Longitudinal bioimpedance vector plots add little value to fluid management of peritoneal dialysis patients

Tan, Boon K.; Yu, Zanzhe; Fang, Wei; Lin, Aiwu; Ni, Zhaohui; Qian, Jiaqi; Woodrow, Graham; Jenkins, Sarah B.; Wilkie, Martin E.; Davies, Simon J.

Abstract

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.

Citation

Tan, B. K., Yu, Z., Fang, W., Lin, A., Ni, Z., Qian, J., Woodrow, G., Jenkins, S. B., Wilkie, M. E., & Davies, S. J. (2016). Longitudinal bioimpedance vector plots add little value to fluid management of peritoneal dialysis patients. Kidney International, 89(2), https://doi.org/10.1038/ki.2015.294

• Journal Article Type: Article
• Acceptance Date: Aug 13, 2015
• Online Publication Date: Jan 22, 2016
• Publication Date: Jan 22, 2016
• Journal: Kidney International
• Print ISSN: 0085-2538
• Electronic ISSN: 1523-1755
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 89
• Issue: 2
• DOI: https://doi.org/10.1038/ki.2015.294
• Keywords: diuretics, peritoneal dialysis, peritoneal membrane, ultrafiltration,water and volume homeostasis
• Public URL: https://keele-repository.worktribe.com/output/405454
• Publisher URL: http://dx.doi.org/10.1038/ki.2015.294