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

Table 1 Baseline demographic

	All	Survivors	Non-cardiac death	Cardiac death	P-value (comparing cardiac vs non cardiac death patients)
No.	336	288	35	13
Age1	57.9 (48.1-69.0)	55.4 (46.9-66.6)	68.9 (61.8-77.0)	68.9 (62.9-76.5)	NS
Male	207 (62%)	167 (58%)	27 (77%)	13 (100%)	NS
Diabetes mellitus	123 (37%)	99 (34%)	15 (43%)	9 (69%)	NS
Assessed as suitable for transplantation	159 (47%)	148 (51%)	10 (29%)	1 (8%)	NS
Dialysis vintage (mo)1	7.6 (0.9-31.4)	6.5 (0.8-24.0)	37.0 (4.0-57.4)	10.3 (2.9-23.1)	< 0.00001
Body composition measurements: Mean (SEM)
OH (L)	1.15 (0.12)	1.04 (0.13)	1.35 (0.32)	2.95 (0.78)	< 0.05
Lean tissue index	13.7 (0.5)	13.9 (0.5)	11.9 (0.5)	12.3 (1.6)	< 0.0001
Fat tissue index	13.2 (0.3)	13.3 (0.3)	11.9 (0.6)	13.3 (1.0)	< 0.01
Ethnicity
Whites	112 (33%)	97 (34%)	14 (40%)	1 (8%)	NS
Blacks	67 (20%)	59 (20%)	5 (14%)	3 (23%)
Asians	139 (41%)	117 (41%)	15 (43%)	7 (54%)
Others	18 (5%)
Cause of renal failure: n (%)
Unknown	82 (24%)	66 (30%)	8 (23%)	2 (15%)	NS
GN	51 (15%)	26 (12%)	1 (3%)	0 (0%)
Cancer/trauma	1 (0%)	3 (1%)	0 (0%)	0 (0%)
Congenital/familial	8 (2%)	5 (2%)	0 (0%)	0 (0%)
Diabetes	105 (31%)	69 (31%)	14 (40%)	9 (69%)
Hypertension	28 (8%)	16 (7%)	5 (14%)	2 (15%)
APKD	12 (4%)	11 (5%)	1 (3%)	0 (0%)
TIN/chronic pyelonephritis	49 (15%)	29 (13%)	6 (17%)	0 (0%)
Blood results
Baseline log(CRP) (mg/L)	0.57 (0.03)	0.52 (0.04)	0.79 (0.12)	0.81 (0.20)	NS
Time av log (CRP) (mg/L)	0.67 (0.04)	0.61 (0.04)	1.09 (0.11)	0.98 (0.17)	NS
Baseline albumin (g/L)	38.9 (0.3)	39.3 (0.3)	36.1 (1.0)	36.8 (1.0)	< 0.05
Time av albumin (g/L)	37.6 (0.2)	38.2 (0.2)	33.8 (1.0)	35.6 (1.1)	< 0.002
Baseline haemoglobin (g/dL)	11.0 (0.1)	10.9 (0.1)	11.8 (0.3)	11.0 (0.5)	NS
Time av haemoglobin (g/dL)	11.2 (0.1)	11.2 (0.1)	11.7 (0.2)	10.7 (0.3)	NS

Values represent mean (SEM) or number (%) unless denoted by¹ (values shown are median, interquartile ranges). OH denotes the “overhydration” reading from the body composition monitor. GN: Glomerulonephritis; APKD: Adult polycystic kidney disease; TIN: Tubular-interstitial nephritis; OH: Overhydration.

Table 2 Baseline demographic of cohort that had overhydration > 2 L

Sub-group: Patients with severe OH
Number	66
Age1	60.1 (51.1-71.1)
Male (%)	44 (67%)
Diabetes mellitus (%)	27 (41%)
Assessed as suitable for transplantation (%)	26 (39%)
Dialysis vintage (mo)1	1.79 (0.5-32.1)
Body composition measurements:
Baseline OH (L)1	2.7 (2.3-3.7)
OH over 6 mo (L/6 mo)1	-0.7 (-0.3--1.5)
Baseline FTM (kg)1	23.6 (17.3-28.9)
FTM over 6 mo (kg)1	2.3 (0.1-3.7)3
Baseline LTM (kg)1	37.2 (29.6-44.6)
LTM over 6 mo (kg)1	-1.5 (-4.5-1.7)2
Number of readings	7.4 (0.4)
Cardiac troponin T measurements (ng/L)
Baseline cTnT1	60 (37-100)
Final cTnT1	71 (37-115)
Number of readings	3.4 (0.2)
Ethnicity: n (%)
Whites	26 (39%)
Blacks	14 (21%)
Asians	23 (35%)
Others	3 (5%)
Cause of renal failure: n (%)
Unknown	15 (23%)
GN	9 (14%)
Cancer/trauma	2 (3%)
Congenital/familial	2 (3%)
Diabetes	23 (35%)
Hypertension	6 (9%)
APKD	0 (0%)
TIN/chronic pyelonephritis	9 (14%)
Blood results
Baseline log (CRP) (mg/L)	0.67 (0.08)4
Time average log (CRP) over 6 mo (mg/L)	0.73 (0.08)4
Baseline albumin (g/L)	36.4 (0.6)4
Time average albumin over 6 mo (g/L)	36.0 (0.6)4
Baseline haemoglobin (g/dL)	10.5 (0.2)4
Time average haemoglobin over 6 mo (g/dL)	10.6 (0.2)4

Values represent mean (SEM) or number (%) unless denoted by¹ (values shown are median, interquartile ranges).

²P < 0.05 by Wilcoxon Signed Rank Test to determine if Median is ≠ 0;

³P < 0.0001 by Wilcoxon Signed Rank Test to determine if Median is ≠ 0;

⁴There were no significant correlation with OH by Pearson r correlation. OH denotes the “overhydration”, FTM denotes fat tissue mass and LTM denotes lean tissue mass from the body composition monitor. GN: Glomerulonephritis; APKD: Adult polycystic kidney disease; TIN: Tubular-interstitial nephritis; OH: Overhydration.