Hydration status does not influence peritoneal equilibration test ultrafiltration volumes.
ABSTRACT The peritoneal equilibration test (PET) was developed some 25 yr ago and has been used to help prescribe peritoneal dialysis. However, PET is affected by several factors, including diabetes and inflammation. It was speculated that extracellular fluid overload would increase PET ultrafiltration volumes, and therefore the usefulness of the PET in routine clinical practice was audited.
Data from 211 consecutive patients attending a university teaching hospital for a standard PET who had multifrequency bioimpedance performance were analyzed to determine which factors affected net PET ultrafiltration volumes.
Net PET ultrafiltration volume was independent of gender, age, diabetes, residual renal function, peritoneal dialysis prescriptions (modes and dialysates), extracellular fluid volume, or C-reactive protein (CRP). There was an inverse regression with serum albumin and sodium on multiple logistical regression analysis (F = 13.4, P < 0.001 and F = 10.1, P = 0.001, respectively) and a positive regression with 24-h net peritoneal ultrafiltration volumes (F = 15.5, P < 0.001). As expected, there was a strong correlation with net sodium losses (r = 0.99, P < 0001).
It was found that PET test ultrafiltration volume in routine clinical practice was not affected by CRP, hyperglycemia, or extracellular fluid volume overload. Ultrafiltration volumes were increased in those patients with reduced serum sodium and albumin, most likely because of inflammation and protein malnutrition.
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ABSTRACT: To evaluate the non-invasive assessments of volume status in patients with cirrhosis. Echocardiography and multifrequency bioimpedance analysis measurements and short synacthen tests were made in 20 stable and 25 acutely decompensated patients with cirrhosis. Both groups had similar clinical assessments, cortisol response and total body water (TBW), however the ratio of extracellular water (ECW)/TBW was significantly greater in the trunk (0.420 ± 0.004 vs 0.404 ± 0.005), and limbs (R leg 0.41 ± 0.003 vs 0.398 ± 0.003, P < 0.05, and L leg 0.412 ± 0.003 vs 0.399 ± 0.003) with decompensated cirrhosis compared to stable cirrhotics, P < 0.05). Echocardiogram derived right atrial and ventricular filling and end diastolic pressures and presence of increased left ventricular end diastolic volume and diastolic dysfunction were similar in both groups. The decompensated group had lower systemic blood pressure, mean systolic 101.8 ± 4.3 vs 122.4 ± 5.3 and diastolic 58.4 ± 4.1 mmHg vs 68.8 ± 3.1 mmHg respectively, P < 0.01, and serum albumin 30 (27-33) vs 32 (31-40.5) g/L, P < 0.01. Decompensated cirrhotics had greater leg and truncal ECW expansion with lower serum albumin levels consistent with intravascular volume depletion and increased vascular permeability.World journal of hepatology. 08/2013; 5(8):433-8.
- Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis. 09/2013; 33(5):578-9.
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ABSTRACT: Residual renal function has been reported to be a major determinant of peritoneal dialysis (PD) technique survival for patients with end-stage kidney disease. Anuria leads to increases in PD prescriptions designed to maintain small solute clearances and ultrafiltration volumes, resulting in greater exposure to hypertonic glucose dialysates. We reviewed the effect of developing anuria in a cohort of 136 PD patients followed for a median of 12 months, to determine whether increasing exposure to higher glucose dialysates affected body composition by increasing body fat and reducing muscle mass. Despite increasing prescription of 22.7 and 38.6 g/l glucose dialysates there was no increase in body fat (31.1±15.4 vs 30.9±16.3 kg) or loss of fat-free weight (36.4±12.1 vs 35.8±12.3 kg). Changing PD prescriptions to maintain small solute clearances and ultrafiltration volumes did not lead to detrimental changes in body composition in the short term.European Journal of Clinical Nutrition advance online publication, 2 July 2014; doi:10.1038/ejcn.2014.119.European journal of clinical nutrition. 07/2014;