The Overhydrated Status of Patients Undergoing Peritoneal Dialysis Is Associated With Malnutrition Inflammation Syndrome

Ling-Pao Cheng ； Chia-Liang Wang ； Shou-Chieh Wang ； Mei-Chun Lu ； Chia-Chu Chang

《Acta Nephrologica》 34卷4期 (2020/12) Pp. 165-170

https://doi.org/10.6221/AN.202012_34(4).0003

摘要

BACKGROUND: Chronic fluid overload (FO) is frequently present in peritoneal dialysis (PD) patients and is associated with hypertension and cardiovascular disease. So to assess the body fluid status of PD patients, we use a new detection device, the Body Composition Monitor (BCM) which is a non-invasive investigation to assess the volume status. METHODS: The aim of this study is to determine the causes of overhydrated patients undergoing PD. We currently use this BCM as a routine test in patients after PD once every year. We used this BCM method in PD patients in July 2014. There were 78 patients enrolled in this study. This study was a retrospective cross-sectional study. We used BCM data and divided it into two groups, the first group was the overhydrated group (32 patients) and the second group was the normal volume status group (46 patients). Further analysis of overhydration (OH) risk factors included age, gender, residual renal function, urea clearance, ultrafiltration, albumin, diabetes mellitus, calcium and phosphate product, use of icodextrin, leukocyte count (white blood cell [WBC]), hemoglobin, serum glutamate pyruvate transaminase, serum creatinine level, blood sugar (AC), cholesterol, low density lipoporotein, and triglyceride. We examined significant effect factors of OH from 17 variables using multiple logistic regression analysis. RESULTS: The results found out that age (54.6 ± 15.7 vs. 63.6 ± 11.9), albumin (3.6 ± 0.5 vs. 3.8 ± 0.4), WBC, serum creatinine level in both groups were significant risk factors for OH (P ＜ 0.05). The multiple logistic regression analysis showed that the significant predictors for OH patients were age, WBC, serum creatinine in model 1, and blood albumin level was a significant predictor for OH in model 2. An increase in age and creatinine decrease the OH in PD patients. Leukocytosis was more likely to be observed in overhydrated patients and so there was more inflammation status in overhydrated patients compared with euvolemic patients. Furthermore, low serum albumin level was observed in overhydrated patients (P ＜ 0.05) in model 2 after eliminating the serum creatinine level. So hypoalbuminemia causes OH in PD. Overhydrated patients had more edema and the edema factor was a statistically significant association (P ＜ 0.05) compared with euvolemic patients. Malnutrition and inflammation are risk factors for morbidity and mortality in the PD population. CONCLUSION: The overhydrated patients undergoing PD have hypoalbuminemia and leukocytosis. That means malnutrition and inflammation play a role in FO in patients undergoing PD. Low albumin level was observed in overhydrated patients and so overhydrated patients had malnutrition. We concluded that overhydrated patients undergoing PD have malnutrition and inflammation in status compared with euvolemic patients.

關鍵字

body composition monitor ； inflammation ； malnutrition ； overhydration ； peritoneal dialysis