Status Of Continuous Ambulatory Peritoneal Dialysis Patients Research Articles

Nutritional status of CAPD patients at three years.

A nutritional assessment was carried out in 63 patients starting treatment from April 1990 up to December 1993. Anthropometric measurements were performed showing a prevalence of protein-calorie malnutrition (PCM) of 21% in a total of 142 clinical surveys carried out in the above-mentioned sample. A steady state of albumin levels in plasma was verified during a three-year follow-up period at a lower level than that of the control group. The patients' lymphocytic profile throughout the study was characterized by lymphopenia and decreased B and T8 lymphocytes. During the first two years of continuous ambulatory peritoneal dialysis (CAPD), a high percentage of patients met the "adequacy" dialysis criteria as residual renal function plays an important role as regards treatment.

Numerical expression of volume status using the bioimpedance ratio in continuous ambulatory peritoneal dialysis patients: A pilot study.

BackgroundVolume overload results in higher mortality rates in patients on continuous ambulatory peritoneal dialysis (CAPD). The ratio of bioimpedance (RBI) might be a helpful parameter in adjusting dry body weight in CAPD patients. This study examined whether it is possible to distinguish between non-hypervolemic status and hypervolemic status in CAPD patients by using only RBI.MethodsRBI was calculated as follows: RBI = impedance at 50 kHz/impedance at 500 kHz. Based on the experts’ judgements, a total of 64 CAPD patients were divided into two groups, a non-hypervolemic group and a hypervolemic group. The RBI was measured from right wrist to right ankle (rw-raRBI) by bioimpedance spectroscopy (BCM®, Fresenius Medical Care) before and after the peritosol was emptied. Other RBIs were measured from the right side of the anterior superior iliac spine to the ipsilateral ankle (rasis-raRBI) to control for the electro-physiological effects of peritoneal dialysate.ResultsThe mean rw-raRBI of non-hypervolemic patients was higher than that of hypervolemic patients in the presence (1.141 ± 0.022 vs. 1.121 ± 0.021, P < 0.001) of a peritosol. Likewise, the mean rasis-raRBI of non-hypervolemic patients was higher than that of hypervolemic patients (presence of peritosol: 1.136 ± 0.026 vs. 1.109 ± 0.022, P < 0.001; absence of peritosol: 1.131 ± 0.022 vs. 1.107 ± 0.022, P < 0.001).ConclusionThe volume status of CAPD patients was able to be simply expressed by RBI. Therefore, this study suggests that when patients cannot be analyzed using BCM, RBI could be an alternative.

Risk factors of heart failure among continuous ambulatory peritoneal dialysis patients

Objective To explore the risk factors of heart failure among continuous ambulatory peritoneal dialysis （CAPD） patients.Methods General information, scale of volume management of CAPD , New York Heart Association （ NYHA） classification and biochemical data were used to analyze independent risk factors of heart failure among CAPD patients .The relationship between level of volume management and incidence of heart failure was also discussed in different nutritional status .Results A total of 114 questionnaires were handed out and 114 were recovered , with the rate of 100%.Level of volume management , serum pre-albumin, blood urea nitrogen were independent risk factors for heart failure among CAPD patients （r=-1.290,-0.006,0.085, respectively;P<0.05）.With a normal level of serum pre-albumin, higher volume management score were associated with lower incidence of heart failure （χ2 =10.542,P<0.05）.No differences were found between volume management scores and incidence of heart failure among those with higher or lower serum pre -albumin levels.Conclusions Improvement of the level of volume management and dialysis adequacy as well as attention to assess nutritional status of CAPD patients can provide references for preventing heart failure . Key words: Peritoneal dialysis,continuous ambulatory; Heart failure; Risk factor

THE CORRELATION OF SERUM PREALBUMIN AND ROUTINE NUTRITION PARAMETERS IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS

Prealbumin is evidenced to reflect recent dietary intake rather than overall nutrition status because of its short half-life. Most of continuous ambulatory peritoneal dialysis (CAPD) patients show hypoalbuminnemia. However, there are many factors which may influence the level of albumin in serum. We demonstrated the correlation of prealbumin and other common nutritional markers in CAPD patients. All participants were undergoing peritoneal dialysis more than 3 months with no active infection elsewhere. The participants were asked to do the handgrip strength (HGS) by Grip strength dynamometer (T.K.K.5001) and bioelectrical impedance analysis. Serum prealbumin, albumin and C-reactive protein (CRP) were tested. Of 48 patients, 56% had serum albumin less than 3.5 g/dL (3.39±0.43) while prealbumin more than 0.35 g/L (0.35±0.08). Sixty-eight percent of all participants had HGS below normal value according to gender. The correlation of prealbumin and the other nutrition parameters was shown in the table. prealbumin albumin HGS CRP lean body mass body cell mass prealbumin 1.000 0.484 b 0.443 b −0.419 b −0.016 −0.012 albumin 0.484 b 1.000 0.218 −0.347 a 0.052 0.073 HGS 0.443 c 0.218 1.000 −0.112 0.401 0.406 a CRP −0.419 b −0.347 a −0.112 1.000 0.128 0.114 lean body mass −0.016 0.052 0.401 0.128 1.000 0.997 b body cell mass −0.012 0.073 0.406 a 0.114 0.997 b 1.000 a p b p c p We concluded that HGS may be a comfortably and non invasive alternative technique used to indicate nutrition status in CAPD patients.

Effectiveness of Dietetic Intervention on Nutritional Status and Hydration Status in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients

In Hong Kong, more than 3,000 patients with end-stage renal failure (ESRF) on CAPD in 20091. Protein-energy malnutrition and volume overload are common problems in CAPD patients and associated with high morbidity and mortality2-6. Hyperphosphatemia is also a frequent complication in Chinese CAPD patients and is associated with development of renal bone disease or osteodystrophy7. The Kidney Dialysis Outcomes Quality Initiative (KDOQI) guidelines suggested a combination of valid, complementary measures should be used to assess nutritional status in CAPD patients and anthropometric measurements are valid and clinically useful indicators of protein-energy nutritional status in maintenance dialysis patients8. Bioelectrical Impedance Analysis (BIA), which is a simple, inexpensive and non-invasive method, provides another powerful tool for monitoring of nutrition and hydration in CAPD patients9—10. The objective of this study is to evaluate the effectiveness of dietetic intervention in a local acute hospital on nutritional status and hydration status of patients on CAPD in outpatient setting. This is a retrospective study of 22 ESRF patients receiving dietetic intervention during CAPD training from February 2010 to January 2011. Patients with cognitive impairment or contraindicated with bioimepdence analysis (BIA) were excluded. Baseline demographic and clinical data were retrieved from the dietetic consultation record and the electronic records in Clinical Management System (CMS). The parameters related to the nutrition and hydration status in the first and follow-up dietetic consultation were also collected from the record. They included the dietary protein and energy intakes estimated from the dietary history, anthropometric measurements such as weight, height, body mass index (BMI), skeletal muscle mass (SMM), body fat mass (BFM), body fat percentage (BF%), intracellular water (ICW), extracellular water (ECW) measured by body composition analyzer (InBody720, Biospace Inc., UK), and the biochemical parameters such as albumin, haemoglobin, sodium, potassium, urea, creatinine and phosphate.

Relationship between Serum N-Terminal Pro-Brain Natriuretic Peptide Level and Left Ventricular Dysfunction and Extracellular Water in Continuous Ambulatory Peritoneal Dialysis Patients

This study inquired the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and left ventricular (LV) dysfunction and extracellular water in continuous ambulatory peritoneal dialysis (CAPD) patients. We conducted a cross-sectional study of 30 CAPD patients. Each patient was admitted to the department of internal medicine, Chosun University Hospital between February and October, 2006. Echocardiography was performed using HDI 5000, allowing M-mode, two-dimensional measurement. A multifrequency bioimpedance analyzer was used; extracellular water was calculated as a percentage of total body water and was understood as the index of volume load of CAPD patients. The mean age was 47±12 years. Underlying causes of renal failure were 14 with diabetes mellitus, 7 with hypertension, and 9 with chronic glomerulonephritis. The mean serum NT-proBNP level was 14236.56 (83-35,000) pg/mL. LV mass index and LV ejection fraction were 151.67±42.5 g/m2 and 57.48±12.9%, respectively. The mean extracellular water was 35.97±1.04%. Serum NT-proBNP levels correlated positively with LV mass index (r=0.768, p=0.01) and extracellular water (r=0.866, p=0.01) and negatively with LV ejection fraction (r=-0.808, p=0.01). Serum NT-proBNP levels significantly correlated with LV mass index, LV ejection fraction, and extracellular water. Therefore, serum NT-proBNP levels can be a clinical predictive marker for LV hypertrophy, LV dysfunction, and volume status in CAPD patients.

Respiratory evaluation of patients on continuous ambulatory peritoneal dialysis prior to renal transplantation

Pulmonary function tests (PFTs) and cardiopulmonary exercise tests (CPETs) are important in predicting preoperative pulmonary complications and mortality rate in potentially renal transplant recipients. There is no adequate clinical research aimed at learning the effect of empty and full status of the peritoneal cavity on PFTs and CPET for estimating decide PFTs and CPET timing in preoperative evaluation. The aim of this study was to investigate whether PFT and CPET results are altered in patients on continuous ambulatory peritoneal dialysis (CAPD) according to the presence of dialysis solution in the abdomen. 22 subjects were included (12 male, 10 female, mean age 29.64 +/- 8.29 years, CAPD duration, 37.35 +/- 7.15 months). Data were collected from each patient when the peritoneal cavity was filled with solution (full status) and again when the cavity had been drained (empty status). Forced expiratory volume in 1 s (FEV1), ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC), total lung capacity (TLC), and residual volume (RV) were calculated. Peak oxygen uptake (peak VO2) and exercise duration were determined by cardiopulmonary exercise testing. When the peritoneal cavity was empty, mean (+/- SD) values for the parameters tested were % predicted FEV1: 85 +/- 17%, %FEV1/FVC: 84 +/- 8%, % predicted TLC: 98 +/- 17%, % predicted RV: 108 +/- 25%, % predicted DLCO: 90 +/- 14%, peak VO2: 43 +/- 11 ml/kg/min, test duration: 6.8 +/- 1.6 min. When the peritoneal cavity was full, mean (+/- SD) values were % predicted FEV1: 86 +/- 17%, %FEV1/FVC: 83 +/- 7%, % predicted TLC: 91 +/- 14%, % predicted RV: 95 +/- 22%, % predicted DLCO: 87 +/- 16%, peak VO2: 42 +/- 8 ml/kg/min, test duration 6.5 +/- 1.7 min. % predicted FEV1, %FEV1/FVC, % predicted DLCO and peak VO2 were not statistically significant between the mean values at empty status versus those at full status (p < 0.05 for all). There were significant decreases between the mean values for % predicted TLC and % predicted RV at full status versus empty status (p < 0.002 for TLC, p < 0.001 for RV). No statistically significant correlation was found between PFTs and % change ratio of dialysate. FEV1, %FEV1/FVC, % predicted DLCO and CPET test results do not differ according to abdomen status in CAPD patients suggesting that the timing of PFT maneuver does not affect preoperative transplantation evaluation. Therefore, when evaluating the results of these tests prior to transplantation period, the presence of dialysis solution in the abdomen may be ignored.

Association between Serum N-Terminal Pro-Brain Natriuretic Peptide Concentration and Left Ventricular Dysfunction and Extracellular Water in Continuous Ambulatory Peritoneal Dialysis Patients

This study investigated the association between serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels and extracellular water (ECW%) and left ventricular (LV) dysfunction in continuous ambulatory peritoneal dialysis (CAPD) patients. The study involved 30 stable CAPD patients: 14 males, 16 females; mean age 52 +/- 14 years; mean CAPD duration 34 +/- 12 months; 12 with diabetes mellitus (DM) and 18 non-DM. Serum NT-pro-BNP levels were determined using electrochemiluminescence immunoassay. Baseline echocardiography was performed using a Hewlett-Packard Sonos 1000 (Andover, Massachusetts, USA) device equipped with a 2.25-MHz probe, allowing M-mode, two-dimensional, and pulsed Doppler measurements. Left ventricular mass index (LVMI) was calculated according to the Penn formula. A multifrequency bioimpedance analyzer was used; ECW% was calculated as a percentage of total body water and was considered the index of volume load. (1) Serum NT-pro-BNP level, ECW%, LVMI, and LV ejection fraction in CAPD patients were 3924 (240 - 74460) pg/mL, 36.7% +/- 2.2%, 158 +/- 48 g/m2, and 60.5% +/-11.2%, respectively. (2) Patients were divided into three tertiles (10 patients each) according to their serum NT-proBNP concentration [1st tertile 1168 (240 - 2096), 2nd tertile 4856 (2295 - 20088), 3rd tertile 35012 (20539 -74460) pg/mL]. The tertiles did not differ significantly in terms of age, sex, presence of DM, body mass index, or PD duration. Patients in the 3rd tertile (highest serum NT-proBNP concentration) had the highest LVMI (126 +/- 45 vs 160 +/-41 vs 200 +/- 23 g/m2 for 1st, 2nd, 3rd tertiles, respectively) and the lowest LV ejection fraction (66% +/- 11% vs 62% +/-6% vs 55% +/- 9%). ECW% did not differ significantly between tertiles (35.5% +/- 2.0% vs 37.5% +/- 2.0% vs 36.5% +/-2.0%). (3) In CAPD patients, serum NT-pro-BNP levels correlated positively with LVMI (r = 0.628, p = 0.003) and negatively with LV ejection fraction (r = -0.479, p = 0.033). Serum NT-pro-BNP levels did not correlate with ECW% (r = 0.227, p = 0.25). (4) Stepwise regression analysis showed that LV ejection fraction (beta = -0.610, p = 0.015) and LVMI (beta = 0.415, p = 0.007) were independently associated with the serum NT-pro-BNP concentration. There was no link between ECW% and serum NT-pro-BNP concentration. Thus, serum NT-pro-BNP levels may not provide objective information with respect to pure hydration status in CAPD patients. In contrast, serum NT-pro-BNP levels were linked to LVMI and LV ejection fraction in CAPD patients. Therefore, while the serum NT-proBNP concentration might not be a useful clinical marker for extracellular fluid volume load, it appears useful for evaluating LV hypertrophy and LV dysfunction in CAPD patients.

Relationship of peritoneal membrane transport characteristics to the nutritional status in CAPD patients.

The study was carried out to evaluate the role of individual peritoneal membrane transport characteristics in the nutritional status expressed as the composite nutritional index (CNI) METHODS: Cross-sectional analyses of the overall nutritional status of 147 continuous ambulatory peritoneal dialysis (CAPD) patients were performed using the CNI. CNIs based on a scoring system of 10 nutritional indices including subjective global assessment, biochemical parameters and anthropometry were compared according to the results of a standard peritoneal equilibration test (PET) RESULTS: Patients were classified as low (n = 16, 10.9%), low average (n=59, 40.2%), high average (n=54, 36.7%) and high (n=18, 12.2%) transporters based on the D/P(Cr) after 4 h dwells. The mean 4 h D/P(Cr) was 0.65 +/- 0.12 (0.34-0.95), and there was no significant correlation between D/P(Cr) and other demographic parameters such as age, duration of peritoneal dialysis and body surface area. D/P(Cr) was correlated with dialytic albumin loss (r=0.47, P<0.001), serum albumin (r=-0.46, P<0.001), serum creatinine (r= -0.38, P<0.001), serum TGF-1 (r=-0.37, P<0.01) and LBM(Cr) (r= -0.26, P<0.05). In high transporters, the serum albumin was significantly lower while dialysate protein and albumin losses were significantly greater compared with low transporters. Serum creatinine and IGF-1 concentrations as well as LBM(Cr) were also decreased in higher transporters. The mean CNI score was 8.1 +/- 4.9, with a range of 0-24. CNI was positively correlated with age, duration of peritoneal dialysis, incidence of peritonitis, CRP and dialytic protein loss, whereas it was inversely correlated with ultrafiltration volume, haemoglobin and NPNA. The CNI score was significantly higher in high transporters compared with low transporters (11.7 +/- 4.3 vs. 5.9 +/- 1.6, P < 0.01). There was also a significant correlation between D/P(Cr) and CNI (r = 0.29, P < 0.05). Multiple regression analysis revealed that the incidence of peritonitis, duration of CAPD, CRP and D/P(Cr) were the independent factors affecting the CNI. Peritoneal membrane transport characteristics correlate with the overall nutritional status of peritoneal dialysis patients assessed by the scoring system of the CNI, although it is associated with a different impact on the individual nutritional indices. The results of this cross-sectional study also suggest that a high permeability state is a risk factor for malnutrition in CAPD patients. Prospective studies evaluating the changes in nutritional parameters among patients with different membrane transport rates are needed to understand better the relationship of peritoneal membrane characteristics to the nutritional status of CAPD patients.

Peritoneal transport kinetics correlate with serum albumin but not with the overall nutritional status in CAPD patients

The present study evaluates the influence of the peritoneal transport rate (PTR) on the nutritional status of continuous ambulatory peritoneal dialysis (CAPD) patients. Additionally, protein intake, dialysis adequacy, and other clinical variables were analyzed. Forty-two CAPD patients were concurrently subjected to the peritoneal equilibration test, a nutritional evaluation that included 24-hour dietary recall, and nutritional scoring system that included anthropometric, biochemical, and subjective parameters. Eight patients were high, 14 were high-average, 16 were low-average, and four were low transporters. Nine patients had normal nutritional status; six had mild, nine had moderate, and 18 had severe malnutrition. Malnutrition was inversely correlated ( P < 0.05) with body surface, hemoglobin, and residual renal function, but not with PTR ( r = 0.14; P = 0.38). In the multivariate analysis, the nutritional status was not predicted by the PTR, protein intake, or dialysis adequacy variables. When serum albumin (SA) level was evaluated as an isolated nutritional indicator, the most significant predictors were dialysate to plasma creatinine ratio at 4 hours (D/P4), body surface area, age, and diabetes mellitus. High transporters receiving a high dose of dialysis displayed a trend of having lower SA levels, whereas low-average transporters receiving a high dose of dialysis showed a trend of have higher SA levels. In conclusion, there was no correlation between PTR and nutritional status. In the multivariate analysis, no association was found between nutritional status and PTR, dialysis adequacy, and protein intake. The best predictors for SA are PTR, body surface area, age, and diabetes mellitus.