Extracellular volume expansion in peritoneal dialysis patients

Abstract

Introduction: Cardiovascular mortality remains high among peritoneal dialysis (PD) patients. Several small studies have suggested that PD patients are volume expanded, and as such this could be a cardiovascular risk factor. We therefore wished to investigate factors which could lead to extracellular water (ECW) expansion.

Methods: Retrospective cross-sectional audit of 600 prevalent, adult PD patients attending two tertiary university PD centers, with corresponding assessments of PD adequacy, transport status, and multifrequency bioimpedance measurements of extracellular water to total body water (ECW/TBW).

Results: 600 PD patients, median age 57.5 (46.9-67.9) years, 54% male, 31% diabetic, 47.6% Caucasoid, median PD vintage 16 (3.7-38) months, (64% prescribed icodextrin, 34% hypertonic glucose dialysates, and 74% antihypertensive medications). Mean ECW 15.1±0.2 L, ICW 20±0.2 L, ECW/TBW ratio 0.437±0.007. On multivariate analysis %ECW/TBW was associated with age (F=13.1 ß=0.045 p=0.000), number of antihypertensive medications (F=10.3 ß=0.43 p=0.001), log CRP (F=12.9 ß=1.3 p=0.000), and negatively with serum albumin (F=25 ß=-0.22 p=0.000), and residual renal function (urine volume mL F=9.96 ß=-0.001 p=0.002) (weekly Kt/Vurine F=8.82 ß=-2.05, p=0.003).

Conclusions: Overhydration as assessed by ECW/TBW is prevalent in adult PD patients, and is associated with loss of residual renal function, inflammation, malnutrition and hypertension - as assessed by antihypertensive medications. As this was a retrospective cross-sectional audit, whether loss of residual renal function, inflammation, and protein energy wasting lead to volume expansion remains to be determined in prospective longitudinal studies.