Kook-Hwan Oh, Seon Ha Baek, Kwon-Wook Joo, Dong Ki Kim, Yon Su Kim, Sejoong Kim, Yun Kyu Oh, Byoung Geun Han, Jae Hyun Chang, Wookyung Chung, Ki Young Na
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Subjects in the control group received fluid management based on the clinical information alone. Those in the BIS group received BIS-guided fluid management along with clinical information.</p><p><strong>Results: </strong>The subjects (<i>N</i> = 137, mean age 51.3 ± 12.8 years, 54% male) were randomly assigned to the BIS group (<i>n</i> = 67) or to the control group (<i>n</i> = 70). There were no significant differences between the 2 groups with regard to age, sex ratio, cause of kidney failure, duration of PD, baseline comorbidity, RRF, PD method, or peritoneal transport type. At baseline, the 2 groups were not different in terms of RRF (glomerular filtration rate [GFR], 5.1 ± 2.9 vs 5.5 ± 3.7 mL/min/1.73 m<sup>2</sup>). After follow-up, changes in the GFR between the 2 groups were not different (-1.5 ± 2.4 vs -1.3 ± 2.6 mL/min/1.73 m<sup>2</sup>, <i>p</i> = 0.593). Over the 1-year study period, both groups maintained stability of various fluid status parameters. Between the 2 groups, there were no differences in the net change of various fluid status parameters such as overhydration (OH) and extracellular water/total body water (ECW/TBW). A net change in ECW over 1 year was slightly but significantly higher in the control group (net increase, 0.57 ± 1.27 vs 0.05 ± 1.63 L, <i>p</i> = 0.047). However, this difference was not translated into an improvement in RRF in the BIS group. There were no differences in echocardiographic parameters or arterial stiffness at the end of follow-up.</p><p><strong>Conclusion: </strong>Routine BIS-guided fluid management in non-anuric PD patients did not provide additional benefit in volume control, RRF preservation, or cardiovascular (CV) parameters. However, our study cannot be generalized to the whole PD population. Further research is warranted in order to investigate the subpopulation of PD patients who may benefit from routine BIS-guided fluid management.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"131-138"},"PeriodicalIF":0.0000,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2016.00241","citationCount":"31","resultStr":"{\"title\":\"Does Routine Bioimpedance-Guided Fluid Management Provide Additional Benefit to Non-Anuric Peritoneal Dialysis Patients? 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Subjects in the control group received fluid management based on the clinical information alone. Those in the BIS group received BIS-guided fluid management along with clinical information.</p><p><strong>Results: </strong>The subjects (<i>N</i> = 137, mean age 51.3 ± 12.8 years, 54% male) were randomly assigned to the BIS group (<i>n</i> = 67) or to the control group (<i>n</i> = 70). There were no significant differences between the 2 groups with regard to age, sex ratio, cause of kidney failure, duration of PD, baseline comorbidity, RRF, PD method, or peritoneal transport type. At baseline, the 2 groups were not different in terms of RRF (glomerular filtration rate [GFR], 5.1 ± 2.9 vs 5.5 ± 3.7 mL/min/1.73 m<sup>2</sup>). After follow-up, changes in the GFR between the 2 groups were not different (-1.5 ± 2.4 vs -1.3 ± 2.6 mL/min/1.73 m<sup>2</sup>, <i>p</i> = 0.593). Over the 1-year study period, both groups maintained stability of various fluid status parameters. Between the 2 groups, there were no differences in the net change of various fluid status parameters such as overhydration (OH) and extracellular water/total body water (ECW/TBW). A net change in ECW over 1 year was slightly but significantly higher in the control group (net increase, 0.57 ± 1.27 vs 0.05 ± 1.63 L, <i>p</i> = 0.047). However, this difference was not translated into an improvement in RRF in the BIS group. There were no differences in echocardiographic parameters or arterial stiffness at the end of follow-up.</p><p><strong>Conclusion: </strong>Routine BIS-guided fluid management in non-anuric PD patients did not provide additional benefit in volume control, RRF preservation, or cardiovascular (CV) parameters. However, our study cannot be generalized to the whole PD population. 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引用次数: 31
摘要
在腹膜透析(PD)患者中,容量过载与心功能障碍和死亡率有关,而血管内容量耗竭与残余肾功能(RRF)的快速下降有关。本研究旨在确定生物阻抗谱(BIS)引导的液体管理在PD患者中保存RRF和心功能的临床用途。对象和方法:这是一项为期1年的多中心、前瞻性、开放标签研究(NCT01887262)。非无尿(尿量> 500 mL/天)PD患者入组。对照组仅根据临床资料进行输液管理。BIS组接受BIS引导的液体管理以及临床信息。结果:137例患者(平均年龄51.3±12.8岁,男性占54%)随机分为BIS组(67例)和对照组(70例)。两组在年龄、性别比例、肾衰竭原因、PD持续时间、基线合并症、RRF、PD方法或腹膜转运类型方面无显著差异。在基线时,两组在RRF(肾小球滤过率[GFR], 5.1±2.9 vs 5.5±3.7 mL/min/1.73 m2)方面没有差异。随访后,两组间GFR变化无差异(-1.5±2.4 vs -1.3±2.6 mL/min/1.73 m2, p = 0.593)。在1年的研究期间,两组患者的各项流体状态参数均保持稳定。两组间过度水合(OH)、细胞外水/全身水(ECW/TBW)等各项体液状态参数净变化无差异。对照组1年内ECW的净变化略高于对照组(净增加,0.57±1.27 vs 0.05±1.63 L, p = 0.047)。然而,这种差异并没有转化为BIS组RRF的改善。随访结束时,超声心动图参数和动脉硬度无差异。结论:在非无尿PD患者中,常规bis引导的液体管理在体积控制、RRF保存或心血管(CV)参数方面没有提供额外的益处。然而,我们的研究不能推广到整个PD人群。为了调查可能从常规bis引导的液体管理中受益的PD患者亚群,需要进一步的研究。
Does Routine Bioimpedance-Guided Fluid Management Provide Additional Benefit to Non-Anuric Peritoneal Dialysis Patients? Results from COMPASS Clinical Trial.
Introduction: In peritoneal dialysis (PD) patients, volume overload is related to cardiac dysfunction and mortality, while intravascular volume depletion is associated with a rapid decline in the residual renal function (RRF). This study sought to determine the clinical usefulness of bioimpedance spectroscopy (BIS)-guided fluid management for preserving RRF and cardiac function in PD patients.
Subjects and methods: This is a multicenter, prospective, open-label study that was conducted over a 1-year period (NCT01887262). Non-anuric (urine volume > 500 mL/day) subjects on PD were enrolled. Subjects in the control group received fluid management based on the clinical information alone. Those in the BIS group received BIS-guided fluid management along with clinical information.
Results: The subjects (N = 137, mean age 51.3 ± 12.8 years, 54% male) were randomly assigned to the BIS group (n = 67) or to the control group (n = 70). There were no significant differences between the 2 groups with regard to age, sex ratio, cause of kidney failure, duration of PD, baseline comorbidity, RRF, PD method, or peritoneal transport type. At baseline, the 2 groups were not different in terms of RRF (glomerular filtration rate [GFR], 5.1 ± 2.9 vs 5.5 ± 3.7 mL/min/1.73 m2). After follow-up, changes in the GFR between the 2 groups were not different (-1.5 ± 2.4 vs -1.3 ± 2.6 mL/min/1.73 m2, p = 0.593). Over the 1-year study period, both groups maintained stability of various fluid status parameters. Between the 2 groups, there were no differences in the net change of various fluid status parameters such as overhydration (OH) and extracellular water/total body water (ECW/TBW). A net change in ECW over 1 year was slightly but significantly higher in the control group (net increase, 0.57 ± 1.27 vs 0.05 ± 1.63 L, p = 0.047). However, this difference was not translated into an improvement in RRF in the BIS group. There were no differences in echocardiographic parameters or arterial stiffness at the end of follow-up.
Conclusion: Routine BIS-guided fluid management in non-anuric PD patients did not provide additional benefit in volume control, RRF preservation, or cardiovascular (CV) parameters. However, our study cannot be generalized to the whole PD population. Further research is warranted in order to investigate the subpopulation of PD patients who may benefit from routine BIS-guided fluid management.