Bioimpedance Spectroscopy for the Detection of Fluid Overload in Chinese Peritoneal Dialysis Patients

Kwan, Bonnie Ching‐Ha; Szeto, Cheuk‐Chun; Chow, Kai‐Ming; Law, Man-Ching; Cheng, Mei Shan; Leung, Chi‐Bon; Pang, Wing‐Fai; Kwong, Vickie Wai‐Ki; Li, Philip Kam-Tao

doi:10.3747/pdi.2013.00066

Cited by 64 publications

(64 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Including a UF target was felt to be imperative given increasing evidence of the risk of overhydration in a large fraction of PD patients (15)(16)(17)(18)(19)(20), and that management of volume status in ESRD patients is now widely recognized as crucial to optimize clinical outcomes (37,38). Obviously, many patients on PD still have a significant urine output and may not require this volume of peritoneal volume removal.…”

Section: Resultsmentioning

confidence: 99%

“…It is notable that several guidelines have been more directive in suggesting a minimum total ultrafiltration (UF) requirement of 750 or 1,000 mL per day (renal + peritoneal) as an additional parameter to assess adequacy (4,7). Current evidence-based literature highlights the prevalence of volume overload in patients with ESRD treated with PD (15)(16)(17)(18)(19)(20), with average volume excesses of > 2 L (18). The relationship between urine output and volume overload (21) is uncertain, however, perhaps related to variable adherence to fluid intake restriction by the ESRD population.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Volume-Based Peritoneal Dialysis Prescription Guide to Achieve Adequacy Targets

et al. 2015

View full text Add to dashboard Cite

♦ 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 (V urea ). 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 V urea , 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 V urea . While these benefits were most notable in high and high-average transporters, similar results were also seen in low and low-average transporters.

show abstract

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Volume-Based Peritoneal Dialysis Prescription Guide to Achieve Adequacy Targets

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Previous studies showed that in hemodynamic stress and pressure overload-induced heart failure, there is a substantial defect in cardiac oxidative capacity due to mitochondrial damage [25], up-regulation of autophagy to remove the damaged mitochondria is an important adaptive response [26], and mitochondrial DNA that escapes from autophagy further aggravates systemic inflammation and heart failure [27]. Since occult fluid overload is common amongst CKD and PD patients [41], it seems possible that plasma mitochondrial DNA level may originate from the myocardium or other edematous tissue and represent the severity of hemodynamic stress or fluid overload. Unfortunately, we did not have any formal assessment of body fluid status or cardiac function in our cohort, and the hypothesis needs to be tested by further studies.…”

Section: Discussionmentioning

confidence: 99%

Plasma Mitochondrial DNA Level is a Prognostic Marker in Peritoneal Dialysis Patients

Szeto

Lai²,

Chow³

et al. 2016

Kidney Blood Press Res

Self Cite

View full text Add to dashboard Cite

Background/Aims: Circulating bacterial DNA fragment is related to systemic inflammatory state in peritoneal dialysis (PD) patients. We hypothesize that circulating mitochondrial DNA, which has a similar structure with bacterial DNA, correlates with systemic inflammatory state and predicts cardiovascular event in new PD patients. Methods: We measured plasma mitochondrial DNA level by quantitative polymerase chain reaction (PCR) in 197 new PD patients and 150 patients with chronic kidney disease. PD patients were followed for 24 months for the development of cardiovascular event, hospitalization, and patient survival. Results: There was a stepwise increase in plasma mitochondrial DNA level with worsening renal function. The average plasma mitochondrial DNA level was 18.0 ± 1.2 PCR cycles. Plasma mitochondrial DNA level correlated with serum CRP level (r = -0.538, p < 0.0001). At 24 months, the event-free survival was 67.4%, 66.4%, 63.4% and 44.2% for plasma mitochondrial DNA level quartiles I, II, III and IV, respectively (p = 0.049). After adjusting for confounders, plasma mitochondrial DNA level, malnutrition-inflammation score, and baseline arterial pulse wave velocity were independent predictors of composite cardiovascular end-point; each doubling in plasma mitochondrial DNA level confers 16.0% (95% confidence interval, 2.5 - 31.3%, p = 0.001) excess in risk. Plasma mitochondrial DNA also correlated with the number of hospital admission (r = -0.218, p = 0.002) and duration of hospitalization for cardiovascular reasons (r = -0.232, p = 0.001). Conclusion: Plasma mitochondrial DNA level significantly correlates with systemic inflammatory state, and is a strong predictor of cardiovascular event as well as the need of hospitalization in new PD patients.

show abstract

“…The method was described in our previous study (26). Briefly, electrodes were attached to one hand and one foot with the patient in a supine position.…”

Section: Measurement Of Body Fat Content and Body Compositionmentioning

confidence: 99%

Metabolic Syndrome in Peritoneal Dialysis Patients

Szeto

Kwan

Chow

et al. 2014

Clinical Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

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 31.7615.5 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 k=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, 18.267.9 versus 10.765.9 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. ConclusionIn 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.

show abstract

Bioimpedance Spectroscopy for the Detection of Fluid Overload in Chinese Peritoneal Dialysis Patients

Cited by 64 publications

References 21 publications

Volume-Based Peritoneal Dialysis Prescription Guide to Achieve Adequacy Targets

Volume-Based Peritoneal Dialysis Prescription Guide to Achieve Adequacy Targets

Plasma Mitochondrial DNA Level is a Prognostic Marker in Peritoneal Dialysis Patients

Metabolic Syndrome in Peritoneal Dialysis Patients

Contact Info

Product

Resources

About