SP503INTERNATIONAL Variation in Peritoneal Dialysis (PD) Catheter Practices: Preliminary Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (Pdopps) (original) (raw)

2017, Nephrology Dialysis Transplantation

Whole-body bioimpedance spectroscopy using the body composition monitor (BCM) is a well-established tool to evaluate the fluid and nutritional status of patients undergoing peritoneal dialysis (PD). Patients with liver cirrhosis and ascites may resemble PD-patients with a full peritoneal cavity. Here we aimed at determining changes in BCM-derived measurements after ascites puncture, and at correlating clinical signs of fluid overload with the BCM result. METHODS: Per our pre-specified sample size calculation (primary endpoint: extracellular volume [ECV]; null hypothesis: ECV change >1L), we performed BCMmeasurements in 32 patients before and after ascites puncture (local Ethics Committee approval: EK#2096/2016). We also recorded demographics, laboratory values and clinical examination parameters. Statistical methods included basic descriptives, 2-sided, paired Student's t-test and Pearson correlation analysis. RESULTS: Twenty-three of 32 patients had Child-Pugh score >A, 26 patients were males, the mean age of the cohort was 58.5611.1 years, mean volume of the ascites puncture was 7.762.6 L, mean duration of the procedure was 123642 minutes. BCM-derived measurements are in the Table: ECV, total body volume and fat mass changed significantly after the puncture. In 11 patients, we did not observe a meaningful correlation between the clinical assessment of the fluid status and the BCM read-out (fluid overload >1L). The correlation of the BCM-derived measurements before and after ascites puncture is shown in the Figure, and was close to one for ECV (R 2 =0.97), but absent for lean tissue mass. CONCLUSIONS: BCM-derived fluid volume measurements changed significantly from before to after the ascites puncture, but these changes did not reflect the ascites volume removal. Our results imply that the filling of the peritoneal cavity is not detected by bioimpedance, as indicated by the manufacturer of the BCM-device. The observed differences in BCM-measured lean tissue mass and fat mass were striking; apparently, the 'missing weight' from the ascites is attributed to the fat compartment in the underlying BCM model. In accordance with previous studies from PD-patients, our analysis suggests that the volume of the PD-fluid should be subtracted from a patient's body weight when the BCM-measurement is performed with a full peritoneal cavity.