• N-terminal fragment of B-type natriuretic peptide
• Outcome
• Peritoneal dialysis-associated peritonitis

• Humans
• Natriuretic Peptide, Brain/blood
• Male
• Female
• Peritoneal Dialysis/adverse effects
• Peptide Fragments/blood
• Middle Aged
• Peritonitis/etiology
• Peritonitis/blood
• Retrospective Studies
• Risk Factors
• Kidney Failure, Chronic/therapy
• Kidney Failure, Chronic/blood
• Kidney Failure, Chronic/complications
• Treatment Failure
• Aged
• Adult
• Biomarkers/blood

• No. 2022YFS0148 Sichuan Province Science and Technology Support Program

• clinical profiles
• congestion
• diuretics
• heart failure
• treatment

• Humans
• Diuretics/therapeutic use
• Sodium Potassium Chloride Symporter Inhibitors/therapeutic use
• Treatment Outcome
• Heart Failure/drug therapy
• Phenotype

• adipose tissue
• bioimpedance
• body composition
• echocardiography
• muscle wasting
• peritoneal dialysis
• volume overload

• Adipose Tissue
• Body Composition
• China
• Electric Impedance
• Humans
• Peritoneal Dialysis/adverse effects
• Water-Electrolyte Imbalance/etiology

• Research Grant 2018 Hong Kong Society of Nephrology
• 6901031 and 7101215 Chinese University of Hong Kong

Left ventricular hypertrophy is a risk factor for cardiovascular mortality in patients on peritoneal dialysis (PD). Because icodextrin has a greater ultrafiltration power compared with glucose-based solutions for long dwell, it could improve left ventricular mass by reducing fluid overload. This was a randomized clinical trial that included patients on PD recruited from 2 teaching hospitals, in Sao Paulo—Brazil. Patients were allocated to the control glucose group (GLU) or the intervention icodextrin (ICO) group. Clinical and cardiac magnetic resonance image (MRI) parameters were evaluated at baseline and 6 months after randomization. The primary outcome was the change in left ventricular mass adjusted by surface area (ΔLVMI), measured by cardiac MRI. A total of 22 patients completed the study (GLU, N = 12 and ICO, N = 10). Baseline characteristics such as age, sex, underlying disease, and time on dialysis were similar in both groups. At baseline, 17 patients (77.3%) presented with left ventricular hypertrophy with no difference between groups (p = 0.748). According to the total body water (TBW)/extracellular water (ECW) ratio, 36.8% and 80% of patients from GLU and ICO groups, respectively, were considered hypervolemic (p = 0.044). During follow-up, ΔLVMI was 3.9 g/m (− 10.7, 2.2) in GLU and 5.2 (− 26.8, 16.8) in ICO group (p = 0.651). ΔLVMI correlated with change in brain natriuretic peptide (r = 0.566, p = 0.044), which remained significant in a multiple regression analysis. The use of the icodextrin-based solution in prevalent patients on PD compared with a glucose-based solution was not able to improve LMV. A larger randomized trial with a longer follow-up period may be needed to show changes in LVM in this patient population.

Trial registration: this study has been registered at ReBEC (Registro Brasileiro de Ensaios Clinicos) under the identification #RBR-2mzhmj2, available at: https://ensaiosclinicos.gov.br/pesquisador.

Dry weight assessment (DWA) is an important part of dialysis and fluid management in patients receiving renal replacement therapy. With the development of bioimpedance analysis (BIA), the development of the direct segmental multi-frequency BIA (DSM–BIA) has provided a more convenient measure for DWA of dialysis patients, but its accuracy remains unclear. This study was designed to evaluate the application of DSM–BIA in DWA of continuous ambulatory peritoneal dialysis (CAPD) patients.

This is a cross-sectional study. Using the conventional BIA as a reference, we examined the accuracy of the DSM–BIA technique for assessing dry weight in CAPD patients and analyzed the potential factors influencing their fluid volume status.

A total of 31 patients with end-stage renal disease receiving CAPD and 310 healthy volunteers were recruited for this study.

The intraclass correlation coefficients (ICC) and Bland–Altman plots were used to assess the consistency between DSM–BIA and the conventional BIA for DWA. Univariate and multivariate linear regression analyses were used to explore the influencing factors associated with the edema index.

DSM–BIA and the conventional BIA technology were consistent in DWA in CAPD patients (ICC female 0.972, ICC male 0.882, ICC total 0.960). Similarly, Bland–Altman plots showed good agreements between the two methods in DWA for both genders. Univariate and multivariate linear regression analysis showed both eGFR level (P = 0.04) and serum NT-pro BNP concentration (P = 0.007) were positively correlated with the ratio of extracellular water to total body water (ECW/TCW).

DSM–BIA in DWA has good accuracy in clinical applications and has potential application value for fluid volume management in CAPD patients.

The online version contains supplementary material available at 10.1007/s11255-022-03281-7.

• Hydration
• Hydration markers
• Water
• Water balance

• Drinking
• Fluid Therapy/methods
• Humans
• Renal Insufficiency, Chronic
• Sodium
• Water

• Chronic kidney disease
• End-stage renal disease
• Natriuretic peptide
• Prognosis

• Bioimpedance analysis
• Inferior vena cava
• Lung ultrasound
• N-terminal pro-B-type natriuretic peptide
• Peritoneal dialysis
• Volume overload

• Body Composition
• Echocardiography
• Electric Impedance
• Humans
• Kidney Failure, Chronic/complications
• Kidney Failure, Chronic/mortality
• Kidney Failure, Chronic/therapy
• Lung/diagnostic imaging
• Natriuretic Peptide, Brain/blood
• Nephrology/methods
• Nephrology/trends
• Peritoneal Dialysis/adverse effects
• Predictive Value of Tests
• Prognosis
• Risk Assessment/methods
• Ultrasonography
• Vena Cava, Inferior/diagnostic imaging
• Water-Electrolyte Imbalance/blood
• Water-Electrolyte Imbalance/diagnosis
• Water-Electrolyte Imbalance/etiology
• Water-Electrolyte Imbalance/mortality

• End-stage kidney disease (ESKD)
• Natriuretic peptides
• Pathophysiology
• Review
• Significance

• Biomarkers/blood
• Heart Failure/blood
• Heart Failure/complications
• Humans
• Kidney Failure, Chronic/blood
• Kidney Failure, Chronic/complications
• Kidney Failure, Chronic/mortality
• Kidney Failure, Chronic/physiopathology
• Natriuretic Peptide, Brain/blood
• Natriuretic Peptide, Brain/metabolism
• Natriuretic Peptide, Brain/physiology
• Natriuretic Peptides/blood
• Natriuretic Peptides/metabolism
• Natriuretic Peptides/physiology
• Peptide Fragments/blood
• Peptide Fragments/metabolism
• Peptide Fragments/physiology
• Prognosis
• Renal Dialysis
• Risk Factors

• Bioimpedance
• Hypertension
• Icodextrin
• Peritoneal dialysis
• Pulse wave velocity

Hypertension is common in peritoneal dialysis (PD) patients and associated with adverse outcomes. Besides solute clearance, PD convective clearance is used to control extracellular water (ECW) volume and sodium balance. Previous studies have reported on hypertension in PD patients treated with continuous ambulatory peritoneal dialysis (CAPD) using hypertonic glucose dialysates. However, increasing numbers of PD patients are now treated with automated peritoneal dialysis (APD) and icodextrin dialysates. As such, we wished to explore factors associated with systolic blood pressure (SBP) in a modern cohort to identify targets to improve blood pressure control in PD patients.

We retrospectively reviewed the results from PD patients attending for peritoneal membrane assessment who had corresponding bioimpedance ECW and brain natriuretic peptide (NT-proBNP) measurements.

We studied 510 PD patients: 317 (72.2%) male, 216 (42.4%) diabetics, median age 59 (47–72) years, and 51% treated by APD with a day-time icodextrin exchange. Mean systolic blood pressure (SBP) was 140 ± 24.8 mmHg. SBP was independently associated with 4-hour dialysate to plasma creatinine ratio (β = 29.5 (95% confidence limits 11.4–47.5, p = 0.001), N-terminal brain natriuretic peptide [β = 11.9 (7.2–16.7), p < 0.001], and daily urine sodium excretion [β = 1.7 (1.0–2.3), p < 0.001].

In the era of APD cyclers and icodextrin, SBP is associated with increased NT-proBNP, a marker of ECW expansion, and faster peritoneal transport, a risk factor for a positive sodium balance, and increased urinary sodium suggestive of higher dietary sodium intake. Patients should be encouraged to restrict sodium intake and PD prescriptions targeted to control ECW to improve SBP control.

• Brain natriuretic peptide
• Extracellular water
• Peritoneal transport
• Sodium
• Systolic blood pressure

• Fluid control
• antihypertensive medication

• Adolescent
• Blood Pressure
• Blood Pressure Determination
• Case-Control Studies
• Child
• Child, Preschool
• Cross-Sectional Studies
• Electric Impedance
• Female
• Humans
• Longitudinal Studies
• Male
• Prospective Studies
• Pulse Wave Analysis/methods
• Renal Dialysis/methods
• Renal Insufficiency, Chronic/therapy
• Water-Electrolyte Balance

• CDF-2016-09-038 Department of Health

• Brain natriuretic peptide
• Bioimpedance
• Extracellular water
• Fast transporter
• Peritoneal protein clearance

• bioimpedance
• fluid overload
• overhydration
• peritoneal dialysis
• quality of life.

• Adult
• Aged
• Dehydration/complications
• Dehydration/physiopathology
• Dielectric Spectroscopy
• Female
• Heart Failure/etiology
• Heart Failure/physiopathology
• Humans
• Kidney Diseases/complications
• Kidney Diseases/physiopathology
• Kidney Diseases/therapy
• Male
• Middle Aged
• Peritoneal Dialysis/adverse effects
• Quality of Life
• Vascular Stiffness/physiology

• Cardiovascular risk
• IL-6
• Overhydration

• Peritoneal dialysis
• biocompatible dialysis fluids
• bioimpedance spectroscopy
• hydration status

It is unclear whether the fluid status, as determined by bioimpedance vector analysis (BIVA) combined with serum N-terminal pro-B-type natriuretic peptides (NT-pro-BNP) measurement, is associated with treatment outcome among patients receiving continuous renal replacement therapy (CRRT). Our objective was to answer this question.

Patients who were in the intensive care units of a university teaching hospital and who required CRRT were screened for enrollment. For the enrolled patients, BIVA and serum NT-pro BNP measurement were performed just before the start of CRRT and 3 days afterward. According to the BIVA and NT-pro BNP measurement results, the patients were divided into four groups according to fluid status type: type 1, both normal; type 2, normal BIVA results and abnormal NT-pro BNP levels; type 3, abnormal BIVA results and normal NT-pro BNP levels; and type 4, both abnormal. The associations between fluid status and outcome were analyzed.

Eighty-nine patients were enrolled, 58 were males, and the mean age was 49.0 ± 17.2 years. The mean score of Acute Physiology and Chronic Health Evaluation II (APACHE II) was 18.8 ± 8.6. The fluid status before CRRT start was as follows: type 1, 21.3% (19 out of 89); type 2, 16.9% (15 out of 89); type 3, 11.2% (10 out of 89); and type 4, 50.6% (45 out of 89). There were significant differences between fluid status types before starting CRRT on baseline values for APACHE II scores, serum creatinine, hemoglobin, platelet count, urine volume, and incidences of oliguria and acute kidney injury (P <0.05). There were significant differences between patients with different fluid status before CRRT start on hospital mortality—type 1, 26.3% (5 out of 19); type 2, 33.3% (5 out of 15); type 3, 40% (4 out of 10); and type 4, 64.4% (29 out of 45) (P = 0.019)—as well as renal function recovery rates: type 1, 57.1% (4 out of 7); type 2, 67.7% (6 out of 9); type 3, 50% (3 out of 6); and type 4, 23.7% (9 out of 38) (P = 0.051).

Fluid status abnormalities were common among patients receiving CRRT. Different types of fluid status distinguished by BIVA combined with serum NT-pro BNP measurements corresponded to different clinical conditions and treatment outcomes, which implies a value of this method for evaluation of fluid status among patients receiving CRRT.

The online version of this article (doi:10.1186/s13054-015-0871-3) contains supplementary material, which is available to authorized users.

• Aged
• Antihypertensive Agents/chemistry
• Biomarkers/blood
• Blood Pressure
• Coronary Artery Bypass
• Diabetes Complications/metabolism
• Electric Impedance
• Extracellular Fluid/metabolism
• Female
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction/complications
• Natriuretic Peptide, Brain/blood
• Outpatients
• Peptide Fragments/blood
• Regression Analysis
• Renal Dialysis/methods
• Water-Electrolyte Imbalance/etiology

• Bioimpedance
• extracellular fluid
• fast transporter
• peritoneal protein loss
• survival

• B-type natriuretic peptide
• cardiovascular disease
• chronic kidney disease
• dialysis
• kidney transplant

• Adult
• Aged
• Female
• Follow-Up Studies
• Glomerular Filtration Rate
• Humans
• Kidney Transplantation
• Male
• Middle Aged
• Natriuretic Peptide, Brain/blood
• Peptide Fragments/blood
• Renal Dialysis
• Renal Insufficiency, Chronic/blood
• Renal Insufficiency, Chronic/therapy
• Severity of Illness Index
• Survival Rate
• Time Factors

AIM: To evaluate the non-invasive assessments of volume status in patients with cirrhosis.

METHODS: Echocardiography and multifrequency bioimpedance analysis measurements and short synacthen tests were made in 20 stable and 25 acutely decompensated patients with cirrhosis.

RESULTS: Both groups had similar clinical assessments, cortisol response and total body water (TBW), however the ratio of extracellular water (ECW)/TBW was significantly greater in the trunk (0.420 ± 0.004 vs 0.404 ± 0.005), and limbs (R leg 0.41 ± 0.003 vs 0.398 ± 0.003, P < 0.05, and L leg 0.412 ± 0.003 vs 0.399 ± 0.003) with decompensated cirrhosis compared to stable cirrhotics, P < 0.05). Echocardiogram derived right atrial and ventricular filling and end diastolic pressures and presence of increased left ventricular end diastolic volume and diastolic dysfunction were similar in both groups. The decompensated group had lower systemic blood pressure, mean systolic 101.8 ± 4.3 vs 122.4 ± 5.3 and diastolic 58.4 ± 4.1 mmHg vs 68.8 ± 3.1 mmHg respectively, P < 0.01, and serum albumin 30 (27-33) vs 32 (31-40.5) g/L, P < 0.01.

CONCLUSION: Decompensated cirrhotics had greater leg and truncal ECW expansion with lower serum albumin levels consistent with intravascular volume depletion and increased vascular permeability.

• Cirrhosis
• Bioimpedance
• Echocardiography
• Extracellular water
• Ascites
• Cortisol