Tracking hydration status changes by bioimpedance spectroscopy in children on peritoneal dialysis

2020 ◽  
pp. 089686082094581
Author(s):  
Vasiliki Karava ◽  
Stella Stabouli ◽  
John Dotis ◽  
Vassilios Liakopoulos ◽  
Fotios Papachristou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Hydration Status ◽  
Bioimpedance Spectroscopy ◽  
Z Score ◽  
Weight Changes ◽  
Status Change ◽  
Prospective Longitudinal Study ◽  
Automated Office Blood Pressure ◽  
Prospective Longitudinal

Background: This 6-month prospective longitudinal study investigates the association between hydration status changes using bioimpedance spectroscopy (BIS) and systolic blood pressure (SBP), pulse pressure (PP), and serum albumin (sAlb) changes in children on peritoneal dialysis (PD). Methods: Thirteen patients (median age: 12.58 years) were enrolled. Normal hydration, moderate hydration, severe overhydration, and dehydration were defined as −7% ≤ relative overhydration (Re-OH) < +7%, +7% ≤ Re-OH < +15%, Re-OH ≥ +15%, and Re-OH < −7%, respectively. Automated office blood pressure z-score, sAlb, and weight z-score were recorded. Results: Fifty-two Re-OH measurements were recorded: three in five, four in five, five in two, and seven in one patient, respectively. SBP was higher and sAlb lower in cases with severe overhydration (9 readings) ( p < 0.001, p < 0.001), but distribution of these parameters did not differ between normal hydration/dehydration (28 readings) and moderate overhydration (15 readings) cases. In patients with hydration status change, SBP and PP were higher while sAlb lower in cases with higher hydration status level ( p = 0.026, p = 0.05, and p = 0.109, respectively). In all patients, visit-to-visit SBP, PP, and sAlb changes were correlated to Re-OH changes ( rs = 0.693, p < 0.001; rs = 0.643, p < 0.001; rs = −0.444, p = 0.008, respectively) but not to weight changes ( rs = 0.052, p = 0.754; rs = 0.034, p = 0.838; rs = −0.156, p = 0.378, respectively). Visit-to-visit Re-OH changes, which were >+4% or <−4%, were linearly correlated to SBP ( r = 0.858, p < 0.001), PP ( r = 0.757, p < 0.001), and sAlb ( r = −0.699, p = 0.002) changes. Conclusion: In children on PD, longitudinal Re-OH changes are superior to weight changes in assessing volume-dependent variations of SBP, PP, and sAlb. Routine BIS application, rather than single BIS measurements, seems useful in the intra-patient monitoring of hydration status.

A Multinational Clinical Validation Study of Pd Adequest 2.0

1999 ◽  
Vol 19 (6) ◽  
pp. 556-571 ◽  
Author(s):  
◽  
Edward F. Vonesh ◽  
Kenneth O. Story ◽  
William T. O'Neill
Keyword(s):  
Peritoneal Dialysis ◽  
Excellent Agreement ◽  
Kinetic Modeling ◽  
Correlation Coefficients ◽  
Residual Renal Function ◽  
Glucose Absorption ◽  
Mathematical Tool ◽  
Prospective Longitudinal Study ◽  
Prospective Longitudinal ◽  
Level Of Agreement

Objective To clinically validate the use of the newly released kinetic modeling program, PD ADEQUEST 2.0 for Windows (Baxter Healthcare Corporation, Deerfield, IL, U.S.A.), by assessing the level of agreement between measured and modeled values of urea and creatinine clearances (CCr), glucose absorption, total drain volumes, and net ultrafiltration for all forms of peritoneal dialysis. Design A nonrandomized, multinational, prospective longitudinal study. Patients The study involved 104 adult patients [41 on continuous ambulatory peritoneal dialysis (CAPD), 63 on automated peritoneal dialysis (APD)] from 16 centers in 7 countries. All patients underwent a 4-hour peritoneal equilibration test (PET) but with varying percentage dextrose concentrations (1.5% or 2.5% dextrose) and varying fill volumes (range 1.5 – 2.5 L). Patients with a residual renal function greater than 10 mL/min were excluded, as were patients who had peritonitis within 6 weeks prior to baseline. Main Outcome Measures Correlation coefficients and Bland–Altman limits of agreement were used to assess the level of agreement between measured and modeled values of weekly peritoneal urea Kt/V (pKt/V) and total Kt/V, weekly peritoneal creatinine clearance (pCCr, L/week/ 1.73 m2) and total CCr (L/week/1.73 m2), daily drain volume (L/day), net ultrafiltration (UF, L/day), daily peritoneal urea and creatinine mass removal (g/day), and daily peritoneal glucose absorption (g/day). Measured values were obtained from three repeat 24-hour urine and dialysate collections per patient, while modeled values were calculated using the Baxter PD ADEQUEST 2.0 program in conjunction with kinetic parameters estimated from a 4-hour PET and long-dwell exchange independent of the 24-hour collections. Results The results show there is excellent agreement between measured and modeled urea Kt/V and CCr with concordance correlation coefficients ranging from 0.83 to 0.97 among CAPD and APD patients. There was also excellent agreement between measured and modeled values of glucose absorption and total drain volumes (concordance correlations of 0.90 and 0.98, respectively). This level of agreement was further supported by a Bland– Altman analysis of individual differences, including differences between measured and modeled net UF (coefficient of clinical agreement ranged from 0.66 to 0.92). Conclusions Data from a carefully performed PET and overnight exchange can, in combination with a scientifically and clinically validated kinetic model, provide clinicians with a powerful mathematical tool for use in CAPD and APD prescription management. Although not intended to replace actual measurements, kinetic modeling can prove useful as a means for quickly estimating approximate levels of clearance for a wide variety of alternative prescriptions. This, in turn, should speed up the process by which a physician can optimize the dose of dialysis suitable for a given patient and his/her lifestyle.

scholarly journals Experience of Continuous Ambulatory Peritoneal Dialysis in Children with Chronic Kidney Disease Stage” V

2017 ◽  
Vol 25 (1) ◽  
pp. 32-38
Author(s):  
Shireen Afroz ◽  
Tahmina Ferdaus ◽  
Rokeya Khanam ◽  
Maliha Alam Simi ◽  
Sanjida Sharmim ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Chronic Kidney Disease Stage ◽  
Pediatric Nephrology ◽  
Disease Stage ◽  
Uncontrolled Hypertension ◽  
College Hospital ◽  
Prospective Longitudinal Study ◽  
Medical College ◽  
Prospective Longitudinal

The lifespan and outcome of End Stage Kidney Failure (ESKF) children have dramatically improved since the development of continuous ambulatory peritoneal dialysis (CAPD), it offers several advantages over hemodialysis. This study was done to evaluate the efficacy, outcome and to find out the complication profile of CAPD. This prospective longitudinal study was carried out in the department of Pediatric Nephrology, Dhaka Medical College Hospital (DMCH), Bangladesh, over a period of 3 year. A total of 8 children with ESKF were included. (Age 5-14 year, M:F=1:1), All underwent CAPD. Average duration of CAPD 40.6 months with a total of 185 patient months of CAPD. The rate of complications was recorded. Common complications being observed were peritonitis 1 episode per 13.9 patient months, catheter obstruction by omental capture was in 4. Catheter tip dislocation was found in 3 children and all needed laparotomy and omentectomy. Satisfactory level of improvement of mean weight, mean serum albumin and declining of serum creatinine has been found after CAPD in all 8 study children. At the end of the study, 3 out of 8 are still on CAPD, 2 transferred to haemodialysis and 3 expired due to uncontrolled hypertension with congestive heart failure and sepsis. So, CAPD is an effective modality of renal replacement therapy for children. Early detection of complications and prompt therapy is essential for a favourable outcome. Placement of catheter by surgical method with elective omentectomy will reduce catheter related complications.J Dhaka Medical College, Vol. 25, No.1, April, 2016, Page 32-38

Impact of overweight, obesity, and post-treatment weight changes on occupational reintegration of breast cancer (BC) survivors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11562-11562
Author(s):  
Antonio Di Meglio ◽  
Gwenn Menvielle ◽  
Agnes Dumas ◽  
Arnauld S. Gbenou ◽  
Thomas Bovagnet ◽  
...  
Keyword(s):  
Weight Gain ◽  
Financial Burden ◽  
Overweight And Obesity ◽  
Excess Weight ◽  
Weight Changes ◽  
Recreational Physical Activity ◽  
Prospective Longitudinal Study ◽  
Occupational Reintegration ◽  
Prospective Longitudinal ◽  
The Impact

11562 Background: Overweight and obesity are strongly linked to poorer BC-specific outcomes, quality of life and financial burden in cancer care. Weight loss interventions have the potential to improve such outcomes. Fewer data exist on whether excess weight and post-diagnosis weight changes impact the ability of BC survivors to return to work (RTW). Methods: CANTO (NCT01993498) is a multicenter prospective longitudinal study of 12000 patients (pts) with stage I-III BC that characterizes long-term toxicities of BC treatment. Of 5801 pts enrolled from 2012-2014 (last data lock), we identified 1874 pts who were professionally active at BC diagnosis, ≥5 years (yrs) younger than minimum legal retirement age (62 yrs) and with updated work status 2 yrs after diagnosis. Logistic regression models evaluated the impact of body mass index (BMI) at diagnosis and of weight changes over 2 yrs after diagnosis on odds of non-RTW, adjusting for age, education, income, BC treatment and recreational physical activity (PA). Results: 37% pts were overweight or obese at diagnosis (BMI ≥25 kg/m2): 34% of them gained ≥5% and 16% lost ≥5% weight after diagnosis. Rates of non-RTW at 2 yrs were significantly higher in overweight or obese vs under or normal weight pts (27% vs 18%, p≤.001; adjusted odds ratio 1.37, 95% Confidence Interval [CI] 1.04-1.80, p = .017). Overweight and obese pts who did not RTW experienced higher increments in weight (mean [95% CI]: +3.6% [+2.3, +4.9] vs +1.5% [+0.8, +2.2]) and reported more modest changes in PA (mean [95% CI]: +1.0 [-1.4, +3.5] vs +2.1 [+0.8, +3.3] MET-h/week) vs those who did RTW. Weight changes independently impacted odds of non-RTW in overweight and obese pts (p for interaction weight change*BMI ≤.001): a 5% weight gain was associated with 17% increase in adjusted odds of non-RTW (95% CI 2-35%, p = .024), whereas a loss ≥5% with 60% reduced odds of non-RTW vs weight gain (95% CI 18-82%, p = .013). Conclusions: Excess weight and weight changes are significantly associated with occupational reintegration after BC in overweight and obese pts. Randomized studies testing dedicated weight control interventions should also measure outcomes of social rehabilitation in this large subset of survivors. Clinical trial information: NCT01993498.

scholarly journals Hydration Status of Patients Dialyzed with Biocompatible Peritoneal Dialysis Fluids

2016 ◽  
Vol 36 (3) ◽  
pp. 257-261 ◽  
Author(s):  
Monika Lichodziejewska-Niemierko ◽  
Michał Chmielewski ◽  
Maria Dudziak ◽  
Alicja Ryta ◽  
Bolesław Rutkowski
Keyword(s):  
Peritoneal Dialysis ◽  
Degradation Products ◽  
Urine Volume ◽  
Residual Renal Function ◽  
Hydration Status ◽  
Bioimpedance Spectroscopy ◽  
Dialysis Fluid ◽  
Dialysis Adequacy ◽  
Stage Renal Disease ◽  
Dialysis Fluids

Background Biocompatible fluids for peritoneal dialysis (PD) have been introduced to improve dialysis and patient outcome in end-stage renal disease. However, their impact on hydration status (HS), residual renal function (RRF), and dialysis adequacy has been a matter of debate. The aim of the study was to evaluate the influence of a biocompatible dialysis fluid on the HS of prevalent PD patients. Methods The study population consisted of 18 prevalent PD subjects, treated with standard dialysis fluids. At baseline, 9 patients were switched to a biocompatible solution, low in glucose degradation products (GDPs) (Balance; Fresenius Medical Care, Bad Homburg, Germany). Hydration status was assessed through clinical evaluation, laboratory parameters, echocardiography, and bioimpedance spectroscopy over a 24-month observation period. Results During the study period, urine volume decreased similarly in both groups. At the end of the evaluation, there were also no differences in clinical (body weight, edema, blood pressure), laboratory (N-terminal pro-brain natriuretic peptide, NTproBNP), or echocardiography determinants of HS. However, dialysis ultra-filtration decreased in the low-GDP group and, at the end of the study, equaled 929 ± 404 mL, compared with 1,317 ± 363 mL in the standard-fluid subjects ( p = 0.06). Hydration status assessed by bioimpedance spectroscopy was +3.64 ± 2.08 L in the low-GDP patients and +1.47 ± 1.61 L in the controls ( p = 0.03). Conclusions The use of a low-GDP biocompatible dialysis fluid was associated with a tendency to overhydration, probably due to diminished ultrafiltration in prevalent PD patients.

scholarly journals Spot urine protein measurements in normotensive pregnancies, pregnancies with isolated proteinuria and preeclampsia

2017 ◽  
Vol 313 (4) ◽  
pp. R418-R424 ◽  
Author(s):  
Andrea Kattah ◽  
Natasa Milic ◽  
Wendy White ◽  
Vesna Garovic
Keyword(s):  
Blood Pressure ◽  
Abrupt Onset ◽  
Urine Protein ◽  
Prospective Longitudinal Study ◽  
Spot Urine ◽  
Urine Protein Excretion ◽  
Protein Excretion ◽  
Blood Pressures ◽  
Prospective Longitudinal ◽  
Isolated Proteinuria

We performed a prospective, longitudinal study of pregnant women presenting to their first obstetrics visits to characterize the changes in spot urine protein-to-creatinine (UPCR) and albumin-to-creatinine ratios (UACR) in normotensive pregnancies, as well as identify clinical characteristics associated with isolated proteinuria and preeclampsia. We measured spot urinary albumin, protein, and creatinine at the first prenatal visit, end of the second trimester, and at delivery. In the normotensive pregnancies ( n = 142), we found that from the beginning of pregnancy to delivery, UACR increased by a median [interquartile range (IQR)] of 14.7 mg/g Cr (3.74–51.8) and UPCR by 60 mg/g Cr (30–130) ( P < 0.001 for both changes). Isolated proteinuria (defined as UPCR > 300 mg/g Cr in the absence of hypertension) was identified in 19/142 (13.4%) normotensive pregnancies. Increases in systolic and diastolic blood pressure from early pregnancy to delivery and increases in UACR from early to midpregnancy were associated with isolated proteinuria at delivery. Twelve women developed preeclampsia. Nulliparity, early, and midpregnancy diastolic blood pressures were strongly associated with the development of preeclampsia, but early changes in UACR were not. In conclusion, women who develop isolated proteinuria at delivery have a larger increase in blood pressure than women without proteinuria and have a “microalbuminuric” phase earlier in gestation, unlike women who develop preeclampsia. These findings suggest a different mechanism of urine protein excretion in women with isolated proteinuria as compared with women with preeclampsia, where proteinuria has a more abrupt onset.

scholarly journals Bioimpedance Spectroscopy for the Detection of Fluid Overload in Chinese Peritoneal Dialysis Patients

2014 ◽  
Vol 34 (4) ◽  
pp. 409-416 ◽  
Author(s):  
Bonnie Ching-Ha Kwan ◽  
Cheuk-Chun Szeto ◽  
Kai-Ming Chow ◽  
Man-Ching Law ◽  
Mei Shan Cheng ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Arterial Stiffness ◽  
Nutritional Status ◽  
Pulse Wave Velocity ◽  
Serum Albumin ◽  
Pulse Wave ◽  
Fluid Overload ◽  
Bioimpedance Spectroscopy ◽  
Dialysis Adequacy

BackgroundFluid overload probably contributes to the cardiovascular risk of peritoneal dialysis (PD) patients. We studied the relationship between over-hydration as determined by bioimpedance spectroscopy and dialysis adequacy, nutritional status, and arterial stiffness in Chinese PD patients.MethodsWe studied 122 asymptomatic prevalent PD patients: bioimpedance spectroscopy, arterial pulse wave velocity, dialysis adequacy and nutritional status were determined.ResultsOf the 122 patients, 88 (72.1%) had over-hydration of ≥ 1 L, while 25 (20.5%) were ≥ 5 L. Over-hydration significantly correlated with total body water (r = 0.474, p < 0.001) and extracellular water (r = 0.755, p < 0.001). Over-hydration was more severe in male and diabetic patients, and significantly correlated with Charlson's comorbidity score, blood pressure, body mass index, body weight, peritoneal transport characteristics, and carotid-femoral pulse wave velocity. Over-hydration significantly correlated with Kt/V (r = -0.287, p = 0.016), serum albumin level (r = -0.465, p < 0.001) and malnutrition inflammation score (r = 0.410, p = 0.006), but not residual renal function.ConclusionOver-hydration is common in asymptomatic Chinese PD patients. The degree of over-hydration is particularly pronounced in patients who are inadequately dialyzed, have multiple comorbid conditions and low serum albumin levels. Over-hydration is associated with high blood pressure and arterial stiffness, and may contribute to the excessive risk of cardiovascular disease in this group of patients.

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