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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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Kaplan-Meier survival curves for the residual renal function survival (event defined as anuria) compared between the high fluid variation group and the low fluid variation group.
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pone.0153115.g003: Kaplan-Meier survival curves for the residual renal function survival (event defined as anuria) compared between the high fluid variation group and the low fluid variation group.

Mentions: The fluid variation was the highest in the IO group (Table 1). The decline rates of mGFR and urine volume in the high fluid variation group were significantly faster than those in the low fluid variation group (median mGFR decline rate: -0.2 vs -0.1 ml/min/1.73m2/month, p = 0.03; median of urine volume decline rate: -31.2 vs -17.5 ml/24h/month, p = 0.004) (data not shown). In the patients with high and low fluid variation, Kaplan-Meier curve showed that the patients in high variation group had significantly poorer RRF survival than those in low variation group (Log-rank chi-square = 4.1, p = 0.04) (Fig 3). Multivariable Cox proportional hazard model showed the fluid variation was not independently associated with RRF survival (Table 3).


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)

Kaplan-Meier survival curves for the residual renal function survival (event defined as anuria) compared between the high fluid variation group and the low fluid variation group.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0153115.g003: Kaplan-Meier survival curves for the residual renal function survival (event defined as anuria) compared between the high fluid variation group and the low fluid variation group.
Mentions: The fluid variation was the highest in the IO group (Table 1). The decline rates of mGFR and urine volume in the high fluid variation group were significantly faster than those in the low fluid variation group (median mGFR decline rate: -0.2 vs -0.1 ml/min/1.73m2/month, p = 0.03; median of urine volume decline rate: -31.2 vs -17.5 ml/24h/month, p = 0.004) (data not shown). In the patients with high and low fluid variation, Kaplan-Meier curve showed that the patients in high variation group had significantly poorer RRF survival than those in low variation group (Log-rank chi-square = 4.1, p = 0.04) (Fig 3). Multivariable Cox proportional hazard model showed the fluid variation was not independently associated with RRF survival (Table 3).

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