Nephrol Dial Transplant (2001) 16: 2378-2385
© 2001 European Renal Association-European Dialysis and Transplant Association
Comparison of body fluid distribution between chronic haemodialysis and peritoneal dialysis patients as assessed by biophysical and biochemical methods
1 Department of Nephrology and Rheumatology, Heinrich-Heine-University Düsseldorf, 2 Dialysis Center, Düsseldorf and 3 Dialysis Center, Mettmann, Germany
Background. The control of extracellular volume is a key parameter for reducing hypertension and the incidence of cardiovascular mortality in dialysis patients. In recent years bioimpedance measurement (BIA) has been proven as a non-invasive and accurate method for measuring intracellular and extracellular fluid spaces in man. In addition, plasma atrial natriuretic peptide (ANP) and cyclic guanosine monophosphatase (cGMP) concentrations have been shown to reflect central venous filling. Using these methods, we compared body fluid status between stable patients on haemodialysis and peritoneal dialysis.
Methods. Thirty-nine chronic haemodialysis patients, 43 chronic peritoneal dialysis patients and 22 healthy controls were included in the study. Multifrequency BIA was performed using the Xitron BIS4000B device (frequencies from 5 to 500 kHz were scanned and fitted) in patients before and after haemodialysis. Peritoneal dialysis patients were measured after drainage of the dialysate. Plasma ANP and cGMP levels were measured in plasma using a 125I solid phase RIA. Serum albumin concentrations and serum osmolality were measured in all patients. The body fluid data were analysed in relation with the clinical findings.
Results. Total body water (TBW) was 0.471±0.066 l/kg before haemodialysis and 0.466±0.054 l/kg after haemodialysis. Peritoneal dialysis patients had a TBW (0.498±0.063 l/kg) that was greater than the before and after dialysis values of haemodialysis patients. The extracellular body fluid (Vecf) was increased pre-haemodialysis. It was even greater in peritoneal dialysis patients compared with patients both pre- and post-haemodialysis (pre 0.276±0.037 l/kg; post 0.254±0.034 l/kg; peritoneal dialysis 0.293±0.042 l/kg, P<0.05). However, plasma ANP concentrations (representing intravascular filling) in peritoneal dialysis patients were comparable with post-haemodialysis values (284±191 pg/ml vs 286±144 pg/ml). The correlation coefficient between sysRR and Vecf was r=0.257 in haemodialysis (P=0.057) and r=0.258 in peritoneal dialysis (P<0.05). A significant negative correlation was found between serum albumin and Vecf/TBW in peritoneal dialysis patients (r=-0.624).
Conclusion. Body fluid analysis by BIA demonstrated that TBW and Vecf were increased in peritoneal dialysis patients, and were comparable or even greater than values found before haemodialysis. However, plasma ANP levels indicated that intravascular filling was not increased in peritoneal dialysis. The ratio of Vecf to TBW was correlated to systolic pressure and negatively to serum albumin in peritoneal dialysis patients.
Keywords: ANP; bioimpedance analysis; body fluid; body water; cGMP; extracellular water; haemodialysis; hypertension; intravascular filling; peritoneal dialysis; serum albumin; total body water
Correspondence and offprint requests to: Prof. Dr Jörg Plum, Heinrich-Heine-University, Department of Nephrology and Rheumatology, MNR, Moorenstr. 5, D-40225 Düsseldorf, Germany. Email: plum{at}uni\|[hyphen]\|duesseldorf.de
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