Bioimpedance and Brain Natriuretic Peptide in Peritoneal Dialysis Patients

Abstract

Assessment of ideal body weight in peritoneal dialysis (PD) patients is important for clinical practice. Fluid overload may produce hypertension, reduced arterial distensibility, left ventricular hypertrophy. All these are risk factors for mortality in PD patients: cardio- and cerebrovascular events are the main causes of morbidity and mortality in PD population. Nowadays, a clear and widely accepted definition of ideal body weight in PD patients does not exist. Probably the ideal body weight is the weight at which the extra cellular volume is normal. Many different tools have been used to assess the hydration status in dialysis patients. Ultrasonic evaluation of inferior vena cava diameter only assesses intravascular volume, and is also influenced by diastolic dysfunction and is thus a reflection of preload and not of tissue hydration. Direct measurement of extra cellular and total body water by dilution methods is considered as the golden standard, but these techniques are laborious and expensive. Parameters, such as brain natriuretic peptide (BNP) or NT-proBNP can reflect changes in hydration status and may help the nephrologist to estimate it. Natriuretic peptides are influenced both by preload and ventricular abnormalities and in patients with renal failure accumulation can occur. Bioimpedance is an accurate, reproducible, not expensive and not invasive technique that permits a good evaluation of hydration status in PD and can drive the nephrologist in his clinical choices. Clinical evaluation, strict control of body weight, diuresis, sodium and fluids intakes, bioimpedance monitoring and serum levels of natriuretic peptides may all together help us to maintain the PD patient euvolemic.

Associations of Peritoneal Glucose Load With Male Sexual Dysfunction and Depression in Peritoneal Dialysis Patients

“…This suggests a negative impact of PGLI >3 g/kg per day on hydration status and inflammation ; and supports an association of PGLI with overhydration and augmented inflammation. In addition, since overhydration is usually accompanied by elevated blood pressure and plasma brain natriuretic peptide, vascular complications may develop . Vascular injury can adversely affect sexual function and contribute to the development of erectile dysfunction.…”

“…In addition, by contributing to the development of overhydration and aggravating the inflammatory status in PD patients , higher PGLI (>3 g/kg per day) can adversely affect sexual function through interfering with sex hormones . Since PGLI >3 g/kg per day produces cumulative peritoneal membrane damage, as discussed above, leading to the development of overhydration and elevated blood pressure and plasma BNP levels, high PGLI values (>3 g/kg per day) may adversely affect sexual function through the accompanied vascular complications .…”

“…Hydration status was assessed by a safe, simple and noninvasive whole‐body bioimpedance spectroscopy (BIS), using a Fresenius Medical Care Body Composition Monitor device (Fresenius Medical Care, Bad Homburg, Germany) . Since differences in body size may affect total body water volume and the degree of fluid overload, the extracellular to intracellular water ratio (E/I ratio) was used as an independent and comparable indicator of hydration status.…”

Is Brain Natriuretic Peptide a Reliable Biomarker of Hydration Status in All Peritoneal Dialysis Patients?

“…However, the measurement of volume status is not easy in PD patients, despite the availability of several methods that have been developed to help clinicians [19]. …”

Predictors of Left Ventricular Hypertrophy and Their Cutoffs in Peritoneal Dialysis Patients

“…[19][20][21] Chronic inflammation is considered a promoting factor for the development of LVH and a very powerful predictor for the development of CV disease and mortality in PD patients. [22][23][24][25] Because the majority of PD patients with HbA1c, PGLI, FO, plasma BNP, hsCRP, or IL-6 values ≥ the determined cutoffs had LVH, efforts should be made to reduce the peritoneal glucose load, to improve the hydration status and to attenuate the inflammatory process in order to reduce the risk of cardiovascular complications among PD patients.…”