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The Impact of Fluid Overload and Variation on Residual Renal Function in Peritoneal Dialysis Patient.

Tian N, Guo Q, Zhou Q, Cao P, Hong L, Chen M, Yang X, Yu X - PLoS ONE (2016)

Bottom Line: The decline rate of mGFR in both PO and IO groups were significantly faster than that of NH group (PO vs NH: -0.2 vs -0.1 ml/min/1.73 m2/month, p < 0.01; IO vs NH: -0.2 vs -0.1 ml/min/1.73 m2/month, p < 0.01).Kaplan-Meier analysis showed poorer RRF outcome in both PO and IO groups compared with that of NH group (PO vs NH: p < 0.001; IO vs NH: p = 0.006).Adjusted Cox regression models indicated the hazard ratio of RRF loss in PO group was 8.90-folds higher (95% confidence interval 3.07-31.89) than that in NH group.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China.

ABSTRACT

Background: The effect of fluid overload and variation on residual renal function (RRF) in peritoneal dialysis (PD) patients is controversial.

Methods: Retrospective cohort study was designed. One-hundred and ninety PD patients with measured glomerular filtration rate (mGFR) ≧ 3 ml/min/1.73 m2 were recruit. Fluid status of every participant was assessed by bioelectrical impedance analysis (BIA) every 3 months for 1 year. The cohort was divided into three hydration groups, namely persistent overhydration (PO) group, intermittent overhydration (IO) group and normal hydration (NH) group. Additionally, participants were also divided into high or low fluid variation groups. The decline rate of RRF and the event of anuria were followed up for 1 year. The association of fluid overload with RRF loss was evaluated by Cox proportional hazard models adjusted for confounders.

Results: Thirty-six (18.9%) patients developed anuria. The decline rate of mGFR in both PO and IO groups were significantly faster than that of NH group (PO vs NH: -0.2 vs -0.1 ml/min/1.73 m2/month, p < 0.01; IO vs NH: -0.2 vs -0.1 ml/min/1.73 m2/month, p < 0.01). Kaplan-Meier analysis showed poorer RRF outcome in both PO and IO groups compared with that of NH group (PO vs NH: p < 0.001; IO vs NH: p = 0.006). Patients with high fluid variation had worse RRF survival than those with low fluid variation (p = 0.04). Adjusted Cox regression models indicated the hazard ratio of RRF loss in PO group was 8.90-folds higher (95% confidence interval 3.07-31.89) than that in NH group.

Conclusions: These findings suggested fluid overload was independently associated with the decline of RRF in PD patients.

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Patient enrollment and follow-up flow diagram.
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pone.0153115.g001: Patient enrollment and follow-up flow diagram.

Mentions: Regular BIA measurements were performed in 313 PD patients for more than one year. One hundred twenty-three were excluded from this study, including four patient’s lack of mGFR data, and 119 patients with mGFR less than 3ml/min/1.73m2. Finally, a total of 190 prevalent patients with PD vintage of 7 (3, 20) months were enrolled in this study (Fig 1). The mean age was 47.7 ± 15.4 years old and 58% of participants were male. The underlying kidney diseases were chronic glomerulonephritis (98, 52%), diabetic nephropathy (46, 24%), hypertensive nephrosclerosis (13, 7%) and other miscellaneous causes (33, 17%). The patients were grouped according to their fluid status, including 77 (41%) patients in NH group, 58 (30%) in PO group, and 55 (29%) in IO group respectively. Among the fluid variation groups, 88 (88/190, 46%) patients were with high fluid variation and 102 (102/190, 54%) with low fluid variation. No patient was transferred from PD to HD or received transplantation during the study.


The Impact of Fluid Overload and Variation on Residual Renal Function in Peritoneal Dialysis Patient.

Tian N, Guo Q, Zhou Q, Cao P, Hong L, Chen M, Yang X, Yu X - PLoS ONE (2016)

Patient enrollment and follow-up flow diagram.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836661&req=5

pone.0153115.g001: Patient enrollment and follow-up flow diagram.
Mentions: Regular BIA measurements were performed in 313 PD patients for more than one year. One hundred twenty-three were excluded from this study, including four patient’s lack of mGFR data, and 119 patients with mGFR less than 3ml/min/1.73m2. Finally, a total of 190 prevalent patients with PD vintage of 7 (3, 20) months were enrolled in this study (Fig 1). The mean age was 47.7 ± 15.4 years old and 58% of participants were male. The underlying kidney diseases were chronic glomerulonephritis (98, 52%), diabetic nephropathy (46, 24%), hypertensive nephrosclerosis (13, 7%) and other miscellaneous causes (33, 17%). The patients were grouped according to their fluid status, including 77 (41%) patients in NH group, 58 (30%) in PO group, and 55 (29%) in IO group respectively. Among the fluid variation groups, 88 (88/190, 46%) patients were with high fluid variation and 102 (102/190, 54%) with low fluid variation. No patient was transferred from PD to HD or received transplantation during the study.

Bottom Line: The decline rate of mGFR in both PO and IO groups were significantly faster than that of NH group (PO vs NH: -0.2 vs -0.1 ml/min/1.73 m2/month, p < 0.01; IO vs NH: -0.2 vs -0.1 ml/min/1.73 m2/month, p < 0.01).Kaplan-Meier analysis showed poorer RRF outcome in both PO and IO groups compared with that of NH group (PO vs NH: p < 0.001; IO vs NH: p = 0.006).Adjusted Cox regression models indicated the hazard ratio of RRF loss in PO group was 8.90-folds higher (95% confidence interval 3.07-31.89) than that in NH group.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China.

ABSTRACT

Background: The effect of fluid overload and variation on residual renal function (RRF) in peritoneal dialysis (PD) patients is controversial.

Methods: Retrospective cohort study was designed. One-hundred and ninety PD patients with measured glomerular filtration rate (mGFR) ≧ 3 ml/min/1.73 m2 were recruit. Fluid status of every participant was assessed by bioelectrical impedance analysis (BIA) every 3 months for 1 year. The cohort was divided into three hydration groups, namely persistent overhydration (PO) group, intermittent overhydration (IO) group and normal hydration (NH) group. Additionally, participants were also divided into high or low fluid variation groups. The decline rate of RRF and the event of anuria were followed up for 1 year. The association of fluid overload with RRF loss was evaluated by Cox proportional hazard models adjusted for confounders.

Results: Thirty-six (18.9%) patients developed anuria. The decline rate of mGFR in both PO and IO groups were significantly faster than that of NH group (PO vs NH: -0.2 vs -0.1 ml/min/1.73 m2/month, p < 0.01; IO vs NH: -0.2 vs -0.1 ml/min/1.73 m2/month, p < 0.01). Kaplan-Meier analysis showed poorer RRF outcome in both PO and IO groups compared with that of NH group (PO vs NH: p < 0.001; IO vs NH: p = 0.006). Patients with high fluid variation had worse RRF survival than those with low fluid variation (p = 0.04). Adjusted Cox regression models indicated the hazard ratio of RRF loss in PO group was 8.90-folds higher (95% confidence interval 3.07-31.89) than that in NH group.

Conclusions: These findings suggested fluid overload was independently associated with the decline of RRF in PD patients.

Show MeSH
Related in: MedlinePlus