Division of Nephrology, Peking University Third Hospital, Beijing, PR China.
Blood Purif. 2011;31(4):296-302. doi: 10.1159/000322617. Epub 2011 Jan 14.
Volume overload is a common problem in peritoneal dialysis patients and may contribute to the high cardiac mortality in this patient population. Controlling volume status is difficult due to the lack of appropriate and accurate assessment of dry weight. This randomized, controlled study was conducted to test if the recent use of overhydration value (OH) provided by bioimpedance spectroscopy and patients' education would help to control overhydration.
160 continuous ambulatory peritoneal patients were included in this study. All the patients were randomly allocated to 2 groups: in Group 1 the patients and their primary nurses were informed of the OH values provided by bioimpedance spectroscopy whereas in Group 2 the values were not revealed and patients' volume was measured by the standard methods. Fluid status was evaluated by means of repeated bioimpedance analysis and clinical assessment. Urine volume, blood pressure and use of antihypertensive medications were recorded.
There were no differences in gender, age, diabetes, height, weight and clinical hydration status between the 2 groups at the baseline. In Group 1, OH (p < 0.05), extracellular volume and the extracellular volume to intracellular volume ratio decreased steadily during the 3-month follow-up. On the contrary, all 3 parameters increased significantly in Group 2. SBP decreased significantly in Group 1 but increased significantly in Group 2.
Our study shows that the use of OH as determined by bioimpedance spectroscopy may facilitate volume control in peritoneal dialysis patients.
容量超负荷是腹膜透析患者的常见问题，可能导致该患者人群中心脏死亡率较高。由于缺乏对干体重的适当和准确评估，控制容量状态较为困难。本随机对照研究旨在测试近期使用生物阻抗谱测定的超水量值（OH）和患者教育是否有助于控制水过多。
本研究纳入了 160 例持续不卧床腹膜透析患者。所有患者均随机分为 2 组：在第 1 组中，向患者及其初级护士告知生物阻抗谱提供的 OH 值，而在第 2 组中则不揭示这些值，并且通过标准方法测量患者的容量。通过反复生物阻抗分析和临床评估评估液体状态。记录尿量、血压和降压药物的使用情况。
两组患者在性别、年龄、糖尿病、身高、体重和临床水合状态方面在基线时无差异。在第 1 组中，OH（p < 0.05）、细胞外液和细胞外液与细胞内液比值在 3 个月的随访中持续稳定下降。相反，所有 3 个参数在第 2 组中均显著增加。第 1 组的 SBP 显著下降，但第 2 组的 SBP 显著升高。
我们的研究表明，生物阻抗谱测定的 OH 的使用可能有助于腹膜透析患者的容量控制。
