Overhydration May Be the Missing Link between Peritoneal Protein Clearance and Mortality

Nephron ◽  
2021 ◽  
pp. 1-7
Author(s):  
Anabela Malho Guedes ◽  
Roberto Marques ◽  
Ana Teresa Domingos ◽  
Ana Paula Silva ◽  
Idalécio Bernardo ◽  
...  
Keyword(s):  
Lean Mass ◽  
Protein Transport ◽  
Fluid Overload ◽  
Multivariable Analysis ◽  
Bioelectrical Impedance ◽  
Continuous Treatment ◽  
Hydration Status ◽  
Protein Loss ◽  
Protein Clearance ◽  
Peritoneal Protein Clearance

<b><i>Introduction:</i></b> Peritoneal protein loss (PPL) has been associated with mortality. Inflammation was assumed a putative cause with malnutrition as a consequence. Hydrostatic convection is a major drive for microvascular protein transport, but most studies in peritoneal dialysis (PD) patients overlooked this mechanism. An association between peritoneal protein clearance (PPCl) and venous congestion has been reported recently. The aim of this study was to explore the importance of fluid overload in PPCl in PD. <b><i>Methods:</i></b> Sixty-seven prevalent PD patients were assessed with peritoneal equilibration test and multifrequency bioelectrical impedance assessment (BIA). PPL and PPCl were calculated from simultaneously obtained 24-h peritoneal effluent. <b><i>Results:</i></b> PPL averaged 5.2 g/24 h. It was higher in patients on continuous treatment than in those without a long dwell. Significant associations between PPCl and BIA parameters of overhydration were found in both univariable and multivariable analyses. Lean mass index, partly dependent on hydration status, was associated with PPCl in univariable but not in multivariable analysis. A multiple linear model identified extracellular water excess and higher D/P creatinine as predictors of higher PPCl, independent of PD duration, type of PD, age, gender, albumin, cardiovascular disease, C-reactive protein, or lean mass index. <b><i>Conclusions:</i></b> The uni- and multivariable strong associations between fluid overload and PPCl support the importance of hydrostatic pressure-induced convection for PPCl. Also, peritoneal small solute transport was associated with PPCl. Both are amenable by adjusted dialysis prescription, especially focused on fluid status and avoidance of overhydration. The assumption of an association with inflammation and malnutrition was not confirmed.

scholarly journals Association of Lean Body Mass Index and Peritoneal Protein Clearance in Peritoneal Dialysis Patients

2019 ◽  
Vol 44 (1) ◽  
pp. 94-102 ◽  
Author(s):  
Jinjin  Fan ◽  
Hongjian  Ye ◽  
Xiaodan  Zhang ◽  
Peiyi  Cao ◽  
Qunying  Guo ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Peritoneal Dialysis ◽  
Nutritional Status ◽  
Lean Body Mass ◽  
Body Mass ◽  
Creatinine Ratio ◽  
Protein Loss ◽  
Protein Clearance ◽  
The Relationship ◽  
Peritoneal Protein Clearance

Background/Aims: The relationship between peritoneal protein clearance (PPCl) and nutritional status in peritoneal dialysis (PD) population have not been clarified. This study aims to investigate the relationship between PPCl and nutritional status in PD population. Methods: Prevalent PD patients were enrolled in the cross-sectional survey in a single center from April to November 2013. The total amount of protein loss in the dialysate was calculated. PPCl reflects the individual differences of peritoneal protein loss, and is calculated by the formula, that PPCl (ml/day)=24-h dialysate protein loss / (albumin/0.4783). Nutritional status measured by lean body mass index (LBMI) was assessed by multi-frequency bioelectrical impedance analysis (BIA). Results: Totally 351 PD patients (55% male, 17.1% with diabetes, mean age 47.7±14.3 years) were included. The median PPC l was 58 ml/day. Patients were divided into four groups for comparison according to the PPC quartiles. Compared with lower PPCl quartiles, patients with higher PPCl had higher body mass index (BMI) (P< 0.001), body surface area (BSA) (P < 0 .001), LBMI (P<0.001), 4-hour D/P creatinine ratio (P< 0.001), and lower residual renal CCl (P<0.001). Compared with conventional body index (BMI and BSA) in ROC analysis, LBMI (area under curve: 0.71, 95% confidence interval [CI]: 0.66-0.77) had better performance in predicting higher PPCl. After adjustment in logistic regression models, each 1 kg/m2 increase of LBMI (odd ratio[OR] =1.37; 95% CI: 1.17-1.60), each 0.1 increase of 4-hour D/P creatinine ratio (OR =1.47; 95% CI: 1.11-1.93), and every 1 L/week/1.73m2 decrease of residual renal CCl (OR =0.98; 95% CI: 0.96-0.99) were independently associated with higher PPCl (> 58 ml/day). Conclusion: Higher LBMI was independently associated with higher , indicating that better nutritional status dominates peritoneal protein metabolism in PD patients.

Relationships between Peritoneal Protein Clearance and Parameters of Fluid Status Agree with Clinical Observations in other Diseases that Venous Congestion Increases Microvascular Protein Escape

2019 ◽  
Vol 39 (2) ◽  
pp. 155-162 ◽  
Author(s):  
Raymond T. Krediet ◽  
Suree Yoowannakul ◽  
Lauren S. Harris ◽  
Andrew Davenport
Keyword(s):  
Total Protein ◽  
Protein Transport ◽  
Left Ventricular ◽  
Venous Congestion ◽  
Right Atrial ◽  
Protein Clearance ◽  
Multifrequency Bioimpedance ◽  
Peritoneal Protein Clearance ◽  
Right Atrial Area ◽  
Atrial Area

Background Peritoneal effluent from peritoneal dialysis (PD) patients contains proteins, mainly transported from the circulation through large pores in the venular part of the peritoneal micro-vessels. Hydrostatic convection is the major driver for peritoneal protein transport, although in PD there is additional diffusion. Consequently, venous pressure may have a role in peritoneal protein transport. The aim of the study was to investigate the importance of venous congestion on the magnitude of peritoneal protein clearance in incident PD patients using non-invasive measurements. Methods A total of 316 adult PD patients, on PD for 8 - 12 weeks and collecting 24-hour urine and dialysate for total protein determination, underwent standard peritoneal equilibration testing (PET) along with measurement of N terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP), multifrequency bioimpedance analysis, and a transthoracic echocardiogram. Results Statistically significant univariate relationships for peritoneal protein clearance with a Spearman correlation coefficient > 0.25 were present for 4-hour dialysate/plasma (D/P) creatinine, NT-proBNP, extracellular/total body water, extracellular water excess, left ventricular mass, and right atrial area. Negative correlations were found with serum total protein and residual renal function. On multivariate analysis, logNTproBNP (β 0.11, p = 0.007) and right atrial area (β 0.01, p = 0.03) were significant independent predictors of peritoneal protein clearance. Conclusion Indicators of venous congestion showed the most important relationships with peritoneal protein clearance. These indicators have not been assessed in previous studies on the presence or absence of relationships between peritoneal protein clearance and mortality.

scholarly journals Bio-electric impedance as a tool to assess hydration in critically ill patients: an integrative review

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Cristiano Corrêa Batista
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Decision Making ◽  
Fluid Overload ◽  
Scientific Information ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Clinical Decision ◽  
Hydration Status

Introduction: Assessing the hydration status of critically ill patients has been a difficult task over the decades. Determining how much fluid overload a patient has often helped in choosing a therapy. Methods such as bioelectrical impedance have been approached as a useful tool for this purpose. Objective: This study proposes to verify, through research in the literature, what is the real importance of the clinical use of bioelectrical impedance in the diagnosis of fluid overload in critically ill patients hospitalized in intensive care units. Methods: bibliographic search in the main scientific information databases: Scielo, PubMed, Cochrane, and Lilacs from January 2000 to July 2018. The selected languages were Spanish, Portuguese, and English. The keywords used were bioelectrical impedance, hydration, Intensive Care Unit, Intensive Care, bioelectrical impedance analysis, fluid balance, hydration overload. Results and Conclusion: The analysis of fluid overload in critically ill patients can be performed using multifrequency bioelectrical impedance. It is a useful tool in the diagnosis as well as in the quantification of water overload and, therefore, a corroborative method for clinical decision-making.

scholarly journals Making the choice between bioelectrical impedance measures for body hydration status assessment

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Dmitry M. Davydov ◽  
Andrey Boev ◽  
Stas Gorbunov
Keyword(s):  
Body Schema ◽  
Bioelectrical Impedance ◽  
Information Criterion ◽  
The Body ◽  
Whole Body ◽  
Hydration Status ◽  
Status Assessment ◽  
Best Fitting ◽  
Body Compartments ◽  
Fitting In

AbstractSituational or persistent body fluid deficit (i.e., de- or hypo-hydration) is considered a significant health risk factor. Bioimpedance analysis (BIA) has been suggested as an alternative to less reliable subjective and biochemical indicators of hydration status. The present study aimed to compare various BIA models in the prediction of direct measures of body compartments associated with hydration/osmolality. Fish (n = 20) was selected as a biological model for physicochemically measuring proximate body compartments associated with hydration such as water, dissolved proteins, and non-osseous minerals as the references or criterion points. Whole-body and segmental/local impedance measures were used to investigate a pool of BIA models, which were compared by Akaike Information Criterion in their ability to accurately predict the body components. Statistical models showed that ‘volumetric-based’ BIA measures obtained in parallel, such as distance2/Rp, could be the best approach in predicting percent of body moisture, proteins, and minerals in the whole-body schema. However, serially-obtained BIA measures, such as the ratio of the reactance to resistance and the resistance adjusted for distance between electrodes, were the best fitting in predicting the compartments in the segmental schema. Validity of these results should be confirmed on humans before implementation in practice.

scholarly journals Multifrecuency bioimpedance phase angle as a tool to predict maturation failure of native fistulae for hemodialysis

2021 ◽  
Vol 5 (2) ◽  
pp. 061-066
Author(s):  
Daza Lopez José Lucas ◽  
Galindo John F ◽  
Villaquiran Mónica R ◽  
Valenzuela Emilio D ◽  
Cardenas Andres ◽  
...  
Keyword(s):  
At Risk ◽  
Arteriovenous Fistula ◽  
Phase Angle ◽  
Vascular Access ◽  
Roc Curve ◽  
Statistical Significance ◽  
Bioelectrical Impedance ◽  
Hydration Status ◽  
P Value ◽  
Patients At Risk

Background and objectives: An arteriovenous fistula is considered to be an ideal vascular access for patients receiving hemodialysis, its main limitation is its high failure rate to achieve maturation and long-term functionality loss. Multiple strategies have attempted to identify patients at risk. Bioelectrical impedance has shown to be a valuable resource in the determination of the hydration status, and the measurement of the phase angle through this method has demonstrated to be a good indicator of the nutritional state and its related as a general marker of survival. The objective of this study is to analyze the role of plasma albumin and phase angle measured through bioelectrical impedance as tools useful for predicting failure of arteriovenous fistulas. Materials and methods: prospective observational study, including 104 patients with chronic kidney disease receiving hemodialysis who underwent a native arteriovenous fistula during a period of 24 months. Analyzing its clinical characteristics, laboratory and phase angle through electrical bioimpedance, both univariate and multivariate analysis was performed both with logistic regression, furthermore calculation of coordinates and ROC curve to establish a better cut-off point. Results: of the variables that were analyzed only the phase angle measurement showed statistical significance OR 2.61 (1.6 – 4.4) p - value 0.001 for predicting arteriovenous fistula failure. In female patients with a phase angle value of 3.25 had a 90% sensibility and 53% specificity for male patients a value of 3.58 showed a sensibility of 84% and a specificity of 52% with ROC curve of 0.78. Conclusion: phase angle through bioimpedance is a useful parameter, helpful in predicting failure of native arteriovenous fistula, it is also an important tool for identifying patients at risk, in early stages prior to the construction of a vascular access.

P1807COMPARISON BETWEEN INFERIOR VENA CAVA DIAMETER, BIOIMPEDANCE SPECTROSCOPY AND CLINICAL CRITERION FOR DRY WEIGHT ESTIMATION IN HEMODIALYZED CHILDREN

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Varvara Askiti ◽  
Georgia Malakasioti ◽  
George Servos ◽  
Georgia Grigoriadou ◽  
Andromachi Mitsioni
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
New Technologies ◽  
Fluid Overload ◽  
Vena Cava ◽  
Dry Weight ◽  
Chronic Hemodialysis ◽  
Hydration Status ◽  
Clinical Criteria

Abstract Background and Aims The determination of dry weight (DW) in children on chronic hemodialysis (HD) remains problematic. No method has been shown superior for DW assessment in the few pediatric studies exploring the utility of inferior vena cava expiratory and inspiratory diameter diameter (IVCDe, IVCDi) and BIS against clinical criteria. We aimed to compare the performance of IVCD, BIS and clinical judgement in DW prediction in hemodialyzed children. Method IVCD and BIS were measured serially pre and post the midweek HD session. IVCDi, IVCDe and IVC contractility index (IVCCI) associations with: (1) BIS estimated (BIS-relOH) and (2) clinically assessed hydration status (OHc) based on deviation from DW were explored. The interpretation of IVC measurements was based on previously published pediatric reference values. The level of agreement between the three tools in fluid overload recognition was studied. Results Fifty-two sets of measurements were undertaken in 13 patients (median age 11 years). OHc and BIS-relOH were positively associated to each other (r=0,5, p&lt;0,05) and to IVCDi (r=0,4, r=0,5, p&lt;0,05) and IVCDe (r=0,4, r=0,6, p&lt;0,05). A negative association between IVCCI and relOH-BIS was observed (r= -0,4, p&lt;0,05). There was a poor agreement between the three methods in identification of fluid overload; out of 28 clinically overloaded patients, BIS identified only 7 whereas IVCD none (Cohen’s k &lt;0). Conclusion IVCD measurements alone are not reliable for accurate fluid status prediction in hemodialyzed children as they seem to underestimate fluid overload compared to BIS and clinical criteria. Further studies are warranted to explore the applicability of new technologies for DW assessment of dialysis patients.

scholarly journals P1200PERITONEAL PROTEIN LOSSES: WHAT DO WE MEAN

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Anabela Malho Guedes ◽  
Ana Domingos ◽  
Roberto Calças ◽  
Ana Silva ◽  
Idalécio Bernardo ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
Protein Transport ◽  
Pearson Correlation ◽  
Clinical Status ◽  
Plasma Creatinine ◽  
Specific Marker ◽  
Sampling Errors ◽  
Protein Loss ◽  
Large Pore ◽  
Multifrequency Bioimpedance

Abstract Background and Aims The report of peritoneal protein loss should be related with a timely collection (24-hour measurement or 4-hour PET assessment) or concentration. Standardized and reproducible estimation of peritoneal protein transport is obtained during PET. The 24-hour measurements estimate the real amount of PPL, but may be affected by other factors unrelated to the prognosis of PD patients, as inconsistencies in collection and management of the samples. Overall, PET protein loss quantification may be a more specific marker of peritoneal large-pore dysfunction and is seemingly more convenient than 24-hour measurements. The aim of this study was to compare the results of both sampling methods. Method A total of 144 adult incident PD patients were included. A standard peritoneal equilibration test, 24-hour urine and dialysate collection, and multifrequency bioimpedance analysis were performed. Independent-samples t test and Pearson correlation coefficient were performed to evaluate relevant clinical associations. Results Statistically significant univariable relationships for 24h PPL were found for continuous ambulatory PD technique (CAPD) and, with a correlation coefficient &gt;0.20, for pulse pressure, 4-hour dialysate/plasma creatinine and extracellular water/total body water. Studying 240 min PPL, only with 4-hour dialysate/plasma creatinine, creatinine clearance and bicarbonate levels were statistically significant. In both samples there was no significant association with age, gender, type of effluent (biocompatible solutions or lactate plus bicarbonate comparing with bicarbonate), comorbidity Charlson Index, or presence of diabetes. Correlation between 240 min PPL and 24h PPL ensues, but it is not strong (p&lt;0.001; r=0.365). Conclusion The weak correlation between 24h and 240 minutes show that these two measurements should not be considered equivalent. Measurements of a 24h sample might be more close to patients’ clinical status and prognosis, despite more frequent sampling errors. PET protein loss quantification should be regarded as a marker of peritoneal large-pore dysfunction.

scholarly journals DOES GENDER INFLUENCE RISK FOR ORTHOSTATIC HYPOTENSION IN OLDER ADULTS WITH SARCOPENIA?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S682-S682
Author(s):  
Melissa J Benton ◽  
Amy L Silva-Smith ◽  
Jefferson M Spicher
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Systolic Blood Pressure ◽  
Orthostatic Hypotension ◽  
Lean Mass ◽  
Bioelectrical Impedance ◽  
Early Morning ◽  
Postural Changes ◽  
Before And After ◽  
Pressure Changes

Abstract Older adults with sarcopenia may be at risk for unstable postural blood pressure due to diminished lean mass that plays a role in maintaining fluid volume. Males have greater lean mass, so risk may be mediated by gender. We compared postural blood pressure changes in older men (77.1 ± 2.0 years; n = 15) and women (79.6 ± 2.0 years; n = 13) with sarcopenia before and after an overnight fast. Sarcopenia was defined using the Lean Mass Index (males ≤ 19.0 kg/m2; females ≤ 15.0 kg/m2). Body composition was measured using multi-frequency bioelectrical impedance, and blood pressure was measured lying, sitting, and standing. On Day 1 (normally hydrated) there were significant drops in systolic blood pressure, with an overall decrease of -9.1 ± 2.2 mmHg (p &lt; 0.001) between lying and standing. On Day 2 (overnight fast), postural changes were more profound, with an overall decrease of -14.1 ± 2.8 mmHg (p &lt; 0.001). However, when compared by gender, postural changes between lying and standing remained significant but did not differ between men and women (Day 1: men -8.9 ± 2.5 vs. women -9.3 ± 2.5 mmHg; Day 2: men -14.6 ± 4.6 vs. women -13.6 ± 3.1 mmHg). On both days diastolic blood pressure remained stable. In this group of older adults, significant decreases in postural systolic blood pressure were observed in the early morning fasted condition, increasing the risk for orthostatic hypotension (drop in systolic blood pressure -20.0 mmHg). Interestingly, gender did not influence risk.

Detection of Hydration Status by Total Body Bioelectrical Impedance Analysis (BIA) in Patients on Hemodialysis

1997 ◽  
Vol 20 (7) ◽  
pp. 371-374 ◽  
Author(s):  
B. Oe ◽  
W.M. De Fijter ◽  
C.W.H. De Fijter ◽  
B. Straver ◽  
P.L. Oe ◽  
...  
Keyword(s):  
Bioelectrical Impedance Analysis ◽  
Bioelectrical Impedance ◽  
Dry Weight ◽  
Impedance Analysis ◽  
Hydration Status ◽  
Fluid Loss ◽  
Nutritional Analysis ◽  
Total Body ◽  
Segmental Bioelectrical Impedance ◽  
Simultaneous Assessment

The purpose of the present study was to investigate whether total body bioelectrical impedance analysis (BIA) could be appropriate to assess normohydration (i.e. dry weight) in hemodialysis patients. This study is warranted, because the simultaneous assessment of both hydration and nutritional status by BIA requires the presence of a situation of normohydration in order to guarantee valid conclusions about the nutritional analysis. Segmental bioelectrical impedance was performed to classify patients according to their hydration status. BIA measurements revealed significant differences in TBW, ECW and ICW/ECW between three hydration subgroups (under-, normo-, and overhydration), whereas ICW was similar. Therefore, TBW, ECW and ICW/ECW appear appropriate variables to assess hydration status in patients on hemodialysis. Hemodialysis diminished ECW significantly, whereas ICW did not change, suggesting that a decrease of ECW explains the fluid loss during hemodialysis.

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