Background: Volume overload is a common problem in peritoneal dialysis patients and may contribute to the high cardiac mortality in this patient population. Controlling volume status is difficult due to the lack of appropriate and accurate assessment of dry weight. This randomized, controlled study was conducted to test if the recent use of overhydration value (OH) provided by bioimpedance spectroscopy and patients’ education would help to control overhydration. Methods: 160 continuous ambulatory peritoneal patients were included in this study. All the patients were randomly allocated to 2 groups: in Group 1 the patients and their primary nurses were informed of the OH values provided by bioimpedance spectroscopy whereas in Group 2 the values were not revealed and patients’ volume was measured by the standard methods. Fluid status was evaluated by means of repeated bioimpedance analysis and clinical assessment. Urine volume, blood pressure and use of antihypertensive medications were recorded. Results: There were no differences in gender, age, diabetes, height, weight and clinical hydration status between the 2 groups at the baseline. In Group 1, OH (p < 0.05), extracellular volume and the extracellular volume to intracellular volume ratio decreased steadily during the 3-month follow-up. On the contrary, all 3 parameters increased significantly in Group 2. SBP decreased significantly in Group 1 but increased significantly in Group 2. Conclusion: Our study shows that the use of OH as determined by bioimpedance spectroscopy may facilitate volume control in peritoneal dialysis patients.

Keywords:
Bioimpedance, Peritoneal dialysis, Randomized controlled study, Volume control
1.
Tzamaloukas AH, Saddler MC, Murata GH, Malhotra D, Sena P, Simon D, Hawkins KL, Morgan K, Nevarez M, Wood B: Symptomatic fluid retention in patients on continuous peritoneal dialysis. J Am Soc Nephrol 1995;2:198–206.
2.
Konings CJ, Kooman JP, Schonck M, Dammers R, Cheriex E, Palmans Meulemans AP, Hoeks AP, van Kreel B, Gladziwa U, van der Sande FM, Leunissen KM: Fluid status, blood pressure, and cardiovascular abnormalities in patients on peritoneal dialysis. Perit Dial Int 2002;4:477–487.
3.
Plum J, Schoenicke G, Kleophas W, Kulas W, Steffens F, Azem A, et al: Comparison of body fluid distribution between chronic haemodialysis and peritoneal dialysis patients as assessed by biophysical and biochemical methods. Nephrol Dial Transplant 2001;16:2378–2385.
4.
Oe B, de Fijter CW, Geers TB, et al: Hemodialysis (HD) versus peritoneal dialysis (PD): Latent overhydration in PD patients? Int J Artif Organs 2002;25:838–843.
5.
Enia G, Mallamaci F, Benedetto FA, et al: Long-term CAPD patients are volume expanded and display more severe left ventricular hypertrophy than haemodialysis patients. Nephrol Dial Transplant 2001;16:1464.
6.
Cheriex EC, Leunissen KML, Janssen J, Mooy J, van Hooff J: Echography of inferior vena cava is a simple and reliable tool for estimation of ‘dry weight’ in hemodialysis patients. Nephrol Dial Transplant 1989;4:563–568.
7.
Lee SW, Sonq JH, Kim GA, Lim HJ, Kim MJ: Plasma brain natriuretic peptide concentration on assessment of hydration status in hemodialysis patient. Am J Kidney Dis 2003;41:1257–1266.
8.
Lauster F, Gerzer R, Weil J, FOlle H, Schiffl H: Assessment of dry body-weight in hemodialysis patients by the biochemical marker cGMP. Nephrol Dial Transplant 1990;5:356–361.
9.
Cannella G, Albertini A, Assanelli D, et al: Effects of changes in intravascular volume on atrial size and plasma levels of immunoreactive atrial natriuretic peptide in uremic man. Gin Nephrol 1988;30:187–192.
10.
Kraemer M, Rode C, Wizemann V: Detection limit of methods to assess fluid status changes in dialysis patients. Kidney Int 2006;69:1609–1620.
11.
Katzarski KS, Nisell J, Bergströsm J: Relationship between blood volume (BV) and inferior vena cava diameter (IVCD) during and after hemodialysis (HD). J Am Soc Nephrol 1994;5:518.
12.
Mandelbaum A, Link A, Wambach G, Ritz E: Vena-cava-Sonographie zur Beurteilung des Hydratationszustandes bei Niereninsuffizienz. Dtsch Med Wschr 1993;118:1309–1315.
13.
Katzarski K, Danielsson A, Bergstrdm J: The ANP secretion during hemodialysis is influenced by vasopressin and noradrenalin. Nephrol Dial Transplant 1992;7:681–682.
14.
Moissl UM, Wabel P, Chamney PW, Bosaeus I, Levin NW, Bosy-Westphal A, Korth O, Müller MJ, Ellegård L, Malmros V, Kaitwatcharachai C, Kuhlmann MK, Zhu F, Fuller NJ: Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas 2006;27:921–933.
15.
Chamney PW, Wabel P, Moissl UM, Müller MJ, Bosy-Westphal A, Korth O, Fuller NJ: A whole-body model to distinguish excess fluid from the hydration of major body tissues. Am J Clin Nutr 2007;85:80–89.
16.
Wabel P, Chamney P, Moissl U, Jirka T: Importance of whole-body bioimpedance spectroscopy for the management of fluid balance. Blood Purif 2009;27:75–80.
17.
Crepaldia C, Sachin S, Chang CY, Wabel P, Cruza DN, Roncoa C: Application of Body Composition Monitoring to Peritoneal Dialysis Patients. Contrib Nephrol 2009;163:1–6.
18.
Wizemanna V, Rodea C, Wabel P: Whole-body spectroscopy (BCM) in the assessment of normovolemia in hemodialysis patients. Contrib Nephrol 2008;161:115–118.
19.
Wabel P, Moissl U, Chamney P, Jirka T, Machek P, et al: Towards improved cardiovascular management: the necessity of combining blood pressure and fluid overload. Nephrol Dial Transplant 2008;23:2965–2971.
20.
Wizemann V, Wabel P, Chamney P, et al: The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant 2009;24:1574–1579.
21.
Su CY, Lu XH, Chen W, Wang T: Promoting self-management improves the health status of patients having peritoneal dialysis. J Adv Nurs 2009;65:1381–1389.
22.
Rallison LR, Kushner RF, Penn D, Schoeller DA: Errors in estimating peritoneal fluid by bioelectric impedance analysis and total body electrical conductivity. J Am Coll Nutr 1993;12:66–72.
23.
McCullough AJ, Mullen KD, Kalhan SC: Measurements of total body and extracellular water in cirrhotic patients with and without ascites. Hepatology 1991;14:1102–1111.
24.
Bandura A: Self-Efficacy: The Exercise of Control. New York, WH Freeman, 1997.
25.
Chen W, Lu XH, Wang T: Menu suggestion: an effective way to improve dietary compliance in peritoneal dialysis patients. J Renal Nutr 2006;16:132–136.
26.
Thomas BJ, Ward LC, Cornish BH: Bioimpedance spectrometry in the determination of body water compartments: accuracy and clinical significance. Appl Radiat Isot 1998;49:447–455.
27.
Hopkins K, Bakris GL: Assessing blood pressure control in dialysis patients: finally a step forward. Hypertension 2009;53:448–449.
28.
Boudville NC, Cordy P, Millman K, Fairbairn L, Sharma A, Lindsay R, Blake PG: Blood pressure, volume, and sodium control in an automated peritoneal dialysis population. Perit Dial Int 2007;27:537–543.
29.
Fozzard HA, Haber E, Jennings RB, Katz AM, et al: The Heart and Cardiovascular System. New York, Raven Press, 1992, pp 333–353.
30.
Levin A, Singer J, Thompson CR, et al: Prevalent left ventricular hypertrophy in the predilaysis population: indentifying opportunities for intervention. Am J Kidney Dis 1996;27:347–354.
31.
Mark PB, Johnston N, Groenning BA, et al: Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac magnetic resonance imaging. Kidney Int 2006;69:1839–1845.
32.
Chan CT, Floras JS, Miller JA, et al: Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis. Kidney Int 2002;61:2235–2239.
33.
Ozkahya M, Ok E, Toz H, et al: Long-termsurvival rates in haemodialysis patients treated with strict volume control. Nephrol Dial Transplant 2006;21:3506–3513.
34.
Jean G, Souberbielle JC, Chazot C: Monthly cholecalciferol administration in haemodialysis patients: a simple and efficient strategy for vitamin D supplementation. Nephrol Dial Transplant 2009;24:3799–3805.
35.
Penne EL, Levin NW, Kotanko P: Improving volume status by comprehensive dietary and dialytic sodium management in chronic hemodialysis patients. Blood Purif 2010;30:71–78.
36.
DiMatteo MR: Enhancing patients adherence to medical recommendations. J Am Med Assoc 1994;271:79–83.
37.
Donovan JL: Patient decision making: the missing ingredient in compliance research. Int J Technol Assess Health Care 1995;11:443–455.
38.
Marinopoulos SS, Dorman T, Ratanawonqsa N, Wilson LM, Sshar BH, et al: Effectiveness of continuing medical education. Evid Rep Technol Assess 2007;149:1–69.
39.
Levack WM, Taylor K, Siegert RJ, Dean SG, McPherson KM, Weatherall M: Is goal planning in rehabilitation effective? A systematic review. Clin Rehabil 2006;20:739–755.
40.
Sivaraman Nair KP: Life goal: the concept and its relevance to rehabilitation. Clin Rehabil 2003;17:192–202.
41.
Cheng LT, Jiang HY, Tang LJ, Wang T: Seasonal variation in blood pressure of patients on continuous ambulatory peritoneal dialysis. Blood Purif 2006;24:499–507.
42.
Woods HF, Cheng CT, Lim PS: Climate and volume and blood pressure trends in Taiwanese hemodialysis patients. Blood Purif 2008;26:404–406.
43.
Leypoldt JK, Cheung AK, Delmez JA, et al: Relationship between volume status and blood pressure during chronic hemodialysis. Kidney Int 2002;61:266–275.
44.
Gu Y, Axelsson J, Zeng J, Chen HM, Cheng LT, Wang T: The impact of changes in extra cellularto-intracellular water ratio on pulse wave velocity in prevalent CAPD patients: a longitudinal study. Perit Dial Int 2008;28:412–415.
45.
Cheng LT, Tang W, Wang T: Strong association between volume status and nutritional status in peritoneal dialysis patients. Am J Kidney Dis 2005;45:891–902.
46.
Dumler F: Hypoalbuminemia is a marker of overhydration in chronic maintenance patients on dialysis. ASAIO J 2003;49:282–286.
47.
Wang AY, Sanderson J, Sea MM, 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 Nutri 2003;77:834–841.
48.
Jones CH, Akbani H, Croft DC, Worth DP: The relationship between serum albumin and hydration status in hemodialysis patients. J Ren Nutr 2002;12:209–212.
49.
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;39:872–875.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.