Asymptomatic fluid overload predicts survival and cardiovascular event in incident Chinese peritoneal dialysis patients

Abstract

Background: Fluid overload is common among asymptomatic peritoneal dialysis (PD) patients. We aim to determine the prevalence and prognostic significance of fluid overload, as measured by bioimpedance spectroscopy, in asymptomatic incident PD patients.

Methods: We performed a single-center study on 311 incident PD patients. Volume status was represented by the volume of overhydration (OH), OH/extracellular water (ECW) ratio, ECW/total body water (TBW) ratio, and ECW to intracellular water (ICW) ratio (E:I ratio). Patient survival, technique survival and cardiovascular event-free survival were determined.

Results: The median period of follow up was 27.3 months. Fluid overload was present in 272 patients (87.5%) when defined as OH volume over 1.1L. All hydration parameters significantly correlated with Charlson Comorbidity Index, and inversely with total Kt/V, and serum albumin. Multivariate cause-specific Cox analysis showed that volume status independently predicted patient survival; every 0.1 unit increase in E:I ratio was associated with 24.5% increase in all-cause mortality (adjusted cause-specific hazard ratio [ACSHR] 1.245, p = 0.002). Hydration status was also an independent predictor of cardiovascular event-free survival after excluding hospital admission for congestive heart failure; each 0.1 unit increase in E:I ratio was associated with 18.7% decrease in cardiovascular event-free survival (ACSHR 1.187, p = 0.011). In contrast, hydration parameters were not associated with technique survival.

Conclusions: Fluid overload is common in asymptomatic incident PD patients and is a strong predictor of patient survival and cardiovascular event. The impact of bioimpedance spectroscopy-guided fluid management on the outcome of PD patients deserves further study.

Fig 1

Kaplan-Meier plot of (A) patient survival; and (B) technique survival. Patients were divided into tertiles according to their baseline E:I ratio (1^st tertile: ≤0.91; 2^nd tertile >0.91–1.07; 3^rd tertile >1.07). Data were compared by the log rank test.

Fig 2

Kaplan-Meier plot of cardiovascular event-free survival with hospital admission for congestive heart failure (A) included; and (B) excluded. Patients were divided into tertiles according to their baseline E:I ratio (1^st tertile: ≤0.91; 2^nd tertile >0.91–1.07; 3^rd tertile >1.07). Data were compared by the log rank test.