Aim In peritoneal dialysis (PD), fluid overload is frequent and associated with cardiac dysfunction and mortality. As it is considered a modifiable risk factor, we wished to describe clinical determinants of fluid overload in a longitudinal cohort of PD outpatients. Methods We consecutively included PD outpatients treated with continuous ambulatory PD (CAPD) or automated PD (APD) attending for their routine clinical visit at a single tertiary hospital. Extracellular water (ECW) to total body water (TBW) ratio was measured by multifrequency …

Purpose Tolvaptan exerts an aquaretic effect by blocking vasopressin V2 receptor. Although tolvaptan ameliorates body fluid retention even in patients with chronic kidney disease (CKD), predictors of body fluid reduction induced by tolvaptan remain unclear. We, therefore, examined the clinical parameters associated with the effect of tolvaptan on fluid volume in CKD patients. Methods Twelve CKD patients (stage 3–5) with fluid retention were treated with tolvaptan in addition to conventional diuretic treatment. Patients were divided into low …

Background: The ratio of bioimpedance in the right leg (rl-RBI) may be helpful in adjusting dry body weight (DBW) in new hemodialysis (HD) patients. Methods: rl-RBI was calculated as follows: rl-RBI= impedance at 50 kHz/impedance at 500 kHz, as measured by bioimpedance spectroscopy (BIS). Theoretically, rl-RBI is inversely related to extracellular water. A reference range of rl-RBI was obtained from 137 chronic but stable HD patients already achieving DBW. In 34 new HD patients (females: males= 16: 18; age 49±12 years) …

Background Hemodialysis patients are at increased risk for bone fracture and sarcopenia. There is close interplay between skeletal muscle and bone. However, it is still unclear whether lower skeletal muscle mass increases the risk for bone fracture. Study Design Cross-sectional study and prospective longitudinal cohort study. Setting & Participants An independent cohort of 78 hemodialysis patients in the cross-sectional study and 3,030 prevalent patients undergoing maintenance hemodialysis prospectively followed up for 4 …

Hyper-and hypophosphatemia are recognized risk factors for all-cause mortality in peritoneal dialysis (PD) patients. Recent changes have now focused PD solute clearance targets on urea clearance, rather than on larger solutes, including phosphate. We therefore studied peritoneal phosphate clearance in a cohort of PD patients to determine which factors were clinically relevant. We reviewed results from 451 adult PD patients who were attending for their first assessment of peritoneal membrane function [31.2% treated by continuous …

Objective To explore the correlation between body composition measurement by bioelectrical impedance analysis (BIA) and intradialytic hypotension (IDH). Methods The clinical data of 127 patients with end-stage renal disease (ESRD) who underwent regular dialysis in the Blood Purification Center of the Second Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. According to the occurrence of IDH, the patients were divided into IDH group and intradialytic normotension group. The difference in …

Arterial stiffness is an important risk factor for cardiovascular disease (CVD) in patients with end-stage renal failure. However, little is known about the factors that contribute to arterial rigidity in peritoneal dialysis (PD) patients. The aim of this study was to define the pattern and determinants of the longitudinal change in arterial stiffness after PD initiation. Arterial stiffening was estimated for 46 PD patients by using brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (cIMT). The cross-sectional relationship …

Results: Weight fell post dialysis from 72.9±17.8 to 70.9±19.9 kg, P< 0.001, soft lean mass from 48.2±12.1 to 45.4±11.0 kg and fat-free mass from 51.8±19.2 to 48.1±11.8 kg, P< 0.001, whereas percentage body fat (PBF) increased from 28.8±11.9 to 30.8±12.1% post dialysis, P< 0.001, with a mean increase post dialysis of 2.0%(95% confidence limits 1.55 to 2.45). There were correlations between the fall in total body water and extracellular water and skeletal muscle mass (r= 0.826, P< 0.001 and r= 0.711, P< 0.001, respectively), and …

Creatinine (Cr) levels are strongly affected by muscle mass, and the estimated glomerular filtration rate (eGFR), a measure based on serum creatinine (SCr), is often overestimated in patients with sarcopenia. To evaluate the coefficient of determination (R 2) between eGFR and the actual measured value, we performed a linear regression analysis of a modified GFR (mGFR: measured Cr clearance× 0.715) and various renal function estimates adjusted for muscle mass in 19 patients with sarcopenia. The eGFR values based on SCr (eGFRcr) …

Background and objectives: The peritoneal equilibration test (PET) was developed some 25 yr ago and has been used to help prescribe peritoneal dialysis. However, PET is affected by several factors, including diabetes and inflammation. It was speculated that extracellular fluid overload would increase PET ultrafiltration volumes, and therefore the usefulness of the PET in routine clinical practice was audited. Design, setting, participants, & measurements: Data from 211 consecutive patients attending a university teaching hospital for a standard …