scholarly journals The efficacy of managing fluid overload in chronic peritoneal dialysis patients by a structured nurse-led intervention protocol

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Man Ching Law ◽  
◽  
Bonnie Ching-Ha Kwan ◽  
Janny Suk-Fun Fung ◽  
Kai Ming Chow ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Fluid Overload ◽  
Extracellular Volume ◽  
Volume Overload ◽  
Volume Status ◽  
Hydration Status ◽  
Dietary Control ◽  
Symptomatic Group ◽  
Intervention Protocol

Abstract Background Extracellular volume overload is a common problem in peritoneal dialysis (PD) patients and is associated with excessive mortality. We determine the effectiveness of treating PD patients with extracellular volume overload by a structured nurse-led intervention program. Methods The hydration status of PD patients was screened by bioimpedance spectroscopy (BIS). Fluid overload was defined as overhydration volume ≥ 2 L. Patients were classified into Symptomatic and Asymptomatic Groups and were managed by a structured nurse-led intervention protocol that focused on education and motivation. Hypertonic cycles were given for short term symptom relief for the Symptomatic group. Patients were followed for 12 weeks for the change in volume status, blood pressure, knowledge and adherence as determined by standard questionnaires. Results We recruited 103 patients (53 Symptomatic, 50 Asymptomatic Group. There was a significant reduction in overhydration volume 4 weeks after intervention, which was sustained by week 12; the overall reduction in overhydration volume was 0.96 ± 1.43 L at 4 weeks, and 1.06 ± 1.70 L at 12 weeks (p < 0.001 for both). The improvement was significant for both Symptomatic and Asymptomatic Groups. There was a concomitant reduction in systolic blood pressure in the Asymptomatic (146.9 ± 20.7 to 136.9 ± 19.5 mmHg, p = 0.037) but not Symptomatic group. The scores of knowledge, adherence to dietary control and advices on daily habit at week 4 were all significantly increased, and the improvement was sustained at week 12. Conclusions The structured nurse-led intervention protocol has a lasting benefit on the volume status of PD patients with extracellular volume overload. BIS screening allows prompt identification of volume overload in asymptomatic patients, and facilitates a focused effort on this high risk group.

scholarly journals Assessment of Hydration Status in Peritoneal Dialysis Patients: Validity, Prognostic Value, Strengths, and Limitations of Available Techniques

2020 ◽  
Vol 51 (8) ◽  
pp. 589-612 ◽  
Author(s):  
Maria-Eleni Alexandrou ◽  
Olga Balafa ◽  
Pantelis Sarafidis
Keyword(s):  
Peritoneal Dialysis ◽  
Natriuretic Peptide ◽  
Vena Cava ◽  
Volume Overload ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Preliminary Evidence ◽  
The Body ◽  
Volume Status ◽  
Hydration Status

Background: The majority of patients undergoing peritoneal dialysis (PD) suffer from volume overload and this overhydration is associated with increased mortality. Thus, optimal assessment of volume status in PD is an issue of paramount importance. Patient symptoms and physical signs are often unreliable indexes of true hydration status. Summary: Over the past decades, a quest for a valid, reproducible, and easily applicable technique to assess hydration status is taking place. Among existing techniques, inferior vena cava diameter measurements with echocardiography and natriuretic peptides such as brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were not extensively examined in PD populations; while having certain advantages, their interpretation are complicated by the underlying cardiac status and are not widely available. Bioelectrical impedance analysis (BIA) techniques are the most studied tool assessing volume overload in PD. Volume overload assessed with BIA has been associated with technique failure and increased mortality in observational studies, but the results of randomized trials on the value of BIA-based strategies to improve volume-related outcomes are contradictory. Lung ultrasound (US) is a recent technique with the ability to identify volume excess in the critical lung area. Preliminary evidence in PD showed that B-lines from lung US correlate with echocardiographic parameters but not with BIA measurements. This review presents the methods currently used to assess fluid status in PD patients and discusses existing data on their validity, applicability, limitations, and associations with intermediate and hard outcomes in this population. Key Message: No method has proved its value as an intervening tool affecting cardiovascular events, technique, and overall survival in PD patients. As BIA and lung US estimate fluid overload in different compartments of the body, they can be complementary tools for volume status assessment.

MO711COMPARISON OF PERITONEAL DIALYSIS EFFICACY MARKERS IN DIABETIC AND NON-DIABETIC PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
João Carvão ◽  
Adriana Paixão Fernandes ◽  
Rita Veríssimo ◽  
Rita Calça ◽  
Ana Rita Martins ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cardiac Dysfunction ◽  
Fluid Overload ◽  
Volume Overload ◽  
Cross Sectional Study ◽  
Hydration Status ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Lv Mass ◽  
End Stage

Abstract Background and Aims Diabetes mellitus (DM) is the leading cause of end-stage kidney disease. Peritoneal dialysis (PD) is an effective and convenient modality of renal replacement therapy, however in diabetic patients, higher technique failure is feared. This cross sectional study aimed to investigate if diabetic patients are good candidates for peritoneal dialysis in terms of dialysis efficacy and volume overload management when compared with non-diabetic patients. Method We conducted a cross-sectional study including 60 patients with end-stage kidney disease currently in peritoneal dialysis. Echocardiography was performed using HDI 5000, allowing M-mode, two-dimensional measurement. Peritoneal equilibration test exam was used to evaluate transport rate and dialysis efficacy. A multifrequency bioimpedance (BIA) analyzer was used. Overhydration (OH) was defined as an extra-cellular water (ECW)/total body water (TBW) over 15%. Clinical and biochemical variables were also explored. Results A total of 60 patients completed evaluation. Overall, 60% (n=36) were males with a mean age of 55,8 ± 15,3 years, BMI 25.9 ± 3.9 kg/m2, 31,7% (n=19) had DM. Median PD vintage was 21 months, automated PD 30%, 8.3% (n=5) were anuric and 10% (n=6) were overhydrated. The median serum N-terminal pro b-type natriuretic peptide (NT-proBNP) level was 1071 pg/mL. Left ventricule (LV) mass index and LV ejection fraction were 129.0 ± 51.1 g/m2 and 62.8 ± 13.0%, respectively. The median excess volume overload was 0.9L. Patients were divided in 2 groups (diabetic and non-diabetic). No differences were found between the 2 groups in terms of time in PD, peritoneal transportation, dialysis efficacy, diuresis, hemoglobin, albumin, normalized protein catabolic rate, hydration status, weight, body mass index, arterial hypertension, chronic heart failure, LV ejection fraction, LV mass index, CA-125 value, clinical signs of fluid overload, systolic and diastolic blood pressure. However, diabetic patients were younger (51,6 versus 58,0; p=0,02), more likely to have peripheral arterial disease (42,1 versus 7,3%, p=0,03), ischemic heart disease (52,6 versus 7,3%, p&lt;0,001) and had higher levels of NT-proBNP (5932 versus 4216 pg/mL, p=0.04). However, when using a multivariable analysis, in a model adjusted to age, residual dialysis, efficacy of dialysis, diabetic patients did not have a significant difference in volume overload, dialysis efficacy and markers of cardiac dysfunction when compared with non-diabetic patients. Conclusion In this population, diabetes was associated with higher levels of NT-proBNP, however it did not translate in higher fluid overload, lower dialysis efficacy or worst cardiac dysfunction, when compared with non-diabetic patients. We conclude that PD is able to control hydration status, dialysis efficacy and cardiac dysfunction in diabetic patients with similar efficiency as in non-diabetic patients.

Volume management as a key dimension of a high-quality PD prescription

2020 ◽  
Vol 40 (3) ◽  
pp. 282-292 ◽  
Author(s):  
Angela Yee-Moon Wang ◽  
Jie Dong ◽  
Xiao Xu ◽  
Simon Davies
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Clinical Care ◽  
Small Sample ◽  
Volume Status ◽  
Volume Control ◽  
High Quality ◽  
Volume Management ◽  
Residual Kidney Function

Background: Appropriate volume control is one of the key goals in a peritoneal dialysis (PD) prescription. As such it is an important component of the International Society of Peritoneal Dialysis (ISPD) guideline for “High-quality PD prescription” necessitating a review of the literature on volume management. The workgroup recognized the importance of including within its scope measures of volume status and blood pressure in prescribing high-quality PD therapy. Methods: A Medline and PubMed search for publications addressing volume status and its management in PD since the publication of the 2015 ISPD Adult Cardiovascular and Metabolic Guidelines, from October 2014 through to July 2019, was conducted. Results: There were no randomized controlled trials on blood pressure intervention and six randomized trials of bioimpedance-guided volume management. Generally, all studies were of small sample size, short duration, and used surrogate markers as primary outcomes. As a consequence, only “practice points” were drawn. High-quality goal-directed PD prescription should aim to achieve and maintain clinical euvolemia taking residual kidney function and its preservation into account, so that both fluid removal from peritoneal ultrafiltration and urine output are considered and residual kidney function is not compromised. Blood pressure should be included as a key objective parameter in assessing the quality of PD prescription but there is currently no evidence for a specific target in PD. Clinical examination remains the keystone of routine clinical care. Conclusions: High-quality goal-directed PD prescription should include volume management as one of the key dimensions.

scholarly journals Hydration Status Is Associated with Aortic Stiffness, but Not with Peripheral Arterial Stiffness, in Chronically Hemodialysed Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Daniel Bia ◽  
Cintia Galli ◽  
Rodolfo Valtuille ◽  
Yanina Zócalo ◽  
Sandra A. Wray ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Body Fluid ◽  
Fluid Management ◽  
Blood Pressure Level ◽  
Whole Body ◽  
Volume Status ◽  
Hydration Status ◽  
Fluid Status ◽  
Peripheral Arterial

Background. Adequate fluid management could be essential to minimize high arterial stiffness observed in chronically hemodialyzed patients (CHP).Aim. To determine the association between body fluid status and central and peripheral arterial stiffness levels.Methods. Arterial stiffness was assessed in 65 CHP by measuring the pulse wave velocity (PWV) in a central arterial pathway (carotid-femoral) and in a peripheral pathway (carotid-brachial). A blood pressure-independent regional arterial stiffness index was calculated using PWV. Volume status was assessed by whole-body multiple-frequency bioimpedance. Patients were first observed as an entire group and then divided into three different fluid status-related groups: normal, overhydration, and dehydration groups.Results. Only carotid-femoral stiffness was positively associated (P<0.05) with the hydration status evaluated through extracellular/intracellular fluid, extracellular/Total Body Fluid, and absolute and relative overhydration.Conclusion. Volume status and overload are associated with central, but not peripheral, arterial stiffness levels with independence of the blood pressure level, in CHP.

scholarly journals Evolution Over Time of Volume Status and PD-Related Practice Patterns in an Incident Peritoneal Dialysis Cohort

2019 ◽  
Vol 14 (6) ◽  
pp. 882-893 ◽  
Author(s):  
Wim Van Biesen ◽  
Christian Verger ◽  
James Heaf ◽  
François Vrtovsnik ◽  
Zita M. Leme Britto ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Practice Patterns ◽  
Cox Model ◽  
Volume Overload ◽  
Relative Volume ◽  
Volume Status ◽  
Treatment Practices ◽  
Time To Death ◽  
Risk Of Death ◽  
Over Time

Background and objectivesVolume overload is frequent in prevalent patients on kidney replacement therapies and is associated with outcome. This study was devised to follow-up volume status of an incident population on peritoneal dialysis (PD) and to relate this to patient-relevant outcomes.Design, setting, participants, & measurementsThis prospective cohort study was implemented in 135 study centers from 28 countries. Incident participants on PD were enrolled just before the actual PD treatment was started. Volume status was measured using bioimpedance spectroscopy before start of PD and thereafter in 3-month intervals, together with clinical and laboratory parameters, and PD prescription. The association of volume overload with time to death was tested using a competing risk Cox model.ResultsIn this population of 1054 participants incident on PD, volume overload before start of PD amounted to 1.9±2.3 L, and decreased to 1.2±1.8 L during the first year. At all time points, men and participants with diabetes were at higher risk to be volume overloaded. Dropout from PD during 3 years of observation by transfer to hemodialysis or transplantation (23% and 22%) was more prevalent than death (13%). Relative volume overload >17.3% was independently associated with higher risk of death (adjusted hazard ratio, 1.59; 95% confidence interval, 1.08 to 2.33) compared with relative volume overload ≤17.3%. Different practice patterns were observed between regions with respect to proportion of patients on PD versus hemodialysis, selection of PD modality, and prescription of hypertonic solutions.ConclusionsIn this large cohort of incident participants on PD, with different treatment practices across centers and regions, we found substantial volume overload already at start of dialysis. Volume overload improved over time, and was associated with survival.

Volume Status and Blood Pressure in Continuous Ambulatory Peritoneal Dialysis Patients

2005 ◽  
Vol 23 (5) ◽  
pp. 373-378 ◽  
Author(s):  
Xin Wang ◽  
Jonas Axelsson ◽  
Bengt Lindholm ◽  
Tao Wang
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Volume Status ◽  
Dialysis Patients

scholarly journals Predictors and Prognostic Significance of Persistent Fluid Overload: a Longitudinal Study in Chinese Peritoneal Dialysis Patients

2021 ◽  
Author(s):  
Jack Kit-Chung Ng ◽  
Bonnie Ching-Ha Kwan ◽  
Gordon Chun-Kau Chan ◽  
Kai-Ming Chow ◽  
Wing-Fai Pang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Risk Model ◽  
Fluid Overload ◽  
Strong Predictor ◽  
Prognostic Significance ◽  
Adverse Outcomes ◽  
Longitudinal Change ◽  
Volume Status ◽  
Time Varying ◽  
Technique Survival

Abstract Background: Cross-sectional studies showed that fluid overload (FO) measured by bioimpedance spectroscopy (BIS) predicted adverse outcomes in patients on peritoneal dialysis (PD). We describe the longitudinal change in volume status in Chinese PD patients, and determine its relation with clinical outcomes.Methods: We performed a single-center, retrospective analysis of all PD patients who underwent repeated BIS from 2010 to 2015. FO was defined by relative hydration index (RHI; volume of overhydration adjusted by extracellular water >7%). Variability of volume status (VVS) was denoted by the standard deviation of all RHI. The association of time-averaged RHI and VVS on patient and technique survival was explored by a competing risk model.Results: A total of 269 patients were followed for a median of 47.1 months. Multivariate mixed linear regression revealed that RHI was significantly associated with time-varying systolic blood pressure, and inversely with time-varying albumin level, lean tissue index and fat tissue index (P <0.0001 for all). Patients without FO at baseline, as compared with those who had FO, showed significantly more fluid accumulation with time (adjusted between-group mean difference in RHI: 3.2% per year, 95% confidence interval [CI] 1.5 to 4.9%, P =0.0002). Time-averaged RHI independently predicted patient survival (subdistribution hazard ratio [SHR] 1.05, 95% CI 1.03-1.08, P <0.0001) and technique survival (SHR 1.04, 95% CI 1.01-1.06, P =0.001), whereas VVS did not.Conclusions: Persistent FO was a strong predictor of patient and technique failure. Repeated bioimpedance measurements for the monitoring of volume status provided additional prognostic information in PD patients.

Can the Inflammation Markers of Patients with High Peritoneal Permeability on Continuous Ambulatory Peritoneal Dialysis be Reduced on Nocturnal Intermittent Peritoneal Dialysis?

2006 ◽  
Vol 26 (3) ◽  
pp. 341-348 ◽  
Author(s):  
Alfonso M. Cueto-Manzano ◽  
Enrique Rojas-Campos ◽  
Héctor R. Martínez-Ramírez ◽  
Isela Valera-González ◽  
Miguel Medina ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Fluid Overload ◽  
Final Evaluation ◽  
Inflammation Markers ◽  
Overload Control ◽  
Tnf Α ◽  
Peritoneal Permeability ◽  
Serum Crp

Background Patients with high peritoneal permeability have the greatest degree of inflammation on continuous ambulatory peritoneal dialysis (CAPD), which may be associated with their higher mortality. Nocturnal intermittent peritoneal dialysis (NIPD; “dry day”) may decrease inflammation by reducing the contact between dialysate and peritoneum and/or providing better fluid overload control. Therefore, the aims of this study were to determine and compare serum and dialysate concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) of patients with high or high-average peritoneal transport on CAPD, changed to NIPD, and ultimately to continuous cyclic peritoneal dialysis (CCPD). Methods Crossover clinical trial in 11 randomly selected patients. All subjects had been on CAPD and were changed to NIPD, and ultimately to CCPD (6.4 ± 3.1 months after initiation of study). All patients used glucose-based dialysate. Evaluations of clinical and biochemical parameters, dialysis adequacy, and serum and dialysis inflammation markers were performed at baseline on CAPD, 7 – 14 days after changing to NIPD, 7 – 14 days after switching to CCPD, and after 1 year of follow-up. All patients used only 1.5% glucose dialysate during evaluation days. CRP was determined by nephelometry, and IL-6 and TNF-α by ELISA. Results Seven patients were high transporters and 4 high average. Ultrafiltration increased ( p < 0.05) when patients changed from CAPD [0.38 L (-0.3 – 1.1 L)] to NIPD [2.64 L (0.7 – 4.7 L)]; it then decreased on CCPD [0.88 L (0.4 – 1.3 L) and at the end of study [0.65 L (0.3 – 1.0 L)]. This better fluid overload control was accompanied by decreased weight and systolic and diastolic blood pressure when patients changed from CAPD (89 ± 13 kg, 160 ± 23 and 97 ± 9 mmHg, respectively) to NIPD (86 ± 17 kg, 145 ± 14 and 86 ± 9 mmHg, respectively), and increased weight and systolic and diastolic blood pressure on CCPD (85 ± 15 kg, 143 ± 23 and 88 ± 14 mmHg, respectively) and at the end of follow-up (87 ± 16 kg, 155 ± 24 and 89 ± 12 mmHg, respectively). Median serum CRP decreased ( p = 0.03), from 3.8 (1.6 – 8.5) mg/L on CAPD to 1.0 (0.4 – 4.4) mg/L on NIPD, but increased on CCPD [1.8 (1.3 – 21) mg/L] and at the end of the study [3.2 (0.3 – 8.2) mg/L]. Dialysate CRP decreased nonsignificantly, from 0.10 (0 – 0.5) mg/L on CAPD to 0 (0 – 0.03) mg/L on NIPD, to 0.01 (0 – 0.08) mg/L on CCPD, and to 0 (0 – 0) mg/L at final evaluation. Serum TNF-α concentration decreased, from 0.14 (0.04 – 0.6) pg/mL on CAPD to 0.01 (0 – 0.08) pg/mL on NIPD, and then increased to 0.06 (0 – 0.4) pg/mL on CCPD and to 0.11 (0 – 0.2) pg/mL at the end of the study; whereas dialysate TNF-α decreased, from 0.08 (0.03 – 0.2) pg/mL on CAPD to 0.04 (0 – 0.2) pg/mL on NIPD, and to 0 (0 – 0) pg/mL and 0 (0 – 0.05) pg/mL on CCPD and final evaluation respectively. Serum IL-6 decreased ( p = 0.07), from 2.5 (2.0 – 4.2) pg/mL on CAPD to 1.0 (0.7 – 2.0) pg/mL on NIPD, and to 1.0 (0.8 – 2.9) pg/mL on CCPD and 1.0 (0.5 – 9.8) pg/mL at the end of the study; whereas dialysate levels remained similar on CAPD [8.0 (3.7 – 13) pg/mL] and NIPD [7.8 (5.1 – 23) pg/mL], and increased on CCPD [11.2 (9.5 – 19) pg/mL] and at final evaluation [11.2 (8.3 – 15) pg/mL]. Conclusions NIPD significantly decreased serum CRP and displayed a trend to decrease TNF-α and IL-6 serum concentrations compared with CAPD; whereas CCPD tended to reverse these effects. These results did not appear to be due to decreased local peritoneal inflammation, but they could be associated with better control of fluid overload on NIPD. Thus, NIPD, as long as the residual renal function allows it, may be useful in reducing the systemic inflammation of patients with high peritoneal membrane permeability.

scholarly journals Impact of Diabetes on Extracellular Volume Status in Patients Initiating Peritoneal Dialysis

2017 ◽  
Vol 46 (1) ◽  
pp. 18-25 ◽  
Author(s):  
Aniema Udo ◽  
Catriona Goodlad ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Pulse Pressure ◽  
Extracellular Volume ◽  
Volume Overload ◽  
Glycated Haemoglobin ◽  
Diabetic Patients ◽  
Membrane Function ◽  
Arterial Blood ◽  
Increased Risk

Background: Recent reports have highlighted that diabetic patients with kidney failure are at increased risk of technique failure and transfer to haemodialysis within 90 days of initiating peritoneal dialysis (PD). We wished to determine whether there were differences between diabetic and non-diabetic patients within the first 3 months of starting PD. Methods: We reviewed results of corresponding bioimpedance and the 1st test of peritoneal membrane function (PET) in consecutive patients, 6-10 weeks after initiating PD electively. Results: Adult patients numbering 386 - 230 males (59.6%), 152 (39.4%) diabetic, 188 (48.7%) white, mean age 57.3 ±16.9 years - were studied. Although weight, residual renal function and peritoneal clearances were not different, diabetic patients had greater extracellular water to total body water (ECW/TBW; 40.4 ± 1.1 vs. 39.2 ± 1.4) and % ECW excess (9.6 [6.3-12.3] vs. 4.9 [0.7-8.9]), lower serum albumin (35.2 ± 4.7 vs. 37.8 ± 4.9 g/L), greater fat mass index (9.5 ± 4.2 vs. 7.7 ± 4.2), and although mean arterial blood pressure was similar, arterial pulse pressure was greater (66.9 ± 10.8 vs. 54.3 ± 17.3 mm Hg, all p < 0.001). On multivariate analysis, glycated haemoglobin was associated with pulse pressure (standardised β 0.24, p < 0.001), N terminal brain natriuretic peptide (β 0.24, p < 0.001), ECW/TBW (β 0.19, p = 0.012) and negatively with serum albumin (β -0.14, p = 0.033) and creatinine (β -0.18, p = 0.02). Conclusion: Diabetic patients electively starting PD were found to have greater ECW/TBW ratios and ECW excess 6-10 weeks after starting PD compared to non-diabetics, despite similar PET. Increased ECW could predispose diabetic patients to be at greater risk of volume overload.

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