da Costa Bernardo M, Del Peso Gloria, Bajo Maria Auxiliadora, Carreño Gilda, Ferreira Marta, Ferreira Carina, Selgas Rafael
Nephrology Department, Curry Cabral Hospital-Central Lisbon Hospital Center, Lisbon - Portugal.
Nephrology Department, La Paz University Hospital, FIBHULP-IdiPAZ, Madrid - Spain.
Int J Artif Organs. 2017 May 29;40(5):212-218. doi: 10.5301/ijao.5000584. Epub 2017 May 18.
In peritoneal dialysis (PD) patients, body fluid homeostasis is dependent on peritoneal elimination of water and solutes. Patients with less favorable peritoneal transport parameters should be more overhydrated. Despite this, the association between faster transport and overhydration (OH) is weak, and the factors that influence hydration status are still poorly characterized. Modified peritoneal equilibration tests (PET) offer us new parameters that might correlate better with hydration status, like free water transport (FWT). The aim of this study was thus to establish the relationships between new peritoneal transport parameters and body composition parameters estimated by bioimpedance spectroscopy (BIS).
Prospective observational study on incident PD patients with a baseline and 1-year follow-up evaluation.
61 patients were included in the baseline evaluation, 19 of whom had a 1-year follow-up evaluation; 67.2% were fluid overloaded. There was a negative correlation between D/P creatinine and FWT (r = -0.598, p = 0.000). The fraction of FWT was negatively correlated with OH (r = -0.302, p = 0.018). Peritoneal protein losses (PPL) were also correlated with OH (r = 0.287, p = 0.028). There were no significant differences in OH according to small-solute transport status or fluid output parameters. After 1 year, we observed a significant worsening of renal function and an improvement in 24-hour ultrafiltration (UF) and hydration status, but we detected no differences in peritoneal transport of water or solutes that could explain these changes.
There is a poor relationship between kidney/peritoneal function parameters and body composition parameters. The fraction of FWT and PPL may be underestimated markers of peritoneal health and of its contribution to the hydration status.
在腹膜透析（PD）患者中，体液平衡依赖于腹膜对水和溶质的清除。腹膜转运参数欠佳的患者水合过度情况可能更严重。尽管如此，快速转运与水合过度（OH）之间的关联较弱，且影响水合状态的因素仍未得到充分描述。改良腹膜平衡试验（PET）为我们提供了可能与水合状态相关性更好的新参数，如自由水转运（FWT）。因此，本研究的目的是建立新的腹膜转运参数与通过生物电阻抗光谱法（BIS）估算的身体成分参数之间的关系。
对新发PD患者进行前瞻性观察研究，进行基线和1年随访评估。
61例患者纳入基线评估，其中19例进行了1年随访评估；67.2%存在液体过载。D/P肌酐与FWT呈负相关（r = -0.598，p = 0.000）。FWT分数与OH呈负相关（r = -0.302，p = 0.018）。腹膜蛋白丢失（PPL）也与OH相关（r = 0.287，p = 0.028）。根据小分子溶质转运状态或液体输出参数，OH无显著差异。1年后，我们观察到肾功能显著恶化，24小时超滤（UF）和水合状态有所改善，但未发现腹膜水或溶质转运方面的差异可以解释这些变化。
肾脏/腹膜功能参数与身体成分参数之间关系不佳。FWT分数和PPL可能是腹膜健康及其对水合状态贡献的被低估的指标。
