Is overhydration in peritoneal dialysis patients associated with cardiac mortality that might be reversible?  

作　　者：Elizabeth Oei Klara Paudel Annemarie Visser Hazel Finney Stanley L Fan 

机构地区：[1]Department of Renal Medicine and Transplantation, Barts Health NHS Trust [2]Department of Nutrition and Dietetics, Barts Health NHS Trust [3]Department of Clinical Biochemistry, Barts Health NHS Trust

出　　处：《World Journal of Nephrology》2016年第5期448-454,共7页世界肾病学杂志（英文版）

摘　　要：AIMTo study the relationship between overhydration （OH） in peritoneal dialysis （PD） patients and cardiac mortality.METHODSOH, as measured by body composition monitor （BCM）, is associated with increased mortality in dialysis pa-tients. BCM has been used to guide treatment on the assumption that correcting OH will improve cardiac morbidity and mortality although data demonstrating causality that is reversible is limited. We wished to determine if OH in PD patients predicted cardiac mor-tality, and if there was a correlation between OH and cardiac troponin-T （cTnT） levels. Finally, we wished to determine if improving OH values would lead to a decrement in cTnT. All prevalent PD patients over the study period of 57 mo who had contemporaneous BCM and cTnT measurements were followed irrespective of transplantation or PD technique failure. We also studied a cohort of patients with who had severe OH （〉 ＋2L）.The Fresenius Body Composition Monitor was used to obtain hydration parameters. cTnT levels were done as part of routine clinical care. Data was analysed using SPSS version 20.0.RESULTSThere were 48 deaths in the 336 patients. The patients that died from cardiac or non-cardiac causes were similar with respect to their age, incidence of diabetes mellitus, gender, ethnicity and cause of renal failure. However, the patients with cardiac causes of death had significantly shorter dialysis vintage （10.3 mo vs 37.0 mo, P 〈 0.0001） and were significantly more overhydrated by BCM measurement （2.95 L vs 1.35 L, P 〈 0.05）. The mean （standard error of the means） hydration status of the 336 patients was ＋1.15 （0.12） L and the median [interquartile range （IQR）] cTnT level was 43.5 （20-90） ng/L. The cTnT results were not normally distributed and were therefore transformed logarithmically. There was a statistically significant correlation between Log （cTnT） with the OH value （Spearman r value 0.425, P 〈 0.0001）. We identifed a sub-group of patients that were severelyAIM To study the relationship between overhydration(OH) in peritoneal dialysis(PD) patients and cardiac mortality.METHODS OH, as measured by body composition monitor(BCM), is associated with increased mortality in dialysis patients. BCM has been used to guide treatment on the assumption that correcting OH will improve cardiac morbidity and mortality although data demonstrating causality that is reversible is limited. We wished to determine if OH in PD patients predicted cardiac mortality, and if there was a correlation between OH and cardiac troponin-T(cT n T) levels. Finally, we wished to determine if improving OH values would lead to a decrement in cT n T. All prevalent PD patients over the study period of 57 mo who had contemporaneous BCM and cT nT measurements were followed irrespective of transplantation or PD technique failure. We also studied a cohort of patients with who had severe OH(> +2L).The Fresenius Body Composition Monitor was used to obtain hydration parameters. cT nT levels were done as part of routine clinical care. Data was analysed using SPSS version 20.0.RESULTS There were 48 deaths in the 336 patients. The patients that died from cardiac or non-cardiac causes were similar with respect to their age, incidence of diabetes mellitus, gender, ethnicity and cause of renal failure. However, the patients with cardiac causes of death had significantly shorter dialysis vintage(10.3 mo vs 37.0 mo, P < 0.0001) and were significantly more overhydrated by BCM measurement(2.95 L vs 1.35 L, P < 0.05). The mean(standard error of the means) hydration status of the 336 patients was +1.15(0.12) L and the median [interquartile range(IQR)] cT nT level was 43.5(20-90) ng/L. The cT nT results were not normally distributed and were therefore transformed logarithmically. There was a statistically significant correlation between Log(cT nT) with the OH value(Spearman r value 0.425, P < 0.0001). We identified a sub-group of patients that were severely overhydrated; median(IQR) hydration at baseline was +2.7(2.3 to 3.7)

关 键 词：BIOIMPEDANCE Fluid status Peritoneal dialysis MORTALITY Overhydration Cardiac troponin 

分 类 号：R459.5[医药卫生—治疗学] R654.2[医药卫生—临床医学]