Clinical significance of normohydration state in peritoneal dialysis patients

Abstract

Introduction: Assessing the fluid status of dialysis patients is crucial, as overhydration can lead to hypertension and left ventricular hypertrophy. Objectives: We aimed to determine the hydration of peritoneal dialysis (PD) patients by using a bioimpedance device and performing concomitant echocardiographic measurements. Patients and Methods: In our cohort, we enrolled PD patients in the study group and kidney transplantation waitlisted patients on hemodialysis (HD) or with stage 4-5 chronic kidney disease (CKD) in the control group. Fluid status was measured with a Fresenius Body Composition Monitor (BCM), and we performed an echocardiography examination. For statistical analysis, we used the Fisher’s exact test for categorical variables and the Kruskal-Wallis test for continuous variables to compare groups. Results: The patients’ average age was 47 (SD 9.45), with a mild female predominance (54.3%). Overhydration was only found in 8 (12%) patients and was related to non-significantly lower ejection fraction (EF). Follow-up found that preserved EF was a non-significantly better outcome (HR: 0.881, 95% CI interval: 0.776; 1.001, P=0.0514). PD patients had significantly lower potassium levels (P=0.0006) and more angiotensin-converting-enzyme inhibitors (ACEis) (46%) and mineralocorticoid receptor antagonists (MRAs) (26%). Conclusion: Lower potassium levels in continuous ambulatory peritoneal dialysis (CAPD) patients allow for the administration of drugs to treat cardiac remodeling and volume overload, which can help reduce patient mortality. The possible usage of MRAs in CKD could reduce cardiovascular mortality effectively.