Hur E, Yildiz G, Budak Kose S, Kokturk F, Musayev O, Gungor O, Magden K, Yildirim I, Duman S, Ok E
Zonguldak Karaelmas University, Department of Nephrology, Zonguldak, Turkey.
Hippokratia. 2012 Oct;16(4):329-34.
Euvolemia is a major issue in chronic kidney disease. The present study compares cardiac condition and volume status in peritoneal dialysis (PD) and hemodialysis (HD) patients and points out importance of volume control.
From a single-center center, 81 PD and 89 HD patients were enrolled. Echocardiography and body composition analysis using bioimpedance spectroscopy (BIS) technique were performed. Overhydration (OH) and extracellular water (ECW) in liters and OH/ECW % were used as volume indices.
Patients were younger (47.6±14. 5 and 53.1±11.8 years, p< 0.05), daily urine volume higher (1068±926 vs 290±444 ml, p <0.001) and dialysis vintage was shorter (30.1±18.6 vs 53.6±35.4 months, p<0.001), systolic blood pressure was lower (127.5±15.4 vs 140.3±18.9 mmHg, p<0.001) in PD than HD group respectively. Volume indices were (OH, OH/ECW %, ECW/height, ECW to Intracellular Water ratios (E/I) (p<0.05)) significantly higher in HD patients compared to PD patients. Over all 66 of 170 patients (39%) had OH/ECW % <5 and OH/ECW % ratio was positively correlated with Left atrium index (R(2):0.105, p<0.05). Interventricular septum diameter and Left ventricular mass index (1.41±0.24 and 159.6±48.2 vs. 1.27±0.17 cm and 115.8±37 g/m(2), p<0.001) were increased in HD than in PD group. After multivariate adjustment OH/ECW increased with: HD and diabetic patients. LVH increased with: HD group, OH/ECW (%) and SBP significantly.
Overhydration was more common among HD. Excess fluid may lead adverse effect in organ functions especially cardiac condition. This indicates that the current clinical and technical tools to achieve euvolemia are insufficient and that an additional tool, such as BIS, could be useful in the diagnosis of overhydration.
血容量正常是慢性肾脏病的一个主要问题。本研究比较了腹膜透析（PD）和血液透析（HD）患者的心脏状况和容量状态，并指出了容量控制的重要性。
从一个单中心纳入了81例PD患者和89例HD患者。进行了超声心动图检查和使用生物电阻抗光谱（BIS）技术的身体成分分析。以升为单位的水负荷过重（OH）和细胞外液（ECW）以及OH/ECW%用作容量指标。
PD组患者比HD组患者更年轻（47.6±14.5岁和53.1±11.8岁，p<0.05），每日尿量更高（1068±926 vs 290±444 ml，p<0.001），透析龄更短（30.1±18.6 vs 53.6±35.4个月，p<0.001），收缩压更低（127.5±15.4 vs 140.3±18.9 mmHg，p<0.001）。HD患者的容量指标（OH、OH/ECW%、ECW/身高、ECW与细胞内液比值（E/I）（p<0.05））显著高于PD患者。170例患者中有66例（39%）的OH/ECW%<5，且OH/ECW%比值与左心房指数呈正相关（R²：0.105，p<0.05）。HD组的室间隔直径和左心室质量指数（1.41±0.24和159.6±48.2 vs. 1.27±0.17 cm和115.8±37 g/m²，p<0.001）高于PD组。多因素调整后，OH/ECW随HD和糖尿病患者增加。左心室肥厚随HD组、OH/ECW（%）和收缩压显著增加。
水负荷过重在HD患者中更常见。过多的液体可能对器官功能尤其是心脏状况产生不良影响。这表明目前实现血容量正常的临床和技术工具不足，而额外的工具，如BIS，可能有助于水负荷过重的诊断。
