Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea.
Eur J Clin Nutr. 2020 Apr;74(4):633-641. doi: 10.1038/s41430-020-0574-y. Epub 2020 Feb 6.
Inadequate fluid removal or high water intake leads to overhydration, which results in malnutrition. The aim of the present study was to evaluate the effects of volume status on body composition in incident peritoneal dialysis (PD) patients.
All incident PD patients who survived ≥1 year after PD initiation were considered eligible. A total of 366 incident PD patients were finally included and divided into three tertiles according to the time-averaged-edema index (TA-EI). The body composition parameters measured using bioimpedance analysis included the EI, fat mass index (FMI, kg/m), and appendicular muscle mass index (AMMI, kg/m). dFMI and dAMMI were defined as delta values for each variable. The cutoff value for sarcopenia (SP) was defined as previously reported. Patients with AMMI below the cutoff values were defined as having SP.
The number of participants in the low, middle, and high tertiles was 126, 100, and 140, respectively. A high volume status was associated with high solute clearance, albumin loss, and glucose absorption through the peritoneal membrane, which led to high dialysate glucose. In addition, volume status was inversely associated with increases in AMMI, but was not associated with changes in FMI. SP as a categorical variable was positively associated with a high volume status. On subgroup analyses, TA-EI had the greatest negative correlation coefficients for dAMMI.
Overhydration in PD patients was associated with decrease in muscle mass indices and the development of SP.
液体清除不足或水摄入过高会导致水过多，从而导致营养不良。本研究旨在评估容量状态对开始腹膜透析（PD）后存活≥1 年的患者身体成分的影响。
所有符合条件的患者均为开始 PD 后存活≥1 年的患者。共纳入 366 例初发 PD 患者，并根据时间平均水肿指数（TA-EI）分为三个三分位数。生物电阻抗分析测量的身体成分参数包括 EI、脂肪质量指数（FMI，kg/m）和四肢肌肉质量指数（AMMI，kg/m）。dFMI 和 dAMMI 定义为每个变量的差值。之前报道的肌少症（SP）的截断值定义为。AMMI 低于截断值的患者被定义为患有 SP。
低、中、高三分位数组的患者人数分别为 126、100 和 140 例。高容量状态与高溶质清除率、白蛋白损失和通过腹膜吸收葡萄糖有关，这导致了高葡萄糖透析液。此外，容量状态与 AMMI 的增加呈负相关，但与 FMI 的变化无关。作为分类变量的 SP 与高容量状态呈正相关。在亚组分析中，TA-EI 与 dAMMI 的负相关系数最大。
PD 患者的水过多与肌肉质量指数下降和肌少症的发生有关。
