Asymptomatic fluid overload predicts survival and cardiovascular event in incident Chinese peritoneal dialysis patients

Abstract

BackgroundFluid 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.MethodsWe 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.ResultsThe 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.ConclusionsFluid 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.

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

“…Fluid overload is common in PD patients [37][38][39][40][41][42][43][44] and an independent predictor of all-cause mortality [39,42]. Ng et al [41] reported that fluid overload was common in asymptomatic incident PD patients and a strong predictor of patient survival and cardiovascular events. Moreover, fluid overload was independently associated with decline in RKF in PD patients [45].…”

Helper-assisted continuous ambulatory peritoneal dialysis: Does the choice of helper matter?

“…Body composition and hydration status were assessed by multifrequency bioimpedance spectroscopy (Body Composition Monitor, Fresenius Medical Care, Germany), the method of which was described previously. 23,24 Vascular stiffness was represented by arterial pulse wave velocity (PWV) as measured by an automatic computerized recorder and analyzed using the Complior ® SP program (Artech Medical, France). The method of PWV measurement has been described previously.…”

Volumenstatus bei Dialysepatienten

“…Überwässerung bei HD-(Hämodialyse) und PD-Patienten (PD: Peritonealdialyse) geht mit einer erhöhten Sterblichkeitsrate einher, und bereits eine symptomlose, klinisch nicht sichtbare Überwässerung ist mit einer schlechteren Herz-Kreislauf bedingten Sterblichkeit assoziiert [1,2]. Vorsichtiger, aber konsequenter Wasserentzug bis zum Erreichen eines Trockengewichts vermindert den Bedarf an Antihypertensiva und verbessert sowohl den Blutdruck, die Herz-Kreislauf-Funktion als auch das Überleben von Dialysepatienten.…”