Crepaldi Carlo, Lamas Elena Iglesias, Martino Francesca Katiana, Rodighiero Maria Pia, Scalzotto Elisa, Wojewodzka-Zelezniakowicz Marzena, Rosner Mitchell H, Ronco Claudio
Contrib Nephrol. 2012;178:174-181. doi: 10.1159/000337849. Epub 2012 May 25.
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.
评估腹膜透析（PD）患者的理想体重对临床实践很重要。液体超负荷可能会导致高血压、动脉扩张性降低、左心室肥厚。所有这些都是PD患者死亡的危险因素：心脑血管事件是PD人群发病和死亡的主要原因。目前，尚无关于PD患者理想体重的明确且被广泛接受的定义。理想体重可能是细胞外液量正常时的体重。已使用多种不同工具来评估透析患者的水合状态。超声评估下腔静脉直径仅能评估血管内容量，且还受舒张功能障碍影响，因此反映的是前负荷而非组织水合状态。通过稀释法直接测量细胞外液和总体水量被视为金标准，但这些技术费力且昂贵。诸如脑钠肽（BNP）或N末端脑钠肽原（NT-proBNP）等参数可反映水合状态的变化，可能有助于肾病学家进行评估。利钠肽受前负荷和心室异常的影响，在肾衰竭患者中可能会蓄积。生物电阻抗是一种准确、可重复、价格低廉且非侵入性的技术，能够很好地评估PD患者的水合状态，并可指导肾病学家做出临床选择。临床评估、严格控制体重、尿量、钠和液体摄入量、生物电阻抗监测以及利钠肽的血清水平，所有这些共同作用可能有助于我们使PD患者保持血容量正常。
