Ronco Claudio, Verger Christian, Crepaldi Carlo, Pham Jenny, De Los Ríos Tatiana, Gauly Adelheid, Wabel Peter, Van Biesen Wim
Department of Nephrology, Ospedale S. Bortolo, Vicenza, Italy.
Centre Hospitalier René Dubos, Pontoise, France.
Nephrol Dial Transplant. 2015 May;30(5):849-58. doi: 10.1093/ndt/gfv013. Epub 2015 Mar 11.
Non-euvolaemia in peritoneal dialysis (PD) patients is associated with elevated mortality risk. There is an urgent need to collect data to help us understand the association between clinical practices and hydration and nutritional status, and their effects on patient outcome.
The aim of this prospective international, longitudinal observational cohort study is to follow up the hydration and nutritional status, as measured by bioimpedance spectroscopy using the body composition monitor (BCM) of incident PD patients for up to 5 years. Measures of hydration and nutritional status and of clinical, biochemical and therapy-related data are collected directly before start of PD treatment, at 1 and 3 months, and then every 3 months. This paper presents the protocol and a pre-specified analysis of baseline data of the cohort.
A total of 1092 patients (58.1% male, 58.0 ± 15.3 years) from 135 centres in 32 countries were included. Median fluid overload (FO) was 2.0 L (males) and 0.9 L (females). Less than half of the patients were normohydrated (38.7%), whereas FO > 1.1 L was seen in 56.5%. Systolic and diastolic blood pressure were 139.5 ± 21.8 and 80.0 ± 12.8 mmHg, respectively, and 25.1% of patients had congestive heart failure [New York Heart Association (NYHA) 1 or higher]. A substantial number of patients judged to be not overhydrated on clinical judgement appeared to be overhydrated by BCM measurement. Overhydration at baseline was independently associated with male gender and diabetic status.
The majority of patients starting on PD are overhydrated already at start of PD. This may have important consequences on clinical outcomes and preservation of residual renal function. Substantial reclassification of hydration status by BCM versus on a clinical basis was necessary, especially in patients who were not overtly overhydrated. Both clinical appreciation and bioimpedance should be combined in clinical decision-making on hydration status.
腹膜透析（PD）患者的非等容状态与死亡风险升高相关。迫切需要收集数据，以帮助我们了解临床实践与水合及营养状况之间的关联，以及它们对患者预后的影响。
这项前瞻性国际纵向观察性队列研究的目的是，使用人体成分监测仪（BCM）通过生物电阻抗光谱法对新入组的PD患者的水合及营养状况进行长达5年的随访。在开始PD治疗前、治疗1个月和3个月时，以及之后每3个月，直接收集水合及营养状况的测量数据以及临床、生化和治疗相关数据。本文介绍了该研究方案以及对队列基线数据的预先指定分析。
纳入了来自32个国家135个中心的1092例患者（男性占58.1%，年龄58.0±15.3岁）。液体超负荷（FO）的中位数男性为2.0L，女性为0.9L。不到一半的患者水合正常（38.7%），而56.5%的患者FO>1.1L。收缩压和舒张压分别为139.5±21.8mmHg和80.0±12.8mmHg，25.1%的患者患有充血性心力衰竭[纽约心脏协会（NYHA）分级为1级或更高]。大量经临床判断认为没有水合过度的患者，经BCM测量显示为水合过度。基线时的水合过度与男性性别和糖尿病状态独立相关。
大多数开始接受PD治疗的患者在治疗开始时就已水合过度。这可能对临床结局和残余肾功能的保留产生重要影响。通过BCM与基于临床判断对水合状态进行实质性重新分类是必要的，尤其是在那些没有明显水合过度的患者中。在关于水合状态的临床决策中，应将临床评估和生物电阻抗结合起来。
