Department of Nephrology, Geneva University Hospitals, Geneva, Switzerland.
UCL Department of Nephrology, Royal Free London NHS Foundation Trust, London, UK.
Nephrology (Carlton). 2020 Oct;25(10):785-791. doi: 10.1111/nep.13716. Epub 2020 May 3.
In peritoneal dialysis (PD), fluid overload is frequent and associated with cardiac dysfunction and mortality. As it is considered a modifiable risk factor, we wished to describe clinical determinants of fluid overload in a longitudinal cohort of PD outpatients.
We consecutively included PD outpatients treated with continuous ambulatory PD (CAPD) or automated PD (APD) attending for their routine clinical visit at a single tertiary hospital. Extracellular water (ECW) to total body water (TBW) ratio was measured by multifrequency bioelectrical impedance. Peritoneal transport characteristics were measured with a standard peritoneal equilibration test. Patients had a second follow-up visit with the same measurements. Univariable and multivariable mixed linear regression models were conducted with ECW/TBW as the dependent variable.
A total of 155 patients were enrolled with a median follow-up time of 12 months. Median dialysis vintage was 13.5 ± 3.4 months. Overall mean value of ECW/TBW was 39.3% ± 1.1. In multivariable analysis, factors positively associated with ECW/TBW were: Age (P < .001), diabetes (P = .002), and SBP (P = .028). Factors negatively associated with ECW/TBW were: nPNA (P = .001), serum albumin (P < .001) and PTH (P = .014). None of the considered variable showed a significant interaction with time.
We confirm a high prevalence of fluid overload in PD patients and show that it is strongly associated with older age, diabetes, hypoalbuminemia and protein energy wasting. In contrast, when PD prescription is tailored to patient's individual characteristics, residual renal function, PD modality and peritoneal characteristics are not decisive in controlling volume status.
在腹膜透析（PD）中，液体超负荷很常见，与心脏功能障碍和死亡率相关。由于它被认为是一个可改变的危险因素，我们希望在 PD 门诊患者的纵向队列中描述液体超负荷的临床决定因素。
我们连续纳入在一家三级医院接受常规临床就诊的接受持续非卧床 PD（CAPD）或自动化 PD（APD）治疗的 PD 门诊患者。细胞外液（ECW）与总体水（TBW）的比值通过多频生物电阻抗测量。腹膜转运特性通过标准腹膜平衡试验测量。患者进行了第二次随访，进行了相同的测量。使用 ECW/TBW 作为因变量进行单变量和多变量混合线性回归模型。
共纳入 155 例患者，中位随访时间为 12 个月。中位透析龄为 13.5±3.4 个月。ECW/TBW 的总体平均值为 39.3%±1.1。在多变量分析中，与 ECW/TBW 呈正相关的因素有：年龄（P<0.001）、糖尿病（P=0.002）和 SBP（P=0.028）。与 ECW/TBW 呈负相关的因素有：nPNA（P=0.001）、血清白蛋白（P<0.001）和 PTH（P=0.014）。没有一个考虑的变量与时间有显著的相互作用。
我们证实 PD 患者存在高患病率的液体超负荷，并且表明它与年龄较大、糖尿病、低白蛋白血症和蛋白质能量消耗密切相关。相反，当 PD 处方根据患者的个体特征、残余肾功能、PD 方式和腹膜特征进行调整时，这些因素对控制容量状态没有决定性作用。
