Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Curr Opin Nephrol Hypertens. 2019 Jan;28(1):58-64. doi: 10.1097/MNH.0000000000000466.
Maintaining euvolaemia is an essential yet challenging objective in management of patients on peritoneal dialysis. Optimal method to assess volume status remains to be determined. In this review, we will discuss the risk factors and clinical outcomes of fluid overload in PD patients, and examine the role of bioimpedance study in fluid management.
Applying bioimpedance study to measure body composition has attracted increasing attention because it is noninvasive and provides point-of-care assessment of fluid status. Observational studies suggested that presence of residual renal function did not necessarily protect peritoneal dialysis patients from developing fluid overload. This reinforces the importance of fluid restriction in peritoneal dialysis patients, in whom the thirst sensation could be exacerbated by hyperglycaemia. Notably, fluid overload is present in significant portion of asymptomatic patients. Moreover, bioimpedance-defined fluid overload is associated with increase in all-cause mortality, technique failure and possibly excess peritonitis rate.
Although future studies should investigate the clinical benefit of bioimpedance-guided fluid management in high-risk subgroup, raising awareness among clinicians, together with structured clinical assessment and dietary counselling are the cornerstone to maintain stable fluid status.
维持血容量平衡是腹膜透析患者管理的重要目标，但极具挑战性。目前仍未确定评估容量状态的最佳方法。在这篇综述中，我们将讨论 PD 患者液体超负荷的风险因素和临床结局，并探讨生物电阻抗研究在液体管理中的作用。
应用生物电阻抗研究来测量身体成分越来越受到关注，因为它是非侵入性的，可以提供即时的液体状态评估。观察性研究表明，残余肾功能的存在并不一定能保护腹膜透析患者免受液体超负荷的影响。这进一步强调了腹膜透析患者限制液体摄入的重要性，因为高血糖可能会加剧他们的口渴感。值得注意的是，大量无症状患者存在液体超负荷的情况。此外，生物电阻抗定义的液体超负荷与全因死亡率、技术失败以及腹膜炎发生率增加有关。
尽管未来的研究应该调查生物电阻抗指导的液体管理在高危亚组中的临床获益，但提高临床医生的认识，结合结构化的临床评估和饮食咨询，是维持稳定液体状态的基石。
