Oh Kook-Hwan, Baek Seon Ha, Joo Kwon-Wook, Kim Dong Ki, Kim Yon Su, Kim Sejoong, Oh Yun Kyu, Han Byoung Geun, Chang Jae Hyun, Chung Wookyung, Na Ki Young
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi Do, Korea.
Perit Dial Int. 2018 Mar-Apr;38(2):131-138. doi: 10.3747/pdi.2016.00241. Epub 2018 Jan 31.
In peritoneal dialysis (PD) patients, volume overload is related to cardiac dysfunction and mortality, while intravascular volume depletion is associated with a rapid decline in the residual renal function (RRF). This study sought to determine the clinical usefulness of bioimpedance spectroscopy (BIS)-guided fluid management for preserving RRF and cardiac function in PD patients.
This is a multicenter, prospective, open-label study that was conducted over a 1-year period (NCT01887262). Non-anuric (urine volume > 500 mL/day) subjects on PD were enrolled. Subjects in the control group received fluid management based on the clinical information alone. Those in the BIS group received BIS-guided fluid management along with clinical information.
The subjects ( = 137, mean age 51.3 ± 12.8 years, 54% male) were randomly assigned to the BIS group ( = 67) or to the control group ( = 70). There were no significant differences between the 2 groups with regard to age, sex ratio, cause of kidney failure, duration of PD, baseline comorbidity, RRF, PD method, or peritoneal transport type. At baseline, the 2 groups were not different in terms of RRF (glomerular filtration rate [GFR], 5.1 ± 2.9 vs 5.5 ± 3.7 mL/min/1.73 m). After follow-up, changes in the GFR between the 2 groups were not different (-1.5 ± 2.4 vs -1.3 ± 2.6 mL/min/1.73 m, = 0.593). Over the 1-year study period, both groups maintained stability of various fluid status parameters. Between the 2 groups, there were no differences in the net change of various fluid status parameters such as overhydration (OH) and extracellular water/total body water (ECW/TBW). A net change in ECW over 1 year was slightly but significantly higher in the control group (net increase, 0.57 ± 1.27 vs 0.05 ± 1.63 L, = 0.047). However, this difference was not translated into an improvement in RRF in the BIS group. There were no differences in echocardiographic parameters or arterial stiffness at the end of follow-up.
Routine BIS-guided fluid management in non-anuric PD patients did not provide additional benefit in volume control, RRF preservation, or cardiovascular (CV) parameters. However, our study cannot be generalized to the whole PD population. Further research is warranted in order to investigate the subpopulation of PD patients who may benefit from routine BIS-guided fluid management.
在腹膜透析（PD）患者中，容量超负荷与心脏功能障碍和死亡率相关，而血管内容量耗竭与残余肾功能（RRF）的快速下降有关。本研究旨在确定生物电阻抗光谱法（BIS）指导的液体管理对保留PD患者的RRF和心脏功能的临床实用性。
这是一项多中心、前瞻性、开放标签研究，为期1年（NCT01887262）。纳入非无尿（尿量>500 mL/天）的PD患者。对照组患者仅根据临床信息进行液体管理。BIS组患者在临床信息基础上接受BIS指导的液体管理。
受试者（n = 137，平均年龄51.3±12.8岁，54%为男性）被随机分配至BIS组（n = 67）或对照组（n = 70）。两组在年龄、性别比例、肾衰竭原因、PD持续时间、基线合并症、RRF、PD方法或腹膜转运类型方面无显著差异。基线时，两组在RRF方面无差异（肾小球滤过率[GFR]，5.1±2.9 vs 5.5±3.7 mL/min/1.73 m²）。随访后，两组GFR的变化无差异（-1.5±2.4 vs -1.3±2.6 mL/min/1.73 m²，P = 0.593）。在1年的研究期间，两组各种液体状态参数均保持稳定。两组之间，各种液体状态参数的净变化，如液体过多（OH）和细胞外液/总体液（ECW/TBW），无差异。对照组1年内ECW的净变化略高但有显著差异（净增加，0.57±1.27 vs 0.05±1.63 L，P = 0.047）。然而，这种差异并未转化为BIS组RRF的改善。随访结束时，超声心动图参数或动脉僵硬度无差异。
在非无尿PD患者中，常规BIS指导的液体管理在容量控制、RRF保留或心血管（CV）参数方面未提供额外益处。然而，我们的研究不能推广至整个PD患者群体。有必要进行进一步研究以调查可能从常规BIS指导的液体管理中获益的PD患者亚群。
