Tan, BK and Yu, Z and Fang, W and Lin, A and Ni, Z and Qian, J and Woodrow, G and Jenkins, SB and Wilkie, ME and Davies, SJ (2016) Longitudinal bioimpedance vector plots add little value to fluid management of peritoneal dialysis patients. Kidney International, 89 (2). ISSN 1523-1755
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Bioimpedance (BI) has the potential to enable better management of fluid balance, which can worsen over time on peritoneal dialysis (PD) due to loss of residual kidney function and progressive muscle wasting. We undertook a prospective, randomized, open-label, blinded end-point controlled trial to determine whether availability of longitudinal BI measures as vector plots helped clinicians maintain stable fluid status over 12 months in 308 peritoneal dialysis patients from the United Kingdom and Shanghai, China. Patients were recruited into 4 groups nested within a single trial design according to country and residual kidney function. Nonanuric subjects from both countries demonstrated stable fluid volumes irrespective of randomization. Hydration worsened in control anuric patients in Shanghai with increased extracellular/total body water (ECW/TBW) ratio (0.04; 95% CI: 0.01, 0.06) and reduced TBW (-1.76 L 95% CI: -2.70, -0.82), but was stable in the BI intervention group whose dialysate glucose prescription was increased. However, multilevel analysis incorporating data from both countries showed worsening ECW/TBW in active and control anuric patients. Clinicians in the United Kingdom reduced target weight in the nonanuric BI intervention group causing a reduction in TBW without beneficial effects on ECW or blood pressure. Thus, routine use of longitudinal BI vector plots to improve clinical management of fluid status is not supported.Kidney International advance online publication, 14 October 2015; doi:10.1038/ki.2015.294.
|Uncontrolled Keywords:||diuretics, peritoneal dialysis, peritoneal membrane, ultrafiltration, water and volume homeostasis|
|Subjects:||R Medicine > R Medicine (General)|
|Divisions:||Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine|
|Date Deposited:||22 Jan 2016 09:50|
|Last Modified:||28 Apr 2016 14:30|
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