su W, Zimmerman D, Lee SF, Gangji AS. Impact of Bioelectrical Impedance-Guided Fluid Management and Vitamin D Supplementation on Left Ventricular Mass in Patients Receiving Peritoneal Dialysis: A Randomized Controlled Trial. Am J Kidney Dis 2021; 79:820-831. [PMID: 34656640 DOI: 10.1053/j.ajkd.2021.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 08/27/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVES Hypervolemia and vitamin D (Vit D) deficiency occur frequently in patients receiving peritoneal dialysis and may contribute to left ventricular hypertrophy (LVH). The effect of bioimpedance analysis-guided volume management or Vit D supplementation on LV mass among those receiving peritoneal dialysis is uncertain. STUDY DESIGN Two-by-two factorial randomized controlled trial. SETTING & PARTICIPANTS Sixty-five patients receiving chronic peritoneal dialysis. INTERVENTION BIA-guided volume management versus usual care and oral cholecalciferol 50,000u weekly for 8 weeks followed by 10,000u weekly for 44 weeks or matching placebo. OUTCOMES Change in left ventricular mass at one-year measured by cardiac magnetic resonance imaging. RESULTS Total body water decreased by 0.9L (standard deviation: 2.4) in the BIA group compared to a 1.5L (± 3.4) increase in the usual care group (adjusted between group difference: -2.4L [95% confidence interval: -4.1, -0.68], p=0.01). Left ventricular mass increased by 1.3g (± 14.3) in the BIA group and decreased by 2.4g (±37.7) in the usual care group (between group difference; +2.2g [-13.9, 18.3], p=0.78). Serum 25-OH Vit D concentration increased by a mean of 17.2 nmol/L (standard deviation: 30.8 nmol/L) in the cholecalciferol group and declined by 8.2 nmol/L (±24.3 nmol/L) in the placebo group (between group difference: 28.3 nmol/L [95% confidence interval 17.2, 39.4]; p<0.001). Left ventricular mass decreased by 3.0g (± 28.1g) in the cholecalciferol group and increased by 2.0g (±31.2g) in the placebo group (between group difference; -4.5g [-20.4, 11.5], p=0.58). LIMITATIONS Relatively small sample size with larger than expected variation in change in left ventricular mass. CONCLUSIONS BIA-guided volume management had a modest impact on volume status with no effect on the change in LV mass. Vitamin D supplementation increased serum Vit D concentration but had no effect on left ventricular mass.
Collapse
Affiliation(s)
- K Scott Brimble
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada.
| | - Javier Ganame
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Peter Margetts
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Arsh Jain
- Department of Medicine, Western University, London, Canada
| | - Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital and the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada
| | - Michael Walsh
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada; Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton Health Sciences / McMaster University, Canada
| | - Jackie Bosch
- Population Health Research Institute, Hamilton Health Sciences / McMaster University, Canada
| | - Salim Yusuf
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton Health Sciences / McMaster University, Canada
| | - Samy Beshay
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Winnie Su
- University of Buffalo, Buffalo, New York, United States
| | - Deborah Zimmerman
- Department of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Shun Fu Lee
- Population Health Research Institute, Hamilton Health Sciences / McMaster University, Canada
| | - Azim S Gangji
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada
| |
Collapse
|
17
|
Li SY, Chuang CL, Lin CC, Tsai SH, Chen JY. Peritoneal-Membrane Characteristics and Hypervolemia Management in Peritoneal Dialysis: A Randomized Control Trial. MEMBRANES 2021; 11:membranes11100768. [PMID: 34677534 PMCID: PMC8541348 DOI: 10.3390/membranes11100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/25/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Abstract
Excessive bodily-fluid retention is the major cause of hypertension and congestive heart failure in patients with end-stage renal disease. Compared to hemodialysis, peritoneal dialysis (PD) uses the abdominal peritoneum as a semipermeable dialysis membrane, providing continuous therapy as natural kidneys, and having fewer hemodynamic changes. One major challenge of PD treatment is to determine the dry weight, especially considering that the speed of small solutes and fluid across the peritoneal membrane varies among individuals; considerable between-patient variability is expected in both solute transportation and ultrafiltration capacity. This study explores the influence of peritoneal-membrane characteristics in the hydration status in patients on PD. A randomized control trial compares the bioimpedance-assessed dry weight with clinical judgment alone. A high peritoneal membrane D/P ratio was associated with the extracellular/total body water ratio, dialysate protein loss, and poor nutritional status in patients on PD. After a six-month intervention, patients with monthly bioimpedance analysis (BIA) assistance had better fluid (−1.2 ± 0.4 vs. 0.1 ± 0.4 kg, p = 0.014) and blood-pressure (124.7 ± 2.7 vs. 136.8 ± 2.8 mmHg, p < 0.001) control; however, hydration status and blood pressure returned to the baseline after we prolonged BIA assistance to a 3-month interval. The dry-weight reduction process had no negative effect on residual renal function or peritoneal-membrane function. We concluded that peritoneal-membrane characteristics affect fluid and nutritional status in patients on PD, and BIA is a helpful objective technique for fluid assessment for PD.
Collapse
Affiliation(s)
- Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan; (S.-Y.L.); (C.-C.L.)
| | - Chiao-Lin Chuang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan;
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan; (S.-Y.L.); (C.-C.L.)
| | - Shin-Hung Tsai
- Division of Nephrology, Department of Medicine, Cheng Hsin General Hospital, Taipei 112201, Taiwan;
| | - Jinn-Yang Chen
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan; (S.-Y.L.); (C.-C.L.)
- Correspondence:
| |
Collapse
|
18
|
Chan GCK, Than WH, Kwan BCH, Lai KB, Chan RCK, Ng JKC, Chow KM, Cheng PMS, Law MC, Leung CB, Li PKT, Szeto CC. Adipose expression of miR-130b and miR-17-5p with wasting, cardiovascular event and mortality in advanced chronic kidney disease patients. Nephrol Dial Transplant 2021; 37:1935-1943. [PMID: 34601609 DOI: 10.1093/ndt/gfab287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There were limited data on the association of adipose microRNA expression with body composition and adverse clinical outcomes in patients with advanced chronic kidney disease (CKD). We aimed to evaluate the association of adipose miR-130b and miR-17-5p expressions with body composition, functional state, cardiovascular outcome and mortality in incident dialysis patients. METHODS We performed a single-centre prospective cohort study. Patients who were planned for peritoneal dialysis were recruited. MiR-130b and miR-17-5p expressions were measured from subcutaneous and pre-peritoneal fat tissue obtained during peritoneal dialysis catheter insertion. Body composition and physical function were assessed by bioimpedance spectroscopy and Clinical Frailty Scale. Primary outcome was 2-year survival. Secondary outcomes were 2-year technique survival and major adverse cardiovascular event (MACE) rate. RESULTS Adipose expression of miR-130b and miR-17-5p correlated with parameters of muscle mass including intracellular water (miR-130b: r = 0.191, P = 0.02; miR-17-5p: r = 0.211, P = 0.013) and lean tissue mass (miR-130b: r = 0.180, P = 0.03; miR-17-5p: r = 0.176, P = 0.004). miR-130b expression predicted frailty significantly (P = 0.016). Adipose miR-17-5p expression predicted 2-year all-cause survival (P = 0.020) and technique survival (P = 0.036), while miR-130b expression predicted incidence of major adverse cardiovascular events (P = 0.015). CONCLUSIONS Adipose miR-130b and miR-17-5p expressions correlated with body composition parameters, frailty, and predicted cardiovascular events and mortality in advanced CKD patients.
Collapse
Affiliation(s)
- Gordon Chun-Kau Chan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - Win Hlaing Than
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - Bonnie Ching-Ha Kwan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - Ka-Bik Lai
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - Ronald Cheong-Kin Chan
- Department of Anatomical & Cellular Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jack Kit-Chung Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - Kai-Ming Chow
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - Phyllis Mei-Shan Cheng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - Man-Ching Law
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - Chi-Bon Leung
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - Philip Kam-Tao Li
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| |
Collapse
|
19
|
Wang Y, Gu Z. Effect of bioimpedance-defined overhydration parameters on mortality and cardiovascular events in patients undergoing dialysis: a systematic review and meta-analysis. J Int Med Res 2021; 49:3000605211031063. [PMID: 34496645 PMCID: PMC8438275 DOI: 10.1177/03000605211031063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/18/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the role of bioimpedance-defined overhydration (BI-OH) parameters in predicting the risk of mortality and cardiovascular (CV) events in patients undergoing dialysis. METHODS We searched multiple electronic databases for studies investigating BI-OH indicators in the prediction of mortality and CV events through 23 May 2020. We assessed the effect of BI-OH indexes using unadjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Sensitivity analysis was used for each outcome. RESULTS We included 55 studies with 104,758 patients in the meta-analysis. Extracellular water/total body water (ECW/TBW) >0.4 (HR 5.912, 95% CI: 2.016-17.342), ECW/intracellular water (ICW) for every 0.01 increase (HR 1.041, 95% CI: 1.031-1.051), and OH/ECW >15% (HR 2.722, 95% CI: 2.005-3.439) increased the risk of mortality in patients receiving dialysis. ECW/TBW >0.4 (HR 2.679, 95% CI: 1.345-5.339) and ECW/ICW per increment of 10% (HR 1.032, 95% CI: 1.017-1.047) were associated with an increased risk of CV events in patients undergoing dialysis. A 1-degree increase in phase angle was a protective factor for both mortality (HR 0.676, 95% CI: 0.474-0.879) and CV events (HR 0.736, 95% CI: 0.589-0.920). CONCLUSIONS BI-OH parameters might be independent predictors for mortality and CV events in patients undergoing dialysis.
Collapse
Affiliation(s)
- Yajie Wang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zejuan Gu
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
20
|
Chan GCK, Ng JKC, Chow KM, Kwong VWK, Pang WF, Cheng PMS, Law MC, Leung CB, Li PKT, Szeto CC. Progression in Physical Frailty in Peritoneal Dialysis Patients. Kidney Blood Press Res 2021; 46:342-351. [PMID: 33957628 DOI: 10.1159/000515635] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Physical frailty contributes to adverse clinical outcomes in peritoneal dialysis (PD) patients. Little has been reported about frailty transitions in this population. We aimed to describe the transitions of frailty in PD patients and identify factors that predicted changes in frailty state. METHODS In a prospective observational study, we recruited 267 PD patients. Frailty was assessed by a validated frailty score. Depression was graded by PHQ-9 score, and nutritional status was evaluated by serum albumin, Subjective Global Assessment (SGA), and comprehensive Malnutrition Inflammation Score (MIS). The primary outcome was the change in frailty score at follow-up compared to baseline. RESULTS At baseline, 194 (72.7%) patients were classified as frail. With time, their frailty scores significantly increased (p < 0.001), and 93 of the surviving subjects (78.2%) were classified as frail. There was a modest significant correlation between change in MIS (p < 0.001), change in SGA score (p < 0.001), and change in PHQ-9 score (p < 0.001) with change in frailty score. An increase in PHQ-9 score (p < 0.001) and MIS (p = 0.001), as well as longer duration of hospitalization (p = 0.001), was independently associated with a greater change in frailty score after adjustment for confounding factors. Frailty score was also improved in patients who were converted to hemodialysis (p = 0.048) and received renal transplantation (p = 0.005). CONCLUSION Our findings suggested that frailty transitions were common in PD patients. Worsening in nutrition and depression, together with a longer duration of hospitalization, were associated with worsening in frailty.
Collapse
Affiliation(s)
- Gordon Chun-Kau Chan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jack Kit-Chung Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai-Ming Chow
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Vickie Wai-Ki Kwong
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing-Fai Pang
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Phyllis Mei-Shan Cheng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Man-Ching Law
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi Bon Leung
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Philip Kam-Tao Li
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
21
|
Ng JKC, Chan GCK, Chow KM, Fung W, Pang WF, Law MC, Leung CB, Li PKT, Szeto CC. Helper-assisted continuous ambulatory peritoneal dialysis: Does the choice of helper matter? Perit Dial Int 2021; 40:34-40. [PMID: 32063149 DOI: 10.1177/0896860819879873] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is an increasing number of elderly patients on continuous ambulatory peritoneal dialysis (CAPD) who could not perform dialysis exchange themselves and require assistance. We examine the outcome of Chinese CAPD patients who required helper-assisted dialysis and compare the outcome between different types of helper. METHODS We reviewed 133 incident patients on helper-assisted CAPD and 266 incident patients who performed self-CAPD exchanges (self-peritoneal dialysis (PD) group). Outcome measures included patient survival, peritonitis-free survival, and overall peritonitis rate. RESULTS At 24 months, patient survival of the helper-assisted and self-PD groups were 56.0% and 80.6%, respectively (p < 0.0001). Within the helper-assisted group, patient survival at 24 months was 55.5%, 63.2%, and 27.2% for the patients with domestic helper, family member, and nursing home staff as their helpers, respectively (p = 0.037). Peritonitis-free survival of the helper-assisted and self-PD groups were 54.2% and 64.9%, respectively (p = 0.039). Within the helper-assisted group, peritonitis-free survival at 24 months was 59.4%, 55.4%, and 37.2% for the patients with domestic helper, family member, and nursing home staff as their helpers, respectively (p = 0.06). There was no significant difference in peritonitis rate between patients with domestic helper, family member, and nursing home staff as their helpers (0.54, 0.57, and 0.94 episodes per patient-year, respectively, p = 0.2). CONCLUSIONS Helper-assisted CAPD patients had worse patient survival and peritonitis-free survival than the self-PD group. Assistance by nursing home staff was associated with worse patients' survival and peritonitis-free survival than assistance by family members or domestic maids.
Collapse
Affiliation(s)
- Jack Kit-Chung Ng
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Gordon Chun-Kau Chan
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Winston Fung
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wing-Fai Pang
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Man-Ching Law
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Chi Bon Leung
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Cheuk Chun Szeto
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| |
Collapse
|
22
|
Baki AH, Kamel CR, Mansour H. Are there any further modalities for prediction of subclinical volume overload in advanced stages of chronic kidney disease? Kidney Res Clin Pract 2021; 40:143-152. [PMID: 33789387 PMCID: PMC8041637 DOI: 10.23876/j.krcp.20.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/29/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Subclinical volume overload in chronic kidney disease (CKD) patient represents a debatable issue. Although many tools were used to detect volume overload in such patients, many non-specific results were due to presence of comorbidities. Bioimpedance spectroscopy is an objective fluid status assessment method, which is shown superior to classical methods in many studies. Combining some of these tools may improve their accuracy and specificity. Inferior vena cava collapsibility index (IVCCI) with brain natriuretic peptide (BNP) can be combined for more specific volume assessment. This study was performed to assess the usage of combined IVCCI and BNP levels in CKD patients to predict subclinical volume overload. METHODS One hundred and ten patients with CKD (stages 4 and 5) not on dialysis and having normal left ventricular systolic function were included in this study. Exclusion criteria were: (1) patients with other causes of raised BNP than volume overload and (2) patients on diuretics. A complete medical history was obtained, and thorough examination and laboratory tests were performed for all included patients. IVCCI and BNP serum levels were evaluated. The patients who exhibited an overhydration (OH)/extracellular water (ECW) ratio of >15% were considered to have volume overload. RESULTS Twenty-six patients (23.6%) had subclinical hypervolemia as diagnosed by OH/ECW ratio of >15%. IVCCI ≤ 38% had higher diagnostic performance than BNP ≥ 24 pg/mL. Combining both IVCCI ≤ 38% and BNP ≥ 24 pg/mL increased the specificity and positive predictive value for detection of subclinical hypervolemia. CONCLUSION Combined elevated BNP level and decreased IVCCI are more precise tools for subclinical volume overload detection in CKD patients.
Collapse
Affiliation(s)
- Aber Halim Baki
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Cherry Reda Kamel
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hazem Mansour
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
23
|
Chan GCK, N. G. JKC, Chow KM, Kwong VWK, Pang WF, Cheng PMS, Law MC, Leung CB, L. I. PKT, Szeto CC. Interaction between central obesity and frailty on the clinical outcome of peritoneal dialysis patients. PLoS One 2020; 15:e0241242. [PMID: 33104712 PMCID: PMC7588087 DOI: 10.1371/journal.pone.0241242] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/11/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Frailty and obesity contribute to the adverse clinical outcome of peritoneal dialysis (PD) patients, but the interaction between frailty and obesity remains uncertain. OBJECTIVE To examine the interaction between frailty and obesity on the clinical outcome of PD patients. DESIGN Single centre prospective observational cohort study. PATIENTS 267 prevalent Chinese PD patients were recruited. MEASUREMENTS Frailty was identified by a standard score. General and central obesity were determined by body mass index (BMI) and waist-hip ratio (WHR), respectively. Body composition was assessed by bioimpedance spectroscopy. All patients were followed for two years. Outcome measures included all-cause as well as cardiovascular mortality and hospitalization. RESULTS Of the 267 patients, 120 (44.9%) were frail. Frail individuals were more likely to have central obesity (p < 0.001) but not general obesity. Although WHR did not predict patient survival, there was a significant interaction between WHR and frailty on patient survival and cardiovascular survival (p = 0.002 and p = 0.038, respectively). For patients without frailty, the two-year cardiovascular survival was 91.3% and 74.4% for those with and without central obesity, respectively (p = 0.002). For patients with frailty, however, the two-year cardiovascular survival was 64.6% and 66.7% for those with and without central obesity, respectively (p = 0.6). For patients without frailty, the number of hospital admission for cardiovascular disease over 2 years were 0.12 ± 0.37 and 0.34 ± 0.72 for those with and without central obesity, respectively (p = 0.03). For frail patients, however, the number of hospital admission was similar between those with and without central obesity. CONCLUSION There is a significant interaction between frailty and central obesity on the outcome of PD patients. The protective role of central obesity is only apparent in PD patients without frailty but not the frail ones, and there is a little prognostic value of general (non-central) obesity.
Collapse
Affiliation(s)
- Gordon Chun-Kau Chan
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jack Kit-Chung N. G.
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kai-Ming Chow
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Vickie Wai-Ki Kwong
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Wing-Fai Pang
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Phyllis Mei-Shan Cheng
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Man-Ching Law
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Chi-Bon Leung
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Philip Kam-Tao L. I.
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Cheuk Chun Szeto
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| |
Collapse
|
24
|
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
|
25
|
Braam B, Lai CF, Abinader J, Bello AK. Extracellular fluid volume expansion, arterial stiffness and uncontrolled hypertension in patients with chronic kidney disease. Nephrol Dial Transplant 2020; 35:1393-1398. [PMID: 30805651 DOI: 10.1093/ndt/gfz020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 01/14/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hypertension is prevalent in patients with chronic kidney disease (CKD) and is related to extracellular fluid volume (ECFV) expansion. Arterial stiffening is another implication of CKD that can be caused by ECFV expansion. In this study, we hypothesized that CKD patients with uncontrolled hypertension are more likely to be fluid volume expanded than normotensive patients, which in turn is associated with increased arterial stiffness. METHODS Adult hypertensive patients with mild-severe CKD (n = 82) were recruited. ECFV was assessed using multifrequency bioimpedance and arterial stiffness by applanation tonometry and oscillometry. RESULTS Patients with uncontrolled hypertension had fluid volume expansion compared with controls (1.0 ± 1.5 versus 0.0 ± 1.6 L, P < 0.001), and had a higher augmentation index (AIx) and pulse wave velocity. Fluid volume expansion was more prevalent in patients with uncontrolled hypertension (58%) than patients who were at target (27%). Fluid volume expansion was correlated with age, AIx and systolic blood pressure. In a binary logistic regression analysis, AIx, age and fluid volume status were independent predictors of uncontrolled hypertension in both univariate and multivariate models. DISCUSSION In summary, uncontrolled hypertension among hypertensive CKD patients is associated with ECFV expansion. Our data suggest a relationship between ECFV expansion, increased arterial stiffness and uncontrolled hypertension.
Collapse
Affiliation(s)
- Branko Braam
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.,Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
| | - Chung Foon Lai
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Abinader
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
| | - Aminu K Bello
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
26
|
Sarmento-Dias M, Santos-Araújo C, Poínhos R, Oliveira B, Sousa M, Simões-Silva L, Soares-Silva I, Correia F, Pestana M. Phase Angle Predicts Arterial Stiffness and Vascular Calcification in Peritoneal Dialysis Patients. Perit Dial Int 2020; 37:451-457. [DOI: 10.3747/pdi.2015.00276] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 06/13/2016] [Indexed: 11/15/2022] Open
Abstract
ObjectivesFluid overload (FO) is frequently present in peritoneal dialysis (PD) patients and is associated with markers of malnutrition, inflammation, and atherosclerosis/calcification (MIAC) syndrome. We examined the relationships in stable PD patients between phase angle (PhA) and the spectrum of uremic vasculopathy including vascular calcification and arterial stiffness and between PhA and changes in serum fetuin-A levels.MethodsSixty-one stable adult PD patients were evaluated in a cross-sectional study (ST1). Phase angle was measured by multifrequency bioimpedance analysis (InbodyS10, Biospace, Korea) at 50 kHz. Augmentation index (AI), a surrogate marker of arterial stiffness, was assessed by digital pulse amplitude tonometry (Endo PAT, Itamar Medical, Caesarea, Israel). Vascular calcification was assessed by simplified calcification score (SCS). Serum fetuin-A levels were measured by ELISA (Thermo scientific; Waltham, MA, USA). Serum albumin was used as a nutritional marker, and serum C-reactive protein (CRP) was used as an inflammatory marker. The same assessments were carried out longitudinally (ST2) in the first 33 patients who completed 1 year of evaluation in ST1.ResultsIn ST1, patients with PhA < 6° had higher CRP levels, AI, and SCS and lower serum albumin and fetuin-A levels, in comparison with patients with PhA ≥ 6°. In addition, PhA was a predictor of both AI ((3 = -0.351, p = 0.023) and SCS > 3 (EXP (B) = 0.243, p = 0.005). In ST2, the increase of PhA over time was associated with decreases in both AI ( r = -0.378, p = 0.042) and CRP levels ( r = -0.426, p = 0.021), as well as with the increase in serum fetuin-A levels ( r = 0.411, p = 0.030).ConclusionsPhase angle predicts both arterial stiffness and vascular calcification in stable PD patients.
Collapse
Affiliation(s)
- Margarida Sarmento-Dias
- i3S – Instituto de Investigação e Inovação em Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Portugal; INEB – Instituto de Engenharia Biomédica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Porto, Portugal; Faculdade de Ciências da Nutrição e Alimentação, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Carla Santos-Araújo
- Universidade do Porto, Portugal; Serviço de Nefrologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Centro Hospitalar de São João, EPE, Porto, Portugal; Unidade de Investigação e Desenvolvimento Cardiovascular, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rui Poínhos
- Universidade do Porto, Porto, Portugal; Faculdade de Ciências da Nutrição e Alimentação, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Bruno Oliveira
- Universidade do Porto, Porto, Portugal; Faculdade de Ciências da Nutrição e Alimentação, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Maria Sousa
- Universidade do Porto, Portugal; Serviço de Nefrologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Liliana Simões-Silva
- i3S – Instituto de Investigação e Inovação em Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Portugal; INEB – Instituto de Engenharia Biomédica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto; Departamento de Doenças Renais Urológicas e Infecciosas, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Isabel Soares-Silva
- i3S – Instituto de Investigação e Inovação em Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Portugal; INEB – Instituto de Engenharia Biomédica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Flora Correia
- i3S – Instituto de Investigação e Inovação em Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Portugal; INEB – Instituto de Engenharia Biomédica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Porto, Portugal; Faculdade de Ciências da Nutrição e Alimentação, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Manuel Pestana
- i3S – Instituto de Investigação e Inovação em Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Portugal; INEB – Instituto de Engenharia Biomédica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Portugal; Serviço de Nefrologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto; Departamento de Doenças Renais Urológicas e Infecciosas, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| |
Collapse
|
27
|
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.
Collapse
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.
| |
Collapse
|
28
|
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
|
29
|
Zhu F, Abbas SR, Bologa RM, Levin NW, Kotanko P. Monitoring of Intraperitoneal Fluid Volume during Peritoneal Equilibration Testing using Segmental Bioimpedance. Kidney Blood Press Res 2019; 44:1465-1475. [PMID: 31678976 DOI: 10.1159/000503924] [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: 02/22/2019] [Accepted: 10/04/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ultrafiltration failure and fluid overload are common in peritoneal dialysis (PD) patients. Knowledge of intraperitoneal volume (IPV) and time to peak IPV during a dwell would permit improved PD prescription. This study aimed to utilize trunk segmental bioimpedance analysis (SBIA) to quasi-continuously monitor IPV (IPVSBIA) during the peritoneal dwell. METHODS IPVSBIA was measured every minute using lower-trunk SBIA (Hydra 4200; Xitron Technologies Inc., CA, USA) in 10 PD patients during a standard 240-min peritoneal equilibration test (PET). The known dialysate volume (2 L) rendered IPVSBIA calibration and calculation of instantaneous ultrafiltration volume (UFVSBIA) possible. UFVSBIA was defined as IPVSBIA - 2 L. RESULTS Based on dialysate-to-plasma creatinine ratio, 2 patients were high, 7 high-average, and 1 low-average transporters. Technically sound IPVSBIA measurements were obtained in 9 patients (age 59.0 ± 8.8 years, 7 females, 5 African Americans). Drained ultrafiltration volume (UFVdrain) was 0.47 ± 0.21 L and correlated (r = 0.74; p < 0.05) with end-dwell UFVSBIA (0.55 ± 0.17 L). Peak UFVSBIA was 1.04 ± 0.32 L, it was reached 177 ± 61 min into the dwell and exceeded end-dwell UFVSBIA by 0.49 ± 0.28 L (95% CI: 0.27-0.7) and UFVdrain by 0.52 ± 0.31 L (95% CI: 0.29-0.76), respectively. CONCLUSION This pilot study demonstrates the feasibility of trunk segmental bioimpedance to quasi-continuously monitor IPVSBIA and identify the time to peak UFVSBIA during a standard PET. Such new insights into the dynamics of intraperitoneal fluid volume during the dwell may advance our understanding of the underlying transport physiology and eventually assist in improving PD treatment prescriptions.
Collapse
Affiliation(s)
- Fansan Zhu
- Renal Research Institute, New York, New York, USA,
| | | | | | | | - Peter Kotanko
- Renal Research Institute, New York, New York, USA.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
30
|
Takhti M, Odame K. A Power Adaptive, 1.22-pW/Hz, 10-MHz Read-Out Front-End for Bio-Impedance Measurement. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2019; 13:725-734. [PMID: 31135369 DOI: 10.1109/tbcas.2019.2918262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This paper presents a read-out front-end application-specific integrated circuit (ASIC) for the measurement of tissue impedances. The 10 mm2 2-channel front-end ASIC is fabricated in a 0.18 μm CMOS technology. The measurement results show that the proposed ASIC operates over a frequency range of 100 Hz up to 10 MHz. The ASIC has 1.22 pW/Hz power performance, with an SNR over 72 dB for frequencies ≤ 1 MHz, and over 65 dB SNR for frequencies ≥ 1 MHz. The total measured power consumption of the read-out front-end is shown to range from 2.1 to 21.7 mW depending on the input frequency. To achieve a wide dynamic range, the instrumentation amplifier has an adaptive gain control feature, and it employs programmable bias currents and reconfigurable structure to save power while processing low-frequency signals. A dual digital-to-analog converter (DAC) hybrid SAR analog-to-digital converter (ADC) is presented that reduces the power consumption of the ADC driver by sevenfold for frequencies between 4 kHz and 1 MHz.
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW Maintaining euvolaemia is an essential yet challenging objective in management of patients on peritoneal dialysis. Optimal method to assess volume status remains to be determined. In this review, we will discuss the risk factors and clinical outcomes of fluid overload in PD patients, and examine the role of bioimpedance study in fluid management. RECENT FINDINGS Applying bioimpedance study to measure body composition has attracted increasing attention because it is noninvasive and provides point-of-care assessment of fluid status. Observational studies suggested that presence of residual renal function did not necessarily protect peritoneal dialysis patients from developing fluid overload. This reinforces the importance of fluid restriction in peritoneal dialysis patients, in whom the thirst sensation could be exacerbated by hyperglycaemia. Notably, fluid overload is present in significant portion of asymptomatic patients. Moreover, bioimpedance-defined fluid overload is associated with increase in all-cause mortality, technique failure and possibly excess peritonitis rate. SUMMARY Although future studies should investigate the clinical benefit of bioimpedance-guided fluid management in high-risk subgroup, raising awareness among clinicians, together with structured clinical assessment and dietary counselling are the cornerstone to maintain stable fluid status.
Collapse
|
32
|
Hwang SD, Lee JH, Lee SW, Kim JK, Kim MJ, Song JH. Risk of overhydration and low lean tissue index as measured using a body composition monitor in patients on hemodialysis: a systemic review and meta-analysis. Ren Fail 2018; 40:51-59. [PMID: 29347876 PMCID: PMC6014525 DOI: 10.1080/0886022x.2017.1419963] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Overhydration and sarcopenia, related to an individual's nutritional status, have been associated with increased cardiovascular mortality and poor prognosis in patients on hemodialysis. The purpose of this study was to investigate the prediction of overhydration and sarcopenia on mortality in patients on hemodialysis using a body composition monitor. We conducted a systematic review and meta-analysis using a random-effects model. We searched the Cochrane Central Register, OVID MEDLINE, EMBASE and PubMed databases for all studies published prior to December 9, 2016 and reviewed the reference lists of relevant reviews, registered trials and relevant conference proceedings. The overhydration group (fluid excess, >15% vs. the normohydration group) and the low lean tissue index group ( <10%) were compared with a reference group. Six trials, consisting of 29,469 patients, were included in the pooled analysis. The pooled hazard ratio for overall survival of the overhydration group, compared with the reference normohydration group was 1.798 (95% confidence interval [CI]: 1.53-2.804, p = .001). The hazard ratio for mortality in the low lean tissue index group was 1.533 (95% CI, 1.411-1.644; p = .001) in the random-effects model. The results from the most recent study showed the greatest heterogeneity in the sensitivity analysis. Low lean tissue index and overhydration, measured using a body composition monitor, were associated with a high mortality rate in patients on hemodialysis.
Collapse
Affiliation(s)
- Seun Deuk Hwang
- a Division of Nephrology and Hypertension, Department of Internal Medicine , Inha University College of Medicine , Incheon , Korea
| | - Jin Ho Lee
- b Divison of Nephrology, Department of Internal Medicine , Bong Seng Memorial Hospital , Busan , Korea
| | - Seoung Woo Lee
- a Division of Nephrology and Hypertension, Department of Internal Medicine , Inha University College of Medicine , Incheon , Korea
| | - Joong Kyung Kim
- b Divison of Nephrology, Department of Internal Medicine , Bong Seng Memorial Hospital , Busan , Korea
| | - Moon-Jae Kim
- a Division of Nephrology and Hypertension, Department of Internal Medicine , Inha University College of Medicine , Incheon , Korea
| | - Joon Ho Song
- a Division of Nephrology and Hypertension, Department of Internal Medicine , Inha University College of Medicine , Incheon , Korea
| |
Collapse
|
33
|
Ng JKC, Kwan BCH, Chow KM, Pang WF, Cheng PMS, Leung CB, Li PKT, Szeto CC. Asymptomatic fluid overload predicts survival and cardiovascular event in incident Chinese peritoneal dialysis patients. PLoS One 2018; 13:e0202203. [PMID: 30102739 PMCID: PMC6089451 DOI: 10.1371/journal.pone.0202203] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/30/2018] [Indexed: 11/20/2022] Open
Abstract
Background Fluid overload is common among asymptomatic peritoneal dialysis (PD) patients. We aim to determine the prevalence and prognostic significance of fluid overload, as measured by bioimpedance spectroscopy, in asymptomatic incident PD patients. Methods We performed a single-center study on 311 incident PD patients. Volume status was represented by the volume of overhydration (OH), OH/extracellular water (ECW) ratio, ECW/total body water (TBW) ratio, and ECW to intracellular water (ICW) ratio (E:I ratio). Patient survival, technique survival and cardiovascular event-free survival were determined. Results The median period of follow up was 27.3 months. Fluid overload was present in 272 patients (87.5%) when defined as OH volume over 1.1L. All hydration parameters significantly correlated with Charlson Comorbidity Index, and inversely with total Kt/V, and serum albumin. Multivariate cause-specific Cox analysis showed that volume status independently predicted patient survival; every 0.1 unit increase in E:I ratio was associated with 24.5% increase in all-cause mortality (adjusted cause-specific hazard ratio [ACSHR] 1.245, p = 0.002). Hydration status was also an independent predictor of cardiovascular event-free survival after excluding hospital admission for congestive heart failure; each 0.1 unit increase in E:I ratio was associated with 18.7% decrease in cardiovascular event-free survival (ACSHR 1.187, p = 0.011). In contrast, hydration parameters were not associated with technique survival. Conclusions Fluid overload is common in asymptomatic incident PD patients and is a strong predictor of patient survival and cardiovascular event. The impact of bioimpedance spectroscopy-guided fluid management on the outcome of PD patients deserves further study.
Collapse
Affiliation(s)
- Jack Kit-Chung Ng
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Bonnie Ching-Ha Kwan
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kai-Ming Chow
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wing-Fai Pang
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Phyllis Mei-Shan Cheng
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Chi-Bon Leung
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Philip Kam-To Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Cheuk-Chun Szeto
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- * E-mail:
| |
Collapse
|
34
|
Rao A, Teng YC, Schaef C, Murphy EK, Arshad S, Halter RJ, Odame K. An Analog Front End ASIC for Cardiac Electrical Impedance Tomography. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2018; 12:729-738. [PMID: 29994267 DOI: 10.1109/tbcas.2018.2834412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this paper, an end-to-end CMOS application specific integrated circuit (ASIC) for readout channel in a cardiac electrical impedance tomography system is presented. The ASIC consists of an integrated current driver for current injection, an instrumentation amplifier, variable gain amplifier at the analog front end for voltage readout from electrodes, and an on-chip 10-bit successive approximation register analog to digital converter with serial peripheral interface. The ASIC is fabricated in the CMOS 0.18 $\mu$ m process with a supply voltage of 3.3 V. Amplitude and phase extraction of the voltages is performed in the digital domain with a matched filter. A fully integrated solution for use in multiple electrode system is demonstrated. The readout chain in the ASIC achieves a minimum signal-to-noise ratio of 71 dB over the frequency range of 500 Hz-700 kHz, while maintaining an average accuracy of 99.7 $\%$. Frame rates of 21 frames per second for a 32 electrode system is feasible, and the ASIC has an overall power consumption of 11.8 mW.
Collapse
|
35
|
Padwal M, Cheng G, Liu L, Boivin F, Gangji AS, Brimble KS, Bridgewater D, Margetts PJ. WNT signaling is required for peritoneal membrane angiogenesis. Am J Physiol Renal Physiol 2018; 314:F1036-F1045. [DOI: 10.1152/ajprenal.00497.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The wingless-type mouse mammary tumor virus integration site family (WNT) signaling pathway is involved in wound healing and fibrosis. We evaluated the WNT signaling pathway in peritoneal membrane injury. We assessed WNT1 protein expression in the peritoneal effluents of 54 stable peritoneal dialysis (PD) patients and WNT-related gene expression in ex vivo mesothelial cell cultures from 21 PD patients. In a transforming growth factor-β (TGF-β)-mediated animal model of peritoneal fibrosis, we evaluated regulation of the WNT pathway and the effect of WNT inhibition on peritoneal fibrosis and angiogenesis. WNT1 and WNT2 gene expression were positively correlated with peritoneal membrane solute transport in PD patients. In the mouse peritoneum, TGF-β-induced peritoneal fibrosis was associated with increased expression of WNT2 and WNT4. Peritoneal β-catenin protein was significantly upregulated after infection with adenovirus expressing TGF-β (AdTGF-β) along with elements of the WNT signaling pathway. Treatment with a β-catenin inhibitor (ICG-001) in mice with AdTGF-β-induced peritoneal fibrosis resulted in attenuation of peritoneal angiogenesis and reduced vascular endothelial growth factor. Similar results were also observed with the WNT antagonist Dickkopf-related protein (DKK)-1. In addition to this, DKK-1 blocked epithelial-mesenchymal transition and increased levels of the cell adhesion protein E-cadherin. We provide evidence that WNT signaling is active in the setting of experimental peritoneal fibrosis and WNT1 correlates with patient peritoneal membrane solute transport in PD patients. Intervention in this pathway is a possible therapy for peritoneal membrane injury.
Collapse
Affiliation(s)
- Manreet Padwal
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Genyang Cheng
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Limin Liu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Felix Boivin
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Azim S. Gangji
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Peter J. Margetts
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
36
|
Szeto CC, McIntyre CW, Li PKT. Circulating Bacterial Fragments as Cardiovascular Risk Factors in CKD. J Am Soc Nephrol 2018; 29:1601-1608. [PMID: 29666156 PMCID: PMC6054355 DOI: 10.1681/asn.2018010068] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Cardiovascular disease (CVD) is a major cause of mortality and morbidity in patients with CKD. In the past decade, intestinal dysbiosis and altered gut epithelial barrier function are increasingly recognized in CKD. Uremic patients have slow intestinal transit time, impaired protein assimilation, and decreased consumption of dietary fiber. The use of multiple medications also may contribute to the proliferation of dysbiotic bacteria, which affect the barrier function of intestinal epithelium. In addition, fluid overload and uremic toxins per se directly reduce the gut barrier function. The major consequence of these alterations, the translocation of bacterial fragments from bowel lumen to systemic circulation, can lead to diverse biologic effects and probably represents an important nontraditional CVD risk factor in CKD. Among all bacterial fragments, endotoxin is the most well studied. Plasma endotoxin levels are markedly elevated in both patients with CKD and those on dialysis, and are associated with the systemic inflammatory state, accelerated atherosclerosis, and clinical CVD in patients on dialysis. Optimization of BP control and the use of ultrapure dialysate can reduce plasma endotoxin levels, with probable metabolic and cardiovascular benefits. The benefit of synbiotic therapy is not confirmed, although results from animal studies are impressive. The biologic effects and clinical relevance of other bacterial fragments, such as bacterial DNA fragments, are less well defined. Further studies are needed to delineate the pathogenic relation between circulating bacterial fragments and CVD, and to define the role of the plasma bacterial fragment level as a prognostic indicator of CKD.
Collapse
Affiliation(s)
- 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, Sha Tin, Hong Kong, China; and
| | - Christopher William McIntyre
- Division of Nephrology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Philip Kam-Tao Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China; and
| |
Collapse
|
37
|
Li JSC, Chan JYH, Tai MMY, Wong SM, Pang SM, Lam FYF, Chu CHM, Ching CSY, Wong JHS, Chak WL. Hydration and nutritional status in patients on home-dialysis-A single centre study. J Ren Care 2018; 44:142-151. [PMID: 29664189 DOI: 10.1111/jorc.12240] [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: 11/29/2022]
Abstract
BACKGROUND Over-hydration (OH) and malnutrition are prevalent among patients on dialysis therapy. The prevalence of OH and malnutrition as well as the risk factors associated with OH and malnutrition in our patients on home peritoneal dialysis (PD) and home haemodialysis (HD) are examined. DESIGN AND METHODS This was a cross-sectional study. The hydration and nutritional status of the study groups were assessed by a Body Composition Monitor. Patients who were stable on home dialysis therapy for over one year were invited to participate. Univariate and multivariate analyses were performed to identify associated factors and determine the predictors of OH and malnutrition, respectively. RESULTS Eighty-eight patients (41 PD and 47 home HD) were recruited. A 32.95% of our patients on home dialysis therapy were in OH status. There was a significance difference in the prevalence of hydration status between patients on PD and home HD (p = 0.014), as overhydration was more common in patients on PD than home HD (46.34 vs. 21.28%). Dehydration was more common in patients on home HD than PD (29.79 vs. 9.76%). Male gender, decreasing haemoglobin level and presence of diabetes mellitus (DM) were risk factors of OH on multivariable analysis. There was no significance difference in the prevalence of malnutrition between patients on PD and home HD (p = 0.27). Increasing Fat Tissue Index (FTI), height and patients on PD therapy were at higher risk of malnutrition. CONCLUSION OH and malnutrition were prevalent patients on home dialysis therapy.
Collapse
Affiliation(s)
- Janet S C Li
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - John Y H Chan
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Mandy M Y Tai
- Central Nursing Division, Queen Elizabeth Hospital, Hong Kong
| | - So M Wong
- Central Nursing Division, Queen Elizabeth Hospital, Hong Kong
| | - S M Pang
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Fanny Y F Lam
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Carmen H M Chu
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Chris S Y Ching
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Joseph H S Wong
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - W L Chak
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| |
Collapse
|
38
|
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
|
39
|
Abstract
Despite the gradual increased use of peritoneal dialysis (PD) globally around the world, it is recognized that a number of areas in PD as a renal-replacement therapy require attention and improvements. The current challenges in PD include how to tackle technique failure and sustain long-term PD, manage and prevent peritoneal infections, malnutrition and inflammation, cardiovascular mortality, volume overload, glucose exposure, adequacy of solute removal, peritoneal access, peritoneal physiology and changes with long-term PD, patient fatigue, psychosocial issues, and care of elderly patients on PD. Obviously, hemodialysis as another renal-replacement therapy modality also has its own areas that need attention and improvement by nephrologists and nurses. With more clinical and basic science research, outcome studies, and through better education and training, together with the implementation of global PD guidelines for enhancing care of PD patients, it is likely that such problem areas in PD gradually will be resolved and PD patient outcomes will be improved.
Collapse
Affiliation(s)
- Philip Kam-Tao Li
- CUHK Carol and Richard Yu PD Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong.
| | - Vickie Wai-Ki Kwong
- CUHK Carol and Richard Yu PD Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
40
|
Abstract
Inflammation is one of the well-recognized nontraditional risk factors that contributes to the excessive cardiovascular mortality in peritoneal dialysis (PD) patients. Serum C-reactive protein and interleukin-6 levels are common surrogate markers used to measure inflammatory burden and predict adverse clinical outcomes in PD patients. Causes of inflammation are complex and can be categorized into factors related to a decrease in renal function and factors related to dialysis. They interact with each other and finally result in systemic and intraperitoneal inflammation. This review discusses the various causes and clinical implications of inflammation in PD patients. More importantly, potential therapeutic options that target the underlying pathogenic mechanisms are explored.
Collapse
Affiliation(s)
- Philip Kam-Tao Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Jack Kit-Chung Ng
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Christopher William Mcintyre
- Division of Nephrology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
41
|
Jang M, Kim WH, Lee JH, Kim MS, Lee EK, Kim SM, Chang JW. Numerical expression of volume status using the bioimpedance ratio in continuous ambulatory peritoneal dialysis patients: A pilot study. Kidney Res Clin Pract 2017; 36:290-295. [PMID: 28904881 PMCID: PMC5592897 DOI: 10.23876/j.krcp.2017.36.3.290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Volume overload results in higher mortality rates in patients on continuous ambulatory peritoneal dialysis (CAPD). The ratio of bioimpedance (RBI) might be a helpful parameter in adjusting dry body weight in CAPD patients. This study examined whether it is possible to distinguish between non-hypervolemic status and hypervolemic status in CAPD patients by using only RBI. METHODS RBI was calculated as follows: RBI = impedance at 50 kHz/impedance at 500 kHz. Based on the experts' judgements, a total of 64 CAPD patients were divided into two groups, a non-hypervolemic group and a hypervolemic group. The RBI was measured from right wrist to right ankle (rw-raRBI) by bioimpedance spectroscopy (BCM®, Fresenius Medical Care) before and after the peritosol was emptied. Other RBIs were measured from the right side of the anterior superior iliac spine to the ipsilateral ankle (rasis-raRBI) to control for the electro-physiological effects of peritoneal dialysate. RESULTS The mean rw-raRBI of non-hypervolemic patients was higher than that of hypervolemic patients in the presence (1.141 ± 0.022 vs. 1.121 ± 0.021, P < 0.001) of a peritosol. Likewise, the mean rasis-raRBI of non-hypervolemic patients was higher than that of hypervolemic patients (presence of peritosol: 1.136 ± 0.026 vs. 1.109 ± 0.022, P < 0.001; absence of peritosol: 1.131 ± 0.022 vs. 1.107 ± 0.022, P < 0.001). CONCLUSION The volume status of CAPD patients was able to be simply expressed by RBI. Therefore, this study suggests that when patients cannot be analyzed using BCM, RBI could be an alternative.
Collapse
Affiliation(s)
- Mun Jang
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Won Hak Kim
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Jung Hee Lee
- Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Mi Soon Kim
- Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Eun Kyoung Lee
- Division of Nephrology, Department of Internal Medicine, Dankook University College of Medicine, Cheonan,
Korea
| | - So Mi Kim
- Division of Nephrology, Department of Internal Medicine, Dankook University College of Medicine, Cheonan,
Korea
| | - Jai Won Chang
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| |
Collapse
|
42
|
|
43
|
Montgomery LD, Montgomery RW, Gerth WA, Lew SQ, Klein MD, Stewart JM, Medow MS, Velasquez MT. Bioimpedance monitoring of cellular hydration during hemodialysis therapy. Hemodial Int 2016; 21:575-584. [PMID: 27860119 DOI: 10.1111/hdi.12511] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction The aim of this paper is to describe and demonstrate how a new bioimpedance analytical procedure can be used to monitor cellular hydration of End Stage Renal Disease (ESRD) patients during hemodialysis (HD). Methods A tetra-polar bioimpedance spectroscope (BIS), (UFI Inc., Morro Bay, CA), was used to measure the tissue resistance and reactance of the calf of 17 ESRD patients at 40 discrete frequencies once a minute during dialysis treatment. These measurements were then used to derive intracellular, interstitial, and intravascular compartment volume changes during dialysis. Findings The mean (± SD) extracellular resistance increased during dialysis from 92.4 ± 3.5 to 117.7 ± 5.8 Ohms. While the mean intracellular resistance decreased from 413.5 ± 11.7 to 348.5 ± 8.2 Ohms. It was calculated from these data that the mean intravascular volume fell 9.5%; interstitial volume fell 33.4%; and intracellular volume gained 20.3%. Discussion These results suggest that an extensive fluid shift into the cells may take place during HD. The present research may contribute to a better understanding of how factors that influence fluid redistribution may affect an ESRD patient during dialysis. In light of this finding, it is concluded that the rate of vascular refill is jointly determined with the rate of "cellular refill" and the transfer of fluid from the intertitial compartment into the intravascular space.
Collapse
Affiliation(s)
| | | | | | - Susie Q Lew
- George Washington University Medical Center, Washington, DC, USA
| | | | | | | | | |
Collapse
|
44
|
Oei E, Paudel K, Visser A, Finney H, Fan SL. Is overhydration in peritoneal dialysis patients associated with cardiac mortality that might be reversible? World J Nephrol 2016; 5:448-454. [PMID: 27648408 PMCID: PMC5011251 DOI: 10.5527/wjn.v5.i5.448] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/02/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To study the relationship between overhydration (OH) in peritoneal dialysis (PD) patients and cardiac mortality.
METHODS OH, as measured by body composition monitor (BCM), is associated with increased mortality in dialysis patients. BCM has been used to guide treatment on the assumption that correcting OH will improve cardiac morbidity and mortality although data demonstrating causality that is reversible is limited. We wished to determine if OH in PD patients predicted cardiac mortality, and if there was a correlation between OH and cardiac troponin-T (cTnT) levels. Finally, we wished to determine if improving OH values would lead to a decrement in cTnT. All prevalent PD patients over the study period of 57 mo who had contemporaneous BCM and cTnT measurements were followed irrespective of transplantation or PD technique failure. We also studied a cohort of patients with who had severe OH (> +2L). The Fresenius Body Composition Monitor was used to obtain hydration parameters. cTnT levels were done as part of routine clinical care. Data was analysed using SPSS version 20.0.
RESULTS There were 48 deaths in the 336 patients. The patients that died from cardiac or non-cardiac causes were similar with respect to their age, incidence of diabetes mellitus, gender, ethnicity and cause of renal failure. However, the patients with cardiac causes of death had significantly shorter dialysis vintage (10.3 mo vs 37.0 mo, P < 0.0001) and were significantly more overhydrated by BCM measurement (2.95 L vs 1.35 L, P < 0.05). The mean (standard error of the means) hydration status of the 336 patients was +1.15 (0.12) L and the median [interquartile range (IQR)] cTnT level was 43.5 (20-90) ng/L. The cTnT results were not normally distributed and were therefore transformed logarithmically. There was a statistically significant correlation between Log (cTnT) with the OH value (Spearman r value 0.425, P < 0.0001). We identified a sub-group of patients that were severely overhydrated; median (IQR) hydration at baseline was +2.7 (2.3 to 3.7) L. They were followed up for a minimum of 6 mo. Reduction in OH values in these patients over 6 mo correlated with lowering of cTnT levels (Spearman r value 0.29, P < 0.02).
CONCLUSION Patients that were overhydrated had higher cTnT, and had deaths that were more likely to be cardiac related. Reduction in OH correlated with lowering of cTnT.
Collapse
|
45
|
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
|
46
|
Lichodziejewska-Niemierko M, Chmielewski M, Dudziak M, Ryta A, Rutkowski B. Hydration Status of Patients Dialyzed with Biocompatible Peritoneal Dialysis Fluids. Perit Dial Int 2015; 36:257-61. [PMID: 26475845 DOI: 10.3747/pdi.2015.00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/13/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND Biocompatible fluids for peritoneal dialysis (PD) have been introduced to improve dialysis and patient outcome in end-stage renal disease. However, their impact on hydration status (HS), residual renal function (RRF), and dialysis adequacy has been a matter of debate. The aim of the study was to evaluate the influence of a biocompatible dialysis fluid on the HS of prevalent PD patients. ♦ METHODS The study population consisted of 18 prevalent PD subjects, treated with standard dialysis fluids. At baseline, 9 patients were switched to a biocompatible solution, low in glucose degradation products (GDPs) (Balance; Fresenius Medical Care, Bad Homburg, Germany). Hydration status was assessed through clinical evaluation, laboratory parameters, echocardiography, and bioimpedance spectroscopy over a 24-month observation period. ♦ RESULTS During the study period, urine volume decreased similarly in both groups. At the end of the evaluation, there were also no differences in clinical (body weight, edema, blood pressure), laboratory (N-terminal pro-brain natriuretic peptide, NTproBNP), or echocardiography determinants of HS. However, dialysis ultrafiltration decreased in the low-GDP group and, at the end of the study, equaled 929 ± 404 mL, compared with 1,317 ± 363 mL in the standard-fluid subjects (p = 0.06). Hydration status assessed by bioimpedance spectroscopy was +3.64 ± 2.08 L in the low-GDP patients and +1.47 ± 1.61 L in the controls (p = 0.03). ♦ CONCLUSIONS The use of a low-GDP biocompatible dialysis fluid was associated with a tendency to overhydration, probably due to diminished ultrafiltration in prevalent PD patients.
Collapse
Affiliation(s)
- Monika Lichodziejewska-Niemierko
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland Department of Palliative Medicine, Medical University of Gdańsk, Poland
| | - Michał Chmielewski
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
| | - Maria Dudziak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdańsk, Poland
| | - Alicja Ryta
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
| | - Bolesław Rutkowski
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
| |
Collapse
|
47
|
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
|
48
|
Davies SJ. What are the Consequences of Volume Expansion in Chronic Dialysis Patients?: Volume Expansion in Peritoneal Dialysis Patients. Semin Dial 2015; 28:239-42. [PMID: 25659261 DOI: 10.1111/sdi.12350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Simon J Davies
- Health Service Research Unit, Institute for Science and Technology in Medicine, Keele University, Keele, Staffordshire, United Kingdom; Department of Nephrology, University Hospital of North Midlands, Stoke-on-Trent, Staffordshire, United Kingdom
| |
Collapse
|
49
|
Szeto CC, Kwan BCH, Chow KM, Leung CB, Cheng MS, Law MC, Li PKT. Metabolic syndrome in peritoneal dialysis patients: choice of diagnostic criteria and prognostic implications. Clin J Am Soc Nephrol 2014; 9:779-87. [PMID: 24458080 DOI: 10.2215/cjn.06620613] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE In the general population, metabolic syndrome (MES) is associated with cardiovascular risk. However, the definition of MES and its prognostic implication among patients undergoing peritoneal dialysis (PD) remain controversial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We studied 329 prevalent PD patients from April 2008 to April 2011 and compared four sets of diagnostic criteria: the original World Health Organization (WHO) criteria, the International Diabetes Federation (IDF) criteria, the original National Cholesterol Education Program (NCEP) criteria, and the modified NCEP criteria. Nutritional status, body composition, and arterial pulse-wave velocity were measured. Patients were followed for 31.7 ± 15.5 months. RESULTS Among the 329 patients, 175 (53.2%) fulfilled the WHO criteria, 177 (53.8%) the IDF criteria, 199 (60.5%) the original NCEP criteria, and 218 (66.3%) the modified NCEP criteria. The agreement among the four sets of criteria was fair to moderate (Cohen κ=0.35-0.58). Patients with MES defined by all four criteria had higher adipose tissue mass than the others, although the difference in adipose tissue mass was most pronounced with the IDF criteria (MES versus no MES, 18.2 ± 7.9 versus 10.7 ± 5.9 kg; P<0.001). Patients with MES, as defined by the IDF criteria, were hospitalized longer than those without MES (3.82 [interquartile range, 0.00-12.61] versus 1.07 [interquartile range, 0.00-6.43]) days per year of follow-up; P=0.01). Overall survival, cardiovascular survival, or technique survival did not differ between patients with and without MES, irrespective of the diagnostic criteria after adjustment for diabetic status. CONCLUSION In patients undergoing PD, overall survival, cardiovascular survival, and technique survival did not differ between patients with and without MES, irrespective of diabetic status and diagnostic criteria. Further studies are needed to establish a new definition or clinical scoring system for risk stratification of PD patients.
Collapse
Affiliation(s)
- Cheuk-Chun Szeto
- From Carol and 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
|