Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
Department of Internal Medicine, Guro Hospital, Korea University, Seoul, South Korea.
Nephrology (Carlton). 2019 Dec;24(12):1279-1289. doi: 10.1111/nep.13571. Epub 2019 Apr 25.
Bioimpedance spectroscopy (BIS) allows volume status to be assessed objectively. This study evaluated the effect of BIS-guided fluid management on residual kidney function (RKF), volume status, and cardiovascular events in peritoneal dialysis (PD) patients.
A multicenter, prospective, randomized, controlled trial was conducted over 12 months in 2013-2017. Non-anuric PD patients (urine volume ≥ 500 mL/day) were randomized to clinical method-guided management (n = 98) or BIS-guided management (n = 103). The volume in the BIS group was controlled with BIS, with the aim of achieving the target overhydration (OH) goal of -2.0 to +2.0 L. The volume in the control group was controlled by clinical assessment alone. The groups were compared in terms of change in RKF and volume status at 12 months relative to baseline and in terms of cardiovascular event rates during a median follow-up period of 36 months.
Compared with the controls, the BIS group did not show a significant improvement in change in OH, after adjustments were made for covariates (P = 0.191). The two groups did not differ in terms of delta OH, renal creatinine and urea clearance, and 24 h urine volume. The control and BIS groups also did not differ significantly in terms of change in peritoneal ultrafiltration volume, blood pressure, body weight and echocardiographic variables or in cardiovascular event rates (10.2% vs 11.3%; P = 0.953).
Bioimpedance spectroscopy-guided fluid management did not show an additional benefit to achieve euvolemia, and did not affect the decline in RKF in non-anuric PD patients.
生物阻抗谱（BIS）可客观评估容量状态。本研究评估了 BIS 指导的液体管理对腹膜透析（PD）患者残余肾功能（RKF）、容量状态和心血管事件的影响。
2013-2017 年进行了一项多中心、前瞻性、随机、对照试验。非少尿 PD 患者（尿量≥500ml/天）随机分为临床方法指导管理组（n=98）或 BIS 指导管理组（n=103）。BIS 组通过 BIS 控制容量，目标是达到目标过度水化（OH）目标-2.0 至+2.0L。对照组仅通过临床评估控制容量。比较两组患者在 12 个月时相对于基线的 RKF 和容量状态变化，以及中位随访 36 个月期间的心血管事件发生率。
与对照组相比，BIS 组在调整协变量后，OH 变化无显著改善（P=0.191）。两组间 delta OH、肾肌酐和尿素清除率以及 24 小时尿量无差异。对照组和 BIS 组之间腹膜超滤量、血压、体重和超声心动图变量的变化以及心血管事件发生率也无显著差异（10.2%比 11.3%；P=0.953）。
BIS 指导的液体管理并未显示出额外的益处来实现正常容量，也未影响非少尿 PD 患者 RKF 的下降。
