Extracellular Water/Intracellular Water Is a Strong Predictor of Patient Survival in Incident Peritoneal Dialysis Patients

Chen, Wei Wei; Guo, Li-Juan; Wang, Tao

doi:10.1159/000101699

Cited by 64 publications

(72 citation statements)

References 62 publications

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“…The abnormal hydration state is related to arterial hypertension, dialysis-associated hypotension and other symptoms and signs, including pulmonary and peripheral edema, heart failure, left ventricular hypertrophy and other adverse cardiovascular sequelae [6,7]. A number of studies have shown that a significant proportion of deaths in dialysis patients can be attributed to left ventricular hypertrophy [8].…”

Section: Introductionmentioning

confidence: 99%

What Is the Upper Limitation of Volume in Chinese Peritoneal Dialysis Patients?

Luo

2011

Blood Purif

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Background: Overhydration (OH) is a well-recognized problem in peritoneal dialysis (PD) patients and is an independent risk factor of mortality in this patient population. Achieving normohydration remains an important issue in dialysis therapy. The present study tries to compare clinical signs and find the optimal range for PD patients in China. Methods: A new bioimpedance spectroscopy device [body composition monitor (BCM)], which allows quantitative determination of how much the hydration status deviates from normal ranges (ΔHS), was selected. Blood pressure and ΔHS were analyzed in 92 PD patients from 1 dialysis center and compared with a matched healthy population (n = 45). Statistical analysis was performed using SPSS software, version 16.0 (SPSS Inc., Chicago, Ill., USA). Results: We took different OH values as cutoff thresholds; predictive accuracy was evaluated with sensitivity and specificity, and a receiver-operating characteristics curve and Youden’s index were adopted. Conclusion: Our data suggest that 2.0 liters is a reasonable cutoff value for ΔHS. This represents an important step towards a more objective choice of strategies for the optimal treatment of hypertension and fluid overload.

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Section: Introductionmentioning

confidence: 99%

What Is the Upper Limitation of Volume in Chinese Peritoneal Dialysis Patients?

Luo

2011

Blood Purif

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“…It is now recognised that hypervolaemia is also prevalent in peritoneal dialysis patients and that failure to achieve adequate ultrafiltration is becoming a greater cause of technique failure [3]. …”

Section: Introductionmentioning

confidence: 99%

Does Diabetes Mellitus Predispose to Increased Fluid Overload in Peritoneal Dialysis Patients?

Davenport

Willicombe²

2009

Nephron Clin Pract

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Background: Diabetic peritoneal dialysis patients have been reported to have faster peritoneal solute transport and may be at risk of reduced ultrafiltration volumes, leading to fluid overload. Methods: We audited multi-frequency bioimpedance data from 198 consecutive peritoneal dialysis patients (141 nondiabetics and 57 diabetics). Results: Diabetic patients had increased body mass index (males 27 ± 4 vs. 26 ± 4; females 28 ± 5 vs. 25 ± 4; p < 0.01 for both), waist to hip ratio (males 0.94 ± 0.07 vs. 0.94 ± 0.04; females 0.99 ± 0.9 vs. 0.94 ± 0.09; p < 0.01 for both) and body fat (males 31 ± 8 vs. 26 ± 11%, p < 0.05; females 40 ± 8 vs. 33 ± 10%, p < 0.01) compared to nondiabetic patients. D4/P creatinine was greater for the female diabetic patients than the nondiabetic patients (0.75 ± 0.1 vs. 0.69 ± 0.1; p = 0.044); otherwise, the peritoneal equilibrium test (PET) results did not differ. Extracellular water (ECW) adjusted for height was similar in diabetic and nondiabetic patients, but the ratio of ECW to total body water (TBW) was greater for diabetics (males 0.40 ± 0.01 vs. 0.39 ± 0.01; females 0.39 ± 0.01 vs. 0.38 ± 0.01; p < 0.05 for both). Conclusions: Diabetic and nondiabetic patients had similar PET results, 24-hour net peritoneal ultrafiltration and blood pressure control. The ratio of ECW to TBW was greater in diabetic patients, and although this could be due to a loss of intracellular water, as albumin and C-reactive protein did not differ, it suggests that diabetic peritoneal dialysis patients have an expanded extracellular volume.

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“…When extrapolated to actual volumes using commercial algorithms, this is frequently expressed as an abnormally high extracellular water (ECW):TBW ratio. This is clearly a relevant biometric as it predicts survival (9) and detects interventions intended to alter fluid status, (5) but suffers a number of problems. First, the ratio will be affected both by muscle wasting and abnormal tissue hydration, and compared with normal subjects, it is the former that is most abnormal (10).…”

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confidence: 99%