engleski

Multifrequency bioimpedance analysis - a helping hand in precise and objective volume status control in peritoneal dialysis patients

Background. Volume overload is a mortality and morbidity risk factor in dialysis patients. Residual renal function (RRF) in peritoneal dialysis (PD) patients remains preserved longer than in hemodialysis patients. In spite of that, PD patients are still at high risk of volume overload leading to a challenging hypertension control. Routine clinical assessment of volume status is subjective, and a new tool was needed for its more precise and objective evaluation. A multifrequency bioimpedance analysis (MF-BIA) is a simple, non-invasive and accurate tool for the evaluation of hydration status. The aim of this study was to determine the impact of long-term MF-BIA volume status assessment and volume-dependent hypertension incidence in PD patients. Methods. In this prospective trial, we included incident PD patients in Department of Nephrology, Dialysis and Kidney Transplantation, Clinical Hospital Centre Rijeka, from January 1, 2014, to December 31, 2015. MF-BIA volume status assessment was conducted every six months on a patient with the full abdomen. Additionally, we assessed systolic and diastolic blood pressure (BP) (hypertension was considered systolic/diastolic BP >140/90) and RRF. Patients who achieved at least three consecutive measurements were included in the study. PD prescription and concomitant therapy were adjusted according to BP and overhydration (OH). Results. Out of total 43 patients, 22 patients (male 63%, age 56.4±14.1 years, body mass index 25.9±2.6 kg/m², 28% diabetic, 60% continuous ambulatory PD) were analyzed. Baseline PD vintage was 9.1±7.1 months with RRF 1878.12±814.65 ml. After collecting data, hydration reference plot was made, and patients were divided into five categories depending on their BP and OH. A number of volume induced hypertensive patients decreased significantly (p=<0.01) between baseline and follow-up measurement, as well as the number of normotensive euvolemic patients increased significantly (p=<0.01). OH and systolic BP were significantly lower at the end of follow-up (p=0.01 and p<0.01, respectively). Conclusions. Using MF-BIA volume assessment resulted in significant decrease in volume overload and volume-dependent hypertension in PD patients. Average RRF didn’t decrease significantly over two years study period. Further investigations including more patients are required.

volume status, peritoneal dialysis, multifrequency bioimpedance analysis

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