The Assessment Of The Volume Status And Relations Between It And Malnutrition-inflammation-atherosclerosis In Patients With Peritoneal Dialysis

Objective Through discussed the effectiveness of different Indicators assess thevolume status in Peritoneal dialysis patients,to find a suitable、 accurate、economical、non-invasion、can repeated method to evaluate the volume status ofperitoneal dialysis patients。For clinical practice provide the theory basis in assess thevolume status of peritoneal dialysis patients. Further understand the relation betweenvolume status and malnutrition–inflammation–atherosclerosis (MIA syndrome) toguide the clinical therapy;Methods A cross-sectional study was performed in CAPD patients treated in thedivision of nephrology, Peking University Third Hospital in June to August,2009.Usebody composition monitor (BCM) systems measure patients，body composition andOH (overhydration) as the marker of the volume status. Normalized extracellular water(nECW) was obtained by ROC(Receiver Operating Characteristic) curve to assess thevolume status in patients with peritoneal dialysis. The effectiveness of differentindicators to assess volume status in patients with peritoneal dialysis was evaluated bychi-square test analysis. And according to the patients’ blood pressure to calculatepulse pressure; We also collected data including fasting blood,24hours urine, toassess residual renal function and dialysis adequacy; albumin, creatinine, C-reactiveprotein and other biochemical indicators. Comparisons between groups andmultivariate analysis were used to explore the relation between volume status andmalnutrition–inflammation–atherosclerosis (MIA syndrome);Results1. There were139cases with peritoneal dialysis patients elected to thepresent study, including71male patients,68female patients, mean age was62.32±13.17years, mean height was161.70±8.57cm mean weight was60.84±11.74kg,mean systolic blood pressure was122.29±24.52mmHg, duration of PD27.92±12.9months, mean albumin and creatinine level were35.33±2.77g/L and797.58±238.15μ mol/L, respectively, Average left ventricular end-diastolic diameter (LVEDD) was47.51±7.97mm;2. By drawing ROC curve, ECW/h and ECW/w can be used as the marker ofvolume status.For the overall group, An ECW/height cut-off value of9.04L/m with asensitivity of73.9%and a specificity of68.6%.In males, An ECW/height cut-off valueof9.25L/m with a sensitivity of90.2%and a specificity of90.2%.,In female, AnECW/height cut-off value of8.24L/m with a sensitivity of78.4%and a specificity of48.4%;Similarly, For the overall group, An ECW/w cut-off value of0.2548L/kg witha sensitivity of60.2%and a specificity of74.5%.In males, An ECW/w cut-off value of0.2563L/kg with a sensitivity of82.4%and a specificity of60.0%.;In female, AnECW/w cut-off value of0.2215L/kg with a sensitivity of86.5%and a specificity of30%;3. ECW/h for diagnosis standard, In which patients with volume overload were81cases, while patients with normal volume status were58cases, the incidence ofvolume overload in peritoneal dialysis patients was58%; ECW/w for diagnosisstandard,66cases were volume overload, but73cases were normal volume status,the incidence of volume overload in peritoneal dialysis patients was47%; LVEDDfor diagnosis standard,28cases were volume overload, but111cases with normalvolume status, the incidence of volume overload in peritoneal dialysis patients was20%; E/I for diagnosis standard, for the overall group, mean value of E/I was0.98. Inmales, the mean value was0.96,but the mean value was1.01for female. Higher thanthe mean value defined as volume overload,66cases were volume overload, and73cases were normal volume status, the incidence of volume overload was47%; OHvalue for diagnostic criteria,89cases were volume overload,50cases were normalvolume status, the incidence of volume overload was64%; OH value for diagnosisstandard,89cases were volume overload, but for ECW/h67were volume overload,for LVEDD,19cases were volume overload, for ECW/w,60cases were volumeoverload; for E/I,54cases were volume overload;4. OH value for diagnostic criteria, evaluate the effectiveness of differentindicators to assess volume status in patients with peritoneal dialysis. ECW/h and OH,edema and OH, there were no statistically significant (P<0.05), respectively; butECW/w,E/I, LVEDD, systolic blood pressure (SBP) between with OH, These resultswere statistically significant (p <0.01);5. Using the parameters of BCM to explore the relation between volume status and malnutrition–inflammation–atherosclerosis (MIA syndrome).Plasma albumin andcreatinine as the marker of nutrition state; CRP as the marker of the inflammation;pulse pressure as the marker of the atherosclerosis;. Multivariate factor correlationanalysis. the results show: TBW, ECW, ICW, OH were negative with albumin levels;TBW, ECW, ICW were positive with serum creatinine; TBW, ECW, ICW, OH werepositive with CRP;OH were positive with PP, these results are significant (P <0.05);6. Multiple regression analysis further showed that: ECW (P <0.001)、is theindependent risk factors of plasma albumin; For C-reaction, the independent riskfactors is ECW (P=0.000)、OH(P=0.027); OH(P=0.008)is the independent riskfactors of PP. Alb(P<0.05),PP(P<0.05),CRP(P<0.01),ECW(P=0.000),ICW (P=0.000) are independently associated with OH.Conclusion1. Volume overload is common in PD patients, but assessment ofhydrationis not easy particularly if blood pressure is within normal limits. There isobviously a need for a practical method for routine clinical assessment of volumeoverload, For OH diagnosis standard, ECW/h, edema also can effectively evaluatevolume status in patients with peritoneal dialysis.2. We found a close relationship between volume measured by BCM and markersof poor nutrition, inflammation, atherosclerosis and volume overload in PD patients.volume overload is independent risk factors of MIA syndrome. In the clinical work，positive correct volume overload，treatment MIA syndrome，enhance the quality oflife.