Relevance of hydration status on the interpretation of nutritional parameters in peritoneal dialysis
Keywords:
Bioimpedance, Peritoneal dialysis, Hydration status, NutritionAbstract
Objective
This study identified determinants of the hydration status of chronic peritoneal dialysis patients and investigated the effects of fluid overload on their nutritional status.
Methods
A cross-sectional study was conducted in 2006 to evaluate 27 chronic peritoneal dialysis patients from the Dialysis Center of the Medical School Hospital of Botucatu (SP), considering clinical, dialytic, laboratory, anthropometric and bioimpedance parameters. A linear multiple regression model was used to evaluate the influence of these parameters on hydration status. The sample was stratified according to hydration status, given by the ratio between extracellular water and total body water (0.47 for males and 0.52 for females), obtained by bioelectrical impedance. Analysis of covariance, Mann-Whitney test, chi-square test, and Fisher’s exact test were used for making comparisons. The significance level was set at 5% (p≤0.05).
Results
Patients with greater urine volume and receiving automatic dialysis presented better hydration status. Patients with higher fluid overload, compared with those with lower overload, presented lower phase angle (M=4.2, SD=0.9 vs. M=5.7, SD=0.7º; p=0.006), lower albumin levels (M=3.06, SD=0.46 vs. M=3.55, SD=0.52g/dL; p=0.05), and higher percentage of triceps skinfold thickness (M=75.3, SD=36.9 vs. M= 92.1, SD=56.9; p=0.058). No other anthropometric differences were observed.
Conclusion
Low levels of albumin and phase angle in patients with higher fluid overload were not related to worse nutritional status. This result suggests that one must consider the set of variables obtained by many methods and relate and interpret them comprehensively in order to obtain areliable nutritional diagnosis of patients with fluid overload.
References
Katzarski KS, Divino-Filho JC, Bergstrom J. Extracellular volume changes and blood pressure levels in hemodialysis patients. Hemodial Int. 2003; 7(2):135-42.
Boudville NC, Cordy P, Millman K, Fairbairn L, Sharma A, Lindsay R, et al. Blood pressure, volume, and sodium control in an automated peritoneal dialysis population. Perit Dial Int. 2007; 27(5): 537-43.
Wabel P, Moissl U, Chamneryl P, Jirka T, Machek P, Ponce P, et al. Towards improved cardiovascular management: the necessity of combining blood pressure and fluid overload. Nephrol Dial Transplant. 2008; 23(9):2965-71.
Wang AY, Sanderson J, Sea MM, Wang M, Lam CW, Li PK, et al. Important factors other than dialysis adequacy associated with inadequate dietary protein and energy intakes in patients receiving maintenance peritoneal dialysis. Am J Clin Nutr. 2003; 77(4):834-41.
Dumler F. Hypoalbuminemia is a marker of overhydration in chronic maintenance patients on dialysis. ASAIO J. 2003; 49(3):282-6
Ashgar RB, Green S, Engel B, Davies S. Relationship of demographic, dietary, and clinical factors to the hydratation status of patients on peritoneal dialysis. Perit Dial Int. 2004; 24(3):231-9.
Cheng L, Tang W, Wang T. Strong association between volume status and nutritional status in peritoneal dialysis patients. Am J Kidney Dis. 2005; 45(5):891-902.
Vicenté-Martínez M, Matínez-Ramírez L, Munos R, Avila M, Ventura M, Rodríguez E, et al. Inflammation in patients on peritoneal dialysis is associated with increased extracellular fluid volume. Arch Med Res. 2004; 35(3):220-4
Dumler F, Kilates C. Use of bioelectrical impedance techniques for monitoring nutritional status in patients on maintenance dialysis. J Ren Nutr. 2000; 10(3):116-24.
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: JNC7; 2004 [cited 2009 Mar 20]. Available from: .m
NKF/KDOQI. Clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis. 2000; 35(6):S1-140
Canadá-USA (CANUSA) Peritoneal Dialysis Study Group. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. J Am Soc Nephrol. 1996; 7(2): 198-207
Kalantar-Zadeh K, Block G, McAllister CJ, Humpreys MH, Kopple JD. Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients. Am J Clin Nutr. 2004; 80(2): 299-307.
Rodriguez-Carmona A, Pérez-Fontán M, Garcia- -Naveiro R, Villaverde P, Peteiro J. Compared time profiles of ultrafiltration, sodium removal, and renal function in incident CAPD and automated peritoneal dialysis patients. Am J Kidney Dis. 2004; 44(1):132-45.
Wang AY, Wang M, Woo J, Lam CW, Lui S, Li PK, et al. Inflammation, residual kidney function, and cardiac hypertrophy are interrelated and combine adversely to enhance mortality and cardiovascular death risk of peritoneal dialysis patients. J Am Soc Nephrol. 2004; 15(8):2186-94.
Liao C, Shiao C, Huang J, Hung K, Chuang H, Chen Y, et al. Predictors of faster decline of residual renal function in Taiwanese peritoneal dialysis patients. Perit Dial Int. 2008; 28(3):S191-5.
Van Biessen W, Lameire N, Verbeke F, Vanholder R. Residual renal function and volume status in peritoneal dialysis patients: a conflict of interest? J Nephrol. 2008; 21(3):299-304.
Jones CH, Smye SW, Newstead CG, Will EJ, Davison AM. Extracellular fluid volume determined by bioelectric impedance and serum albumin in CAPD patients. Nephrol Dial Transplant. 1998; 13(2):393-7.
Jones CH, Newstead CG. The ratio of extracelular fluid to total body water and technique survival in peritoneal dialysis patients. Perit Dial Int. 2004; 24(4):353-8
Ávila-Díaz M, Ventura M, Valle D, Vicenté-Martínez M, García-González Z, Cisneros A, et al. Inflammation and extracellular volume expansion are related to sodium and water removal in patients on peritoneal dialysis. Perit Dial Int. 2006; 26(5):574-80.
Jones CH, Wells L, Stoves J, Farquhar F, Woodrow G. Can a reduction in extracellular fluid volume result in increased serum albumin in peritoneal dialysis patients? Am J Kidney Dis. 2002; 39(4):872-5.
Yonova C, Valderrabano F. The influence of extracellular fluid volume on serum proteins in peritoneal dialysis patients. Minerva Urol Nefrol. 2004; 56(4):367-9.
Cheng L, Tang W, Wang T. Strong association between volume status and nutritional status in peritoneal dialysis patients. Am J Kidney Dis. 2005; 45(5):891-902.
Thijissen S, Wystrychowski G, Usvyat L, Kotanko P, Levin NW. Determinants of serum albumin concentration analyzed in a large cohort of patients on maintenance hemodialysis. J Ren Nutr. 2007; 17(1):70-4.
Chertow GM, Lazarus JM, Lew NL, Ma L, Lowrie EG. Bioimpedance norms for the hemodialysis population. Kidney Int.1997; 52(6):1617-21.
Dumler F, Kilates C. Prospective nutritional surveillance using bioelectrical impedance in chronic kidney disease patients. J Ren Nutr. 2005; 15(1):148-51.
Vannini FD, Antunes AA, Caramori JCT, Martin LC, Barretti P. Associations between nutritional markers and inflammation in hemodialysis patients. Int Urol Nephrol. 2009; 41(4):1003-9.
Mushnick R, Fein PA, Mittman N, Goel N, Chattopahyay J, Avram MM. Relationship of bioelectrical impedance parameters to nutrition and survival in peritoneal dialysis patients. Kidney Int. 2003; 64:S53-6.
Iorio BD, Scalfi L, Terracciano V, Bellizzi V. A systematic evaluation of bioelectrical impedance measurement after hemodialysis session. Kidney Int. 2004; 65(6):2435-40.
Cocchi R, Espodti ED, Fabbri A, Lucatello A, Sturani A, Quarello F. Prevalence of hypertension in patients on peritoneal dialysis: results of an Italian multicentre study. Nephrol Dial Transplant. 1999; 14(6):1536-40.
Tattersall J. Bioimpedance analysis in dialysis: state of the art and what we can expect. Blood Purif. 2009; 27(1):70-4.
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Copyright (c) 2023 Aline de Araujo ANTUNES, Francieli Cristina Delatim VANNINI, Luis Cuadrado MARTIN, Silméia Garcia ZANATI, Pasqual BARRETTI, Jacqueline Costa Teixeira CARAMOR
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