Methodology of Assessment of Fluid Status and Ultrafiltration Problems

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos, 8 figures, 4 tables, and 73 references. Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure

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Does Routine Bioimpedance-Guided Fluid Management Provide Additional Benefit to Non-Anuric Peritoneal Dialysis Patients? Results from Compass Clinical Trial

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00241 ◽

2017 ◽

Vol 38 (2) ◽

pp. 131-138 ◽

Cited By ~ 12

Author(s):

Kook-Hwan Oh ◽

Seon Ha Baek ◽

Kwon-Wook Joo ◽

Dong Ki Kim ◽

Yon Su Kim ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Fluid Management ◽

Urine Volume ◽

Clinical Information ◽

Additional Benefit ◽

Volume Control ◽

Control Group ◽

Rapid Decline ◽

Fluid Status

Introduction In peritoneal dialysis (PD) patients, volume overload is related to cardiac dysfunction and mortality, while intravascular volume depletion is associated with a rapid decline in the residual renal function (RRF). This study sought to determine the clinical usefulness of bioimpedance spectroscopy (BIS)-guided fluid management for preserving RRF and cardiac function in PD patients. Subjects and methods This is a multicenter, prospective, open-label study that was conducted over a 1-year period (NCT01887262). Non-anuric (urine volume > 500 mL/day) subjects on PD were enrolled. Subjects in the control group received fluid management based on the clinical information alone. Those in the BIS group received BIS-guided fluid management along with clinical information. Results The subjects ( N = 137, mean age 51.3 ± 12.8 years, 54% male) were randomly assigned to the BIS group ( n = 67) or to the control group ( n = 70). There were no significant differences between the 2 groups with regard to age, sex ratio, cause of kidney failure, duration of PD, baseline comorbidity, RRF, PD method, or peritoneal transport type. At baseline, the 2 groups were not different in terms of RRF (glomerular filtration rate [GFR], 5.1 ± 2.9 vs 5.5 ± 3.7 mL/min/1.73 m2). After follow-up, changes in the GFR between the 2 groups were not different (-1.5 ± 2.4 vs -1.3 ± 2.6 mL/min/1.73 m2, p = 0.593). Over the 1-year study period, both groups maintained stability of various fluid status parameters. Between the 2 groups, there were no differences in the net change of various fluid status parameters such as overhydration (OH) and extracellular water/total body water (ECW/TBW). A net change in ECW over 1 year was slightly but significantly higher in the control group (net increase, 0.57 ± 1.27 vs 0.05 ± 1.63 L, p = 0.047). However, this difference was not translated into an improvement in RRF in the BIS group. There were no differences in echocardiographic parameters or arterial stiffness at the end of follow-up. Conclusion Routine BIS-guided fluid management in non-anuric PD patients did not provide additional benefit in volume control, RRF preservation, or cardiovascular (CV) parameters. However, our study cannot be generalized to the whole PD population. Further research is warranted in order to investigate the subpopulation of PD patients who may benefit from routine BIS-guided fluid management.

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Peritoneal Dialysis

10.2310/im.12057 ◽

2019 ◽

Author(s):

Karlien François ◽

Joanne M. Bargman

Keyword(s):

Renal Failure ◽

Peritoneal Dialysis ◽

Peritoneal Cavity ◽

Fluid Overload ◽

Kidney Injury ◽

Dialysis Fluid ◽

Keywords Peritoneal Dialysis ◽

Stage Renal Disease ◽

End Stage ◽

Developed World

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos, 8 figures, 4 tables, and 73 references. Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure

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Cardiomyopathy in patients with end-stage renal disease on long-term peritoneal dialysis therapy : a prospective, longitudinal observational study

10.5353/th_991044069405003414 ◽

2018 ◽

Author(s):

Duo Huang

Keyword(s):

Peritoneal Dialysis ◽

Observational Study ◽

Renal Disease ◽

End Stage Renal Disease ◽

Dialysis Therapy ◽

Longitudinal Observational Study ◽

Stage Renal Disease ◽

End Stage ◽

Prospective Longitudinal

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Fluid Management With Peritoneal Dialysis After Pediatric Cardiac Surgery

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118800699 ◽

2018 ◽

Vol 9 (6) ◽

pp. 696-704 ◽

Cited By ~ 4

Author(s):

Matthew F. Barhight ◽

Danielle Soranno ◽

Sarah Faubel ◽

Katja M. Gist

Keyword(s):

Cardiac Surgery ◽

Peritoneal Dialysis ◽

Cardiopulmonary Bypass ◽

Fluid Overload ◽

Fluid Management ◽

Kidney Injury ◽

Clinical Markers ◽

Fluid Removal ◽

Vasoactive Medication ◽

Potential Benefits

Children who undergo cardiac surgery with cardiopulmonary bypass are a unique population at high risk for postoperative acute kidney injury (AKI) and fluid overload. Fluid management is important in the postoperative care of these children as fluid overload is associated with increased morbidity and mortality. Peritoneal dialysis catheters are an important tool in the armamentarium of a cardiac intensivist and are used for passive drainage for fluid removal or dialysis for electrolyte and uremia control in AKI. Prophylactic placement of a peritoneal catheter is a safe method of fluid removal that is associated with few major complications. Early initiation of peritoneal dialysis has been associated with improved clinical markers and outcomes such as early achievement of a negative fluid balance, lower vasoactive medication needs, shorter duration of mechanical ventilation, and decreased mortality. In this review, we discuss the safety and potential benefits of peritoneal catheters for dialysis or passive drainage in children following cardiopulmonary bypass.

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A Retrospective Survey of Attitudes toward Acceptance of Peritoneal Dialysis in Chinese End-Stage Renal Failure Patients in Hong Kong—From a Cultural Point of View

Peritoneal Dialysis International ◽

10.1177/089686080102103s56 ◽

2001 ◽

Vol 21 (3_suppl) ◽

pp. 318-321 ◽

Cited By ~ 8

Author(s):

Wai-Kei Lo ◽

Fu-Keung Li ◽

Cindy B.Y. Choy ◽

Suk-Wai Cheng ◽

Wai-Ling Chu ◽

...

Keyword(s):

Renal Failure ◽

Peritoneal Dialysis ◽

Family Support ◽

Ethnic Origin ◽

Point Of View ◽

Cultural Perspective ◽

Dialysis Therapy ◽

Cultural Elements ◽

End Stage Renal Failure ◽

End Stage

Objective We undertook to study the attitudes toward dialysis of patients approaching end-stage renal failure and to analyze those attitudes from a cultural perspective. Setting The study was performed in the pre-dialysis clinic of a tertiary referral renal center. Patients All patients of Chinese ethnic origin seen in the pre-dialysis clinic from 1995 to 2000 for assessment of dialysis therapy were included. Method We performed a retrospective analysis of patient records with regard to attitudes of the patients toward dialysis, reasons for those attitudes, and factors that could lead to a subsequent change in attitude. Results We assessed 462 patients over the 6-year period. Their mean age was 65.5 ± 13.3 years, and 43.9% of the patients had diabetes. Peritoneal dialysis (PD) was offered to 74% of the patients, and hemodialysis (HD) to 3.9%. Among the patients offered PD, only 44% accepted dialysis. After counselling, 54% of the patients who originally declined PD ultimately accepted it. The major reasons for refusing PD were the ideas of “having lived long enough” and “lack of family support.” Most other reasons could be overcome by counselling. Only a minority of patients demanded hemodialysis. Conclusions Declining an offer of dialysis was common. Counselling helped patients to accept PD. Certain cultural elements that hindered acceptance of dialysis were involved in the ideas of “having lived long enough” and “lack of family support.” Those cultural elements should be tackled more specifically during counselling.

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Peritoneal Dialysis

10.2310/fm.12057 ◽

2019 ◽

Author(s):

Karlien François ◽

Joanne M. Bargman

Keyword(s):

Renal Failure ◽

Peritoneal Dialysis ◽

Peritoneal Cavity ◽

Fluid Overload ◽

Kidney Injury ◽

Dialysis Fluid ◽

Keywords Peritoneal Dialysis ◽

Stage Renal Disease ◽

End Stage ◽

Developed World

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos, 8 figures, 4 tables, and 73 references. Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure

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On the potential of wearable bioimpedance for longitudinal fluid monitoring in end-stage kidney disease

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab025 ◽

2021 ◽

Author(s):

Lucas Lindeboom ◽

Seulki Lee ◽

Fokko Wieringa ◽

Willemijn Groenendaal ◽

Carlo Basile ◽

...

Keyword(s):

Kidney Disease ◽

Fluid Management ◽

Wearable Devices ◽

Invasive Technique ◽

Haemodynamic Instability ◽

End Stage Kidney Disease ◽

Similar Frequency ◽

Home Dialysis ◽

Fluid Status ◽

End Stage

Abstract Bioimpedance spectroscopy (BIS) has proven to be a promising non-invasive technique for fluid monitoring in haemodialysis (HD) patients. While current BIS-based monitoring of pre- and post-dialysis fluid status utilizes benchtop devices, designed for intramural use, advancements in micro-electronics have enabled the development of wearable bioimpedance systems. Wearable systems meanwhile can offer a similar frequency range for current injection as commercially available benchtop devices. This opens opportunities for unobtrusive longitudinal fluid status monitoring, including transcellular fluid shifts, with the ultimate goal of improving fluid management, thereby lowering mortality and improving quality of life for HD patients. Ultra-miniaturized wearable devices can also offer simultaneous acquisition of multiple other parameters, including haemodynamic parameters. Combination of wearable BIS and additional longitudinal multiparametric data may aid in the prevention of both haemodynamic instability as well as fluid overload. The opportunity to also acquire data during interdialytic periods using wearable devices likely will give novel pathophysiological insights and the development of smart (predicting) algorithms could contribute to personalizing dialysis schemes and ultimately to autonomous (nocturnal) home dialysis. This review provides an overview of current research regarding wearable bioimpedance, with special attention to applications in end-stage kidney disease patients. Furthermore, we present an outlook on the future use of wearable bioimpedance within dialysis practice.

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Perioperative Intravascular Fluid Assessment and Monitoring: A Narrative Review of Established and Emerging Techniques

Anesthesiology Research and Practice ◽

10.1155/2011/231493 ◽

2011 ◽

Vol 2011 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Sumit Singh ◽

Ware G. Kuschner ◽

Geoffrey Lighthall

Keyword(s):

Perioperative Care ◽

Fluid Overload ◽

Fluid Management ◽

Critically Ill Patient ◽

Intravascular Volume ◽

Unstable Patient ◽

Fluid Status ◽

Assessment And Monitoring ◽

Invasive Techniques ◽

Intravascular Volume Status

Accurate assessments of intravascular fluid status are an essential part of perioperative care and necessary in the management of the hemodynamically unstable patient. Goal-directed fluid management can facilitate resuscitation of the hypovolemic patient, reduce the risk of fluid overload, reduce the risk of the injudicious use of vasopressors and inotropes, and improve clinical outcomes. In this paper, we discuss the strengths and limitations of a spectrum of noninvasive and invasive techniques for assessing and monitoring intravascular volume status and fluid responsiveness in the perioperative and critically ill patient.

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