Abstract
Excessive bodily-fluid retention is the major cause of hypertension and congestive heart failure in patients with end-stage renal disease. Compared to hemodialysis, peritoneal dialysis (PD) uses the abdominal peritoneum as a semipermeable dialysis membrane, providing continuous therapy as natural kidneys, and having fewer hemodynamic changes. One major challenge of PD treatment is to determine the dry weight, especially considering that the speed of small solutes and fluid across the peritoneal membrane varies among individuals; considerable between-patient variability is expected in both solute transportation and ultrafiltration capacity. This study explores the influence of peritoneal-membrane characteristics in the hydration status in patients on PD. A randomized control trial compares the bioimpedance-assessed dry weight with clinical judgment alone. A high peritoneal membrane D/P ratio was associated with the extracellular/total body water ratio, dialysate protein loss, and poor nutritional status in patients on PD. After a six-month intervention, patients with monthly bioimpedance analysis (BIA) assistance had better fluid (−1.2 ± 0.4 vs. 0.1 ± 0.4 kg, p = 0.014) and blood-pressure (124.7 ± 2.7 vs. 136.8 ± 2.8 mmHg, p < 0.001) control; however, hydration status and blood pressure returned to the baseline after we prolonged BIA assistance to a 3-month interval. The dry-weight reduction process had no negative effect on residual renal function or peritoneal-membrane function. We concluded that peritoneal-membrane characteristics affect fluid and nutritional status in patients on PD, and BIA is a helpful objective technique for fluid assessment for PD.
Highlights
The pathogenesis of hypertension (HTN) and congestive heart failure in patients with end-stage renal disease (ESRD) is multifactorial, and fluid overload is one of the most important determining factors [1,2,3,4]
bioimpedance analysis (BIA), extracellular water (ECW), intracellular water (ICW), and total body water (TBW) can be conveniently estimated in a single measurement
One major problem involving the utilization of BIA results as hydration index is that normalization reference for ECW could influence hydration status classification [28]
Summary
The pathogenesis of hypertension (HTN) and congestive heart failure in patients with end-stage renal disease (ESRD) is multifactorial, and fluid overload is one of the most important determining factors [1,2,3,4]. An artificial dialysis membrane is used to remove body toxins and fluid in hemodialysis, and the patient’s dry weight is defined as the lowest postdialysis body weight without hypotension. This weight should be similar to what a person with normal kidney function would weigh after urinating. Nephrologists use the peritoneal equilibration test (PET) to categorize peritoneal-membrane characteristics in four groups, but whether peritoneal-membrane characteristics influence hydration status in patients on PD is controversial Another concern of dry-weight setting in PD is the risk of damaging residual renal function (RRF) because rapid bodily-fluid reduction leads to urine volume depletion and RRF loss in patients on PD [6]. A considerable portion of patients on PD have HTN [15,16]
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