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Observational Study
. 2015 May;30(5):849-58.
doi: 10.1093/ndt/gfv013. Epub 2015 Mar 11.

Baseline hydration status in incident peritoneal dialysis patients: the initiative of patient outcomes in dialysis (IPOD-PD study)†

Claudio Ronco  1 , Christian Verger  2 , Carlo Crepaldi  1 , Jenny Pham  3 , Tatiana De Los Ríos  3 , Adelheid Gauly  3 , Peter Wabel  3 , Wim Van Biesen  4 ; IPOD-PD Study Group
Affiliations
Observational Study

Baseline hydration status in incident peritoneal dialysis patients: the initiative of patient outcomes in dialysis (IPOD-PD study)†

Claudio Ronco et al. Nephrol Dial Transplant. 2015 May.

Abstract

Background: Non-euvolaemia in peritoneal dialysis (PD) patients is associated with elevated mortality risk. There is an urgent need to collect data to help us understand the association between clinical practices and hydration and nutritional status, and their effects on patient outcome.

Methods: The aim of this prospective international, longitudinal observational cohort study is to follow up the hydration and nutritional status, as measured by bioimpedance spectroscopy using the body composition monitor (BCM) of incident PD patients for up to 5 years. Measures of hydration and nutritional status and of clinical, biochemical and therapy-related data are collected directly before start of PD treatment, at 1 and 3 months, and then every 3 months. This paper presents the protocol and a pre-specified analysis of baseline data of the cohort.

Results: A total of 1092 patients (58.1% male, 58.0 ± 15.3 years) from 135 centres in 32 countries were included. Median fluid overload (FO) was 2.0 L (males) and 0.9 L (females). Less than half of the patients were normohydrated (38.7%), whereas FO > 1.1 L was seen in 56.5%. Systolic and diastolic blood pressure were 139.5 ± 21.8 and 80.0 ± 12.8 mmHg, respectively, and 25.1% of patients had congestive heart failure [New York Heart Association (NYHA) 1 or higher]. A substantial number of patients judged to be not overhydrated on clinical judgement appeared to be overhydrated by BCM measurement. Overhydration at baseline was independently associated with male gender and diabetic status.

Conclusions: The majority of patients starting on PD are overhydrated already at start of PD. This may have important consequences on clinical outcomes and preservation of residual renal function. Substantial reclassification of hydration status by BCM versus on a clinical basis was necessary, especially in patients who were not overtly overhydrated. Both clinical appreciation and bioimpedance should be combined in clinical decision-making on hydration status.

Trial registration: ClinicalTrials.gov NCT01285726.

Keywords: bioimpedance; end-stage renal disease; hydration status; peritoneal dialysis; prospective cohort study; volaemia.

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Figures

FIGURE 1:
FIGURE 1:
Hydration status in different subcategories (univariate). (A) Gender, (B) diabetes and (C) Transport status. Dotted lines reflect range of euvolaemia (±1.1 L).
FIGURE 2:
FIGURE 2:
Hydration status in different subcategories (multivariate). (A) Transport status and gender, (B) transport status and diabetes; dotted lines reflect range of euvolaemia (±1.1 L).
FIGURE 3:
FIGURE 3:
Scatter plot on fluid overload (L) versus systolic blood pressure (mmHg).
FIGURE 4:
FIGURE 4:
Assessment of hydration status with BCM versus clinical assessment by investigator using the physician specific assessment.
See this image and copyright information in PMC

References

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