Prevalence and risk factors of fluid overload in Southern Chinese continuous ambulatory peritoneal dialysis patients

Qunying Guo, Chunyan Yi, Jianying Li, Xiaofeng Wu, Xiao Yang, Xueqing Yu, Qunying Guo, Chunyan Yi, Jianying Li, Xiaofeng Wu, Xiao Yang, Xueqing Yu

Abstract

Background: Fluid overload is frequently present in CAPD patients and one of important predictors of mortality. The aim of this study is to investigate the prevalence and associated risk factors in a cohort study of Southern Chinese CAPD patients.

Methods: The patients (receiving CAPD 3 months and more) in our center were investigated from January 1, 2008 to December 31, 2009. Multi-frequency bioelectrical impedance analysis was used to assess the patient's body composition and fluid status.

Results: A total of 307 CAPD patients (43% male, mean age 47.8±15.3 years) were enrolled, with a median duration of PD 14.6 (5.9-30.9) months. Fluid overload (defined by Extracellular water/Total body water (ECW/TBW)≥0.40) was present in 205 (66.8%) patients. Univariate analysis indicated that ECW/TBW were inversely associated with body mass index (r = -0.11, P = 0.047), subjective global assessment score (r = -0.11, P = 0.004), body fat mass (r = -0.15, P = 0.05), serum albumin (r = -0.32, P<0.001), creatinine (r = -0.14, P = 0.02), potassium (r = -0.15, P = 0.02), and residual urine output (r = -0.14, P = 0.01), positively associated with age (r = 0.27, P<0.001), Chalrlson Comorbidity Index score (r = 0.29, P<0.001), and systolic blood pressure (r = 0.22, P<0.001). Multivariate linear regression showed that lower serum albumin (β = -0.223, P<0.001), lower body fat mass (β = -0.166, P = 0.033), old age (β = 0.268, P<0.001), higher systolic blood pressure (β = 0.16, P = 0.006), less residual urine output (β = -0.116, P = 0.042), and lower serum potassium (β = -0.126, P = 0.03) were independently associated with higher ECW/TBW. After 1 year of follow-up, the cardiac event rate was significantly higher in the patients with fluid overload (17.1% vs 6.9%, P = 0.023) than that of the normal hydrated patients.

Conclusions: The prevalence of fluid overload was high in CAPD patients. Fluid overload in CAPD patients were independently associated with protein-energy wasting, old age, and decreased residual urine output. Furthermore, CAPD patients with fluid overload had higher cardiac event rate than that of normal hydrated patents.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. ROC analysis of edema for…
Figure 1. ROC analysis of edema for fluid overload (AUC = 0.653, sensitivity 0.562, specificity 0.745, P
Figure 2. ECW/TBW in the CAPD patients…
Figure 2. ECW/TBW in the CAPD patients with and without malnutrition.
*, P

Figure 3. ECW/TBW in the CAPD patients…

Figure 3. ECW/TBW in the CAPD patients with and without CVD.

**, P

Figure 3. ECW/TBW in the CAPD patients with and without CVD.
**, P

Figure 4. ECW/TBW in the diabetic and…

Figure 4. ECW/TBW in the diabetic and non-diabetic CAPD patients.

**, P

Figure 4. ECW/TBW in the diabetic and non-diabetic CAPD patients.
**, P

Figure 5. ECW/TBW was positively correlated with…

Figure 5. ECW/TBW was positively correlated with systolic blood pressure (mmHg).

Figure 5. ECW/TBW was positively correlated with systolic blood pressure (mmHg).

Figure 6. ECW/TBW was negatively correlated with…

Figure 6. ECW/TBW was negatively correlated with residual urine output (ml/24

h).
Figure 6. ECW/TBW was negatively correlated with residual urine output (ml/24
h).
Similar articles
Cited by
References
    1. Lo WK, Bargman JM, Burkart J, Krediet RT, Pollock C, et al. (2006) Guideline on targets for solute and fluid removal in adult patients on chronic peritoneal dialysis. Perit Dial Int 26: 520–522. - PubMed
    1. Van Biesen W, Williams JD, Covic AC, Fan S, Claes K, et al. (2011) Fluid status in peritoneal dialysis patients: the European Body Composition Monitoring (EuroBCM) study cohort. PLoS One 6: e17148. - PMC - PubMed
    1. Cheng LT, Tian JP, Tang LJ, Chen HM, Gu Y, et al. (2008) Why is there significant overlap in volume status between hypertensive and normotensive patients on dialysis? Am J Nephrol 28: 508–516. - PubMed
    1. Konings CJ, Kooman JP, Schonck M, Dammers R, Cheriex E, et al. (2002) Fluid status, blood pressure, and cardiovascular abnormalities in patients on peritoneal dialysis. Perit Dial Int 22: 477–487. - PubMed
    1. Enia G, Mallamaci F, Benedetto FA, Panuccio V, Parlongo S, et al. (2001) Long-term CAPD patients are volume expanded and display more severe left ventricular hypertrophy than haemodialysis patients. Nephrol Dial Transplant 16: 1459–1464. - PubMed
Show all 42 references
Publication types
MeSH terms
Grant support
This work was supported by a grant from Key Project of Chinese Ministry of Health Clinical Disciplines ([2010]493). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Follow NCBI
Figure 3. ECW/TBW in the CAPD patients…
Figure 3. ECW/TBW in the CAPD patients with and without CVD.
**, P

Figure 4. ECW/TBW in the diabetic and…

Figure 4. ECW/TBW in the diabetic and non-diabetic CAPD patients.

**, P

Figure 4. ECW/TBW in the diabetic and non-diabetic CAPD patients.
**, P

Figure 5. ECW/TBW was positively correlated with…

Figure 5. ECW/TBW was positively correlated with systolic blood pressure (mmHg).

Figure 5. ECW/TBW was positively correlated with systolic blood pressure (mmHg).

Figure 6. ECW/TBW was negatively correlated with…

Figure 6. ECW/TBW was negatively correlated with residual urine output (ml/24

h).
Figure 6. ECW/TBW was negatively correlated with residual urine output (ml/24
h).
Similar articles
Cited by
References
    1. Lo WK, Bargman JM, Burkart J, Krediet RT, Pollock C, et al. (2006) Guideline on targets for solute and fluid removal in adult patients on chronic peritoneal dialysis. Perit Dial Int 26: 520–522. - PubMed
    1. Van Biesen W, Williams JD, Covic AC, Fan S, Claes K, et al. (2011) Fluid status in peritoneal dialysis patients: the European Body Composition Monitoring (EuroBCM) study cohort. PLoS One 6: e17148. - PMC - PubMed
    1. Cheng LT, Tian JP, Tang LJ, Chen HM, Gu Y, et al. (2008) Why is there significant overlap in volume status between hypertensive and normotensive patients on dialysis? Am J Nephrol 28: 508–516. - PubMed
    1. Konings CJ, Kooman JP, Schonck M, Dammers R, Cheriex E, et al. (2002) Fluid status, blood pressure, and cardiovascular abnormalities in patients on peritoneal dialysis. Perit Dial Int 22: 477–487. - PubMed
    1. Enia G, Mallamaci F, Benedetto FA, Panuccio V, Parlongo S, et al. (2001) Long-term CAPD patients are volume expanded and display more severe left ventricular hypertrophy than haemodialysis patients. Nephrol Dial Transplant 16: 1459–1464. - PubMed
Show all 42 references
Publication types
MeSH terms
Grant support
This work was supported by a grant from Key Project of Chinese Ministry of Health Clinical Disciplines ([2010]493). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 4. ECW/TBW in the diabetic and…
Figure 4. ECW/TBW in the diabetic and non-diabetic CAPD patients.
**, P

Figure 5. ECW/TBW was positively correlated with…

Figure 5. ECW/TBW was positively correlated with systolic blood pressure (mmHg).

Figure 5. ECW/TBW was positively correlated with systolic blood pressure (mmHg).

Figure 6. ECW/TBW was negatively correlated with…

Figure 6. ECW/TBW was negatively correlated with residual urine output (ml/24

h).
Figure 6. ECW/TBW was negatively correlated with residual urine output (ml/24
h).
Figure 5. ECW/TBW was positively correlated with…
Figure 5. ECW/TBW was positively correlated with systolic blood pressure (mmHg).
Figure 6. ECW/TBW was negatively correlated with…
Figure 6. ECW/TBW was negatively correlated with residual urine output (ml/24
h).

References

    1. Lo WK, Bargman JM, Burkart J, Krediet RT, Pollock C, et al. (2006) Guideline on targets for solute and fluid removal in adult patients on chronic peritoneal dialysis. Perit Dial Int 26: 520–522.
    1. Van Biesen W, Williams JD, Covic AC, Fan S, Claes K, et al. (2011) Fluid status in peritoneal dialysis patients: the European Body Composition Monitoring (EuroBCM) study cohort. PLoS One 6: e17148.
    1. Cheng LT, Tian JP, Tang LJ, Chen HM, Gu Y, et al. (2008) Why is there significant overlap in volume status between hypertensive and normotensive patients on dialysis? Am J Nephrol 28: 508–516.
    1. Konings CJ, Kooman JP, Schonck M, Dammers R, Cheriex E, et al. (2002) Fluid status, blood pressure, and cardiovascular abnormalities in patients on peritoneal dialysis. Perit Dial Int 22: 477–487.
    1. Enia G, Mallamaci F, Benedetto FA, Panuccio V, Parlongo S, et al. (2001) Long-term CAPD patients are volume expanded and display more severe left ventricular hypertrophy than haemodialysis patients. Nephrol Dial Transplant 16: 1459–1464.
    1. Demirci MS, Demirci C, Ozdogan O, Kircelli F, Akcicek F, et al. (2011) Relations between malnutrition-inflammation-atherosclerosis and volume status. The usefulness of bioimpedance analysis in peritoneal dialysis patients. Nephrol Dial Transplant 26: 1708–1716.
    1. Paniagua R, Ventura MD, Avila-Diaz M, Hinojosa-Heredia H, Mendez-Duran A, et al. (2010) NT-proBNP, fluid volume overload and dialysis modality are independent predictors of mortality in ESRD patients. Nephrol Dial Transplant 25: 551–557.
    1. Chen W, Gu Y, Han QF, Wang T (2008) Contrasting clinical outcomes between different modes of peritoneal dialysis regimens: two center experiences in China. Kidney Int Suppl: S56–62.
    1. Woodrow G (2007) Methodology of assessment of fluid status and ultrafiltration problems. Perit Dial Int 27 Suppl 2S143–147.
    1. Cocchi R, Degli Esposti E, Fabbri A, Lucatello A, Sturani A, et al. (1999) Prevalence of hypertension in patients on peritoneal dialysis: results of an Italian multicentre study. Nephrol Dial Transplant 14: 1536–1540.
    1. Matthie J, Zarowitz B, De Lorenzo A, Andreoli A, Katzarski K, et al. (1998) Analytic assessment of the various bioimpedance methods used to estimate body water. J Appl Physiol 84: 1801–1816.
    1. Moissl UM, Wabel P, Chamney PW, Bosaeus I, Levin NW, et al. (2006) Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas 27: 921–933.
    1. Wabel P, Chamney P, Moissl U, Jirka T (2009) Importance of whole-body bioimpedance spectroscopy for the management of fluid balance. Blood Purif 27: 75–80.
    1. Pecoits-Filho R, Lindholm B, Stenvinkel P (2002) The malnutrition, inflammation, and atherosclerosis (MIA) syndrome – the heart of the matter. Nephrol Dial Transplant 17 Suppl 1128–31.
    1. John B, Tan BK, Dainty S, Spanel P, Smith D, et al. (2010) Plasma volume, albumin, and fluid status in peritoneal dialysis patients. Clin J Am Soc Nephrol 5: 1463–1470.
    1. Boudville NC, Cordy P, Millman K, Fairbairn L, Sharma A, et al. (2007) Blood pressure, volume, and sodium control in an automated peritoneal dialysis population. Perit Dial Int 27: 537–543.
    1. Rallison LR, Kushner RF, Penn D, Schoeller DA (1993) Errors in estimating peritoneal fluid by bioelectrical impedance analysis and total body electrical conductivity. J Am Coll Nutr 12: 66–72.
    1. National Institutes of Health Technology Assessment Conference and Workshops (1996) Bioelectrical impedance analysis in body composition measurement: National Institutes of Health Technology Assessment Conference Statement. Am J Clin Nutr 64: 524S–532S.
    1. van den Ham EC, Kooman JP, Christiaans MH, Nieman FH, Van Kreel BK, et al. (1999) Body composition in renal transplant patients: bioimpedance analysis compared to isotope dilution, dual energy X-ray absorptiometry, and anthropometry. J Am Soc Nephrol 10: 1067–1079.
    1. Chertow GM, Lowrie EG, Wilmore DW, Gonzalez J, Lew NL, et al. (1995) Nutritional assessment with bioelectrical impedance analysis in maintenance hemodialysis patients. J Am Soc Nephrol 6: 75–81.
    1. Jones CH, Smye SW, Newstead CG, Will EJ, Davison AM (1998) Extracellular fluid volume determined by bioelectric impedance and serum albumin in CAPD patients. Nephrol Dial Transplant 13: 393–397.
    1. Cooper BA, Aslani A, Ryan M, Zhu FY, Ibels LS, et al. (2000) Comparing different methods of assessing body composition in end-stage renal failure. Kidney Int 58: 408–416.
    1. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, et al. (2008) What is subjective global assessment of nutritional status? 1987. Classical article. Nutr Hosp 23: 400–407.
    1. Volk ML, Hernandez JC, Lok AS, Marrero JA (2007) Modified Charlson comorbidity index for predicting survival after liver transplantation. Liver Transpl 13: 1515–1520.
    1. Yong DS, Kwok AO, Wong DM, Suen MH, Chen WT, et al. (2009) Symptom burden and quality of life in end-stage renal disease: a study of 179 patients on dialysis and palliative care. Palliat Med 23: 111–119.
    1. Wizemann V, Wabel P, Chamney P, Zaluska W, Moissl U, et al. (2009) The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant 24: 1574–1579.
    1. Wizemann V, Rode C, Wabel P (2008) Whole-body spectroscopy (BCM) in the assessment of normovolemia in hemodialysis patients. Contrib Nephrol 161: 115–118.
    1. Passauer J, Petrov H, Schleser A, Leicht J, Pucalka K (2010) Evaluation of clinical dry weight assessment in haemodialysis patients using bioimpedance spectroscopy: a cross-sectional study. Nephrol Dial Transplant 25: 545–551.
    1. Machek P, Jirka T, Moissl U, Chamney P, Wabel P (2010) Guided optimization of fluid status in haemodialysis patients. Nephrol Dial Transplant 25: 538–544.
    1. Devolder I, Verleysen A, Vijt D, Vanholder R, Van Biesen W (2010) Body composition, hydration, and related parameters in hemodialysis versus peritoneal dialysis patients. Perit Dial Int 30: 208–214.
    1. Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, et al. (2008) A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 73: 391–398.
    1. Van Biesen W, Lameire N, Verbeke F, Vanholder R (2008) Residual renal function and volume status in peritoneal dialysis patients: a conflict of interest? J Nephrol 21: 299–304.
    1. Bargman JM, Thorpe KE, Churchill DN (2001) Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. J Am Soc Nephrol 12: 2158–2162.
    1. Ates K, Nergizoglu G, Keven K, Sen A, Kutlay S, et al. (2001) Effect of fluid and sodium removal on mortality in peritoneal dialysis patients. Kidney Int 60: 767–776.
    1. Rodriguez-Carmona A, Fontan MP (2002) Sodium removal in patients undergoing CAPD and automated peritoneal dialysis. Perit Dial Int 22: 705–713.
    1. Rodriguez-Carmona A, Perez-Fontan M, Garca-Naveiro R, Villaverde P, Peteiro J (2004) Compared time profiles of ultrafiltration, sodium removal, and renal function in incident CAPD and automated peritoneal dialysis patients. Am J Kidney Dis 44: 132–145.
    1. Ortega O, Gallar P, Carreno A, Gutierrez M, Rodriguez I, et al. (2001) Peritoneal sodium mass removal in continuous ambulatory peritoneal dialysis and automated peritoneal dialysis: influence on blood pressure control. Am J Nephrol 21: 189–193.
    1. Davison SN, Jhangri GS, Jindal K, Pannu N (2009) Comparison of volume overload with cycler-assisted versus continuous ambulatory peritoneal dialysis. Clin J Am Soc Nephrol 4: 1044–1050.
    1. Chen W, Cheng LT, Wang T (2007) Salt and fluid intake in the development of hypertension in peritoneal dialysis patients. Ren Fail 29: 427–432.
    1. Covic A, Haydar AA, Bhamra-Ariza P, Gusbeth-Tatomir P, Goldsmith DJ (2005) Aortic pulse wave velocity and arterial wave reflections predict the extent and severity of coronary artery disease in chronic kidney disease patients. J Nephrol 18: 388–396.
    1. Lameire N, Van Biesen W (2001) Importance of blood pressure and volume control in peritoneal dialysis patients. Perit Dial Int 21: 206–211.
    1. Konings CJ, Kooman JP, Schonck M, Struijk DG, Gladziwa U, et al. (2003) Fluid status in CAPD patients is related to peritoneal transport and residual renal function: evidence from a longitudinal study. Nephrol Dial Transplant 18: 797–803.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する