Changes in body composition parameters in patients on haemodialysis and peritoneal dialysis
Cambios en los parámetros de composición corporal en pacientes en hemodiálisis y diálisis peritoneal
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"apellidos" => "Herrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 12 => array:3 [ "nombre" => "Ana" "apellidos" => "Vigil" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Nefrologia, Hospital Severo Ochoa, Leganés, Madrid, Spain, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Severo Ochoa, Leganés, Madrid, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cambios en los parámetros de composición corporal en pacientes en hemodiálisis y diálisis peritoneal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10938_16025_25393_en_t110938.jpg" "Alto" => 1663 "Ancho" => 2158 "Tamanyo" => 1120501 ] ] "descripcion" => array:1 [ "en" => "Clinical, biochemical, and bioelectrical impedance parameters from the initial analysis" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">Achieving a normal hydration state is one of the primary objectives in haemodialysis (HD) and peritoneal dialysis (PD) treatments. The concept of dry weight is essential to integrated dialysis therapy.<span class="elsevierStyleSup">1</span> The abnormal state of overhydration has been related to arterial hypertension, signs and symptoms of pulmonary and peripheral oedema, heart failure, left ventricular hypertrophy, and other adverse cardiovascular effects.<span class="elsevierStyleSup">2</span> The increase in left ventricular mass is correlated with worse cardiovascular evolution in PD patients,<span class="elsevierStyleSup">3</span> and it has also been described that hydration state is an important independent predictor for mortality in chronic HD patients.<span class="elsevierStyleSup">4</span> It appears essential that dialysis providers have a good strategy for maintaining the euvolemic state of their patients. However, the evaluation of normovolemia is difficult, since there is no method that has been established for use in daily clinical practice. The clinical evaluation of dry weight is the most commonly used method, but this leads to frequent conditions of sub-clinical over-hydration and sub-hydration, which can cause increased morbidity rates.<span class="elsevierStyleSup">5 </span>Among the various tests that can be used to measure dry weight, chest x-ray aids in the clinical management of patients, but does not comply with the aims of being rapid and non-invasive; the diameter of the inferior vena cava and its respiratory variations are good measures of preload,<span class="elsevierStyleSup">6</span> but they are also influenced by cardiovascular factors such as diastolic dysfunction, pulmonary hypertension, and chronic obstructive pulmonary disease.<span class="elsevierStyleSup">7</span> Biochemical markers such as ANP (atrial natriuretic peptide) have a prognostic value and may indirectly reflect overhydration due to its effect on left ventricular mass,<span class="elsevierStyleSup">5</span> but these levels appear to depend more on the primary situation of the ventricle. It is difficult to establish the proper concentration in dialysis patients, and values frequently remain elevated in patients considered to be properly hydrated.<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">The standard methods for measuring body water such as deuterium and sodium bromide for extracellular water are laborious and are not commonly used in clinical practice.<span class="elsevierStyleSup">9</span></p><p class="elsevierStylePara">The new bioelectrical impedance analysis techniques are being used for the evaluation and follow-up of hydration state. In a study evaluating the detection limits for different methods used for determining hydration states in dialysis patients, bioimpedance spectroscopy has demonstrated high sensitivity, emerging as the most promising method for a practical treatment of dialysis patients.<span class="elsevierStyleSup">7</span> This technique uses the variation in the electrical frequency applied and distinguishes between extracellular water and total body water. The variation in frequency applying currents that range between 5kHz and 1000kHz facilitates the determination of extracellular water (ECW) and total body water (TBW); intracellular water (ICW) is extrapolated by analysing at different frequencies.<span class="elsevierStyleSup">8,10</span></p><p class="elsevierStylePara">It has been well established that the changes produced over time in body weight among peritoneal dialysis patients are due to changes both in body water content and lean tissue/fat mass. Multifrequency bioelectrical impedance analysis offers the possibility of evaluating body composition and hydration state.<span class="elsevierStyleSup">11</span></p><p class="elsevierStylePara">The body composition monitor (BCM, Fresenius Medical Care) has been validated for use in clinical practice to determine hydration state.<span class="elsevierStyleSup">10</span> As measured by BCM, a relative overhydration greater than 15% has been shown to be associated with increased cardiovascular mortality in haemodialysis patients.<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">Recently, overhydration has also been correlated with inflammation, malnutrition, and atherosclerosis in PD patients.<span class="elsevierStyleSup">12</span></p><p class="elsevierStylePara">The objective of our study is to compare the body composition of prevalent HD and PD patients in a cross-sectional analysis, and to evaluate the changes in these values by performing two studies 6 months apart in both techniques, HD and PD, in a dialysis unit with special attention to maintaining dry weight.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">METHODS</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patients</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">We performed a cross-sectional study of prevalent patients on HD (n=62) and PD (n=19) monitored at the same centre for a period that included two measurements of bioelectrical impedance with an interval of 6 months. The number of patients at the start of the study was 65 on HD and 19 on PD. After 6 months, there were 49 on HD and 14 on PD. All patients were older than 18 years. We excluded those patients with contraindications for bioelectrical impedance: an implanted electronic device, any type of metallic implants, amputation, pregnancy, and lactating women. All patients signed an informed consent that was approved by the ethics committee.</p><p class="elsevierStylePara">Of the 62 patients on HD, 21 used online haemodiafiltration and 41 were on conventional HD. Of the 19 patients on PD, 10 were on automated PD (APD) and 9 were on continuous ambulatory PD (CAPD); icodextrin was administered in 49% of patients on both techniques, and 23 patients (27%) were diabetic.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Measurements</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">In the initial cross-sectional study, we compared the following clinical parameters for the two techniques: age, sex, Charlson comorbidity index,<span class="elsevierStyleSup">13</span> time on dialysis, weight, body mass index (BMI), and systolic and diastolic blood pressure (BP).</p><p class="elsevierStylePara">Laboratory analyses: we measured C-reactive protein (CRP) using immunoturbidimetry, and creatinine, total protein, albumin, transferrin, and haemoglobin were measured using certified methods in the biochemistry department of the Severo Ochoa Hospital. The erythropoietin resistance index<span class="elsevierStyleBold"> </span>was defined as the weekly doses of erythropoietin (U/kg predialysis/dose) divided by haemoglobin (Hb) g/dl.</p><p class="elsevierStylePara">We performed the predialysis bioelectrical impedance analysis immediately before the second session of the week, and in PD patients, coinciding with the peritoneal equilibration test and with the peritoneum full. We used a body mass composition analysis device using bioimpedance spectroscopy (BCM, Fresenius Medical Care). The parameters for bioelectrical impedance were: TBW in litres (l), ECW in l, ICW in l, ECW/ICW, lean tissue mass (LTM) in kg, LTM% in percentage, lean tissue mass index in kg/m<span class="elsevierStyleSup">2</span>, total fat (FAT) in kg, FAT% in percentage, phase angle (Phi 50), total cellular mass (TCM) in kg, and overhydration (OH) in l. The state of OH was calculated by standardising OH to ECW and considering OH to be present if >15%.<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">The clinical, biochemical, and bioelectrical impedance values were analysed after six months for both dialysis techniques.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical Analysis</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">We performed all statistical analyses using SPSS statistical software version 12 (Chicago, Illinois, SL, USA). Normally distributed variables were expressed as a mean and standard deviation, and non-normal variables as a median and range (maximum and minimum). We compared the means between groups using Student’s t-tests or Mann-Whitney U-tests and/or chi-square tests according to the nature of the variable. Categorical variables were expressed as number and percentage. We set the value of statistical significance at <span class="elsevierStyleItalic">P</span><.05. For the univariate analysis, we used Pearson’s or Spearman’s correlation coefficients, according to the nature of the variable. The multivariate analysis involved linear correlation, considering the increase in weight as the dependent variable, and individually introducing variables that were statistically significant in the univariate analysis.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">We analysed the data from a total of 65 patients on HD and 19 on PD. The demographic, clinical, biochemical, and bioelectrical impedance values from the initial analysis are summarised in Table 1. The patients on PD were younger (50±10 years vs 57±14 years, <span class="elsevierStyleItalic">P</span>=<span class="elsevierStyleItalic">.</span>031), with a lower Charlson comorbidity index (4,8±3 vs 7,5±3, <span class="elsevierStyleItalic">P</span><<span class="elsevierStyleItalic">.</span>001), less time on dialysis (16.9±18.01 months vs 51.88±68.79 months, <span class="elsevierStyleItalic">P</span>=<span class="elsevierStyleItalic">.</span>020), lower CRP [3 (3-9.3) vs 5.25 (1-76.4)] and had higher values of total protein (TP) (7.46±0.44g/dl vs 7.04±0.55g/dl, <span class="elsevierStyleItalic">P</span>=<span class="elsevierStyleItalic">.</span>005) and transferrin (205±41mg/dl vs 185±29mg/dl, <span class="elsevierStyleItalic">P</span>=<span class="elsevierStyleItalic">.</span>024) than HD patients. Patients on PD had a residual renal function (RRF) of 5.33±3.89ml/min, diuresis at 1115±758ml/day, and ultrafiltration at 887±445ml/day. The ultrafiltration volume per session of HD patients on the day of bioelectrical impedance analysis was 2372±921ml.</p><p class="elsevierStylePara">As regards the bioelectrical impedance analysis parameters, PD patients had values of ICW (19.67±3.61 vs 16.51±3.36 litres, <span class="elsevierStyleItalic">P</span>=<span class="elsevierStyleItalic">.</span>010), LTM (37.20±8.65kg vs 32.57±8.72kg, <span class="elsevierStyleItalic">P</span>=<span class="elsevierStyleItalic">.</span>029), TCM (20.53±5.65kg vs 17.56±5.91kg, <span class="elsevierStyleItalic">P</span>=<span class="elsevierStyleItalic">.</span>033) and phase angle (5.81±0.86 vs 4.74±0.98, <span class="elsevierStyleItalic">P</span>=<span class="elsevierStyleItalic">.</span>000) greater than HD patients. Under the conditions the study was being carried out in, a total of 14 HD patients and 2 PD patients were overhydrated (22% and 10%, respectively).</p><p class="elsevierStylePara">Diabetic patients had a higher mean systolic BP (<span class="elsevierStyleItalic">P</span>=.012) and lower phase angle (<span class="elsevierStyleItalic">P</span>=.008), with no difference in the rest of the parameters used to measure body composition.</p><p class="elsevierStylePara">In patients on PD after 6 months (table 2), we observed a significant increase in weight (73.75±12.27kg vs 75.22±11.87kg, <span class="elsevierStyleItalic">P</span>=<span class="elsevierStyleItalic">.</span>027), with an increase in total fat (26.88±10kg vs 30.02±10kg, <span class="elsevierStyleItalic">P</span>=<span class="elsevierStyleItalic">.</span>011) and relative fat (35.75±9.87% vs 39.34±9.12%, <span class="elsevierStyleItalic">P</span>=<span class="elsevierStyleItalic">.</span>010), and decreased ICW (18.56±3.45l vs 17.65±3.69l, <span class="elsevierStyleItalic">P</span>=<span class="elsevierStyleItalic">.</span>009), total LTM (36.95±8.88kg vs 34±9.70kg, <span class="elsevierStyleItalic">P</span>=<span class="elsevierStyleItalic">.</span>008) and relative LTM (50.85±12.33% vs 45.40±11.95%, <span class="elsevierStyleItalic">P</span>=<span class="elsevierStyleItalic">.</span>012). There was a global correlation between the variation (¿) in weight and ¿ in fat, but not with ¿ in extracellular weight. In the multivariate analysis, the ¿ in weight was correlated with ¿ in fat (<span class="elsevierStyleItalic">P</span><.001). There was also a correlation between the increase in fat and a decrease in LTM (<span class="elsevierStyleItalic">P</span>=.01). In the multivariate analysis that held the decrease in LTM as the dependent variable and a progressive introduction of age, sex, dialysis technique, and BMI, only age had an influence on the decrease in LTM (<span class="elsevierStyleItalic">P</span>=.012).</p><p class="elsevierStylePara">Upon analysing the data according to the technique of PD used, we observed a tendency towards lower increase in fat when on APD (1.58±3.05 vs 3.5±3.05), despite a higher glucose load (206±58 vs 62.98±75.5, <span class="elsevierStyleItalic">P</span>=.006).</p><p class="elsevierStylePara">In patients on HD, only ECW was significantly reduced (<span class="elsevierStyleItalic">P</span>=.001); all other parameters measured using bioelectrical impedance did not vary in the measurements taken over the 6-month interval (Table 3).</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">This study demonstrates the differences in body composition between patients on HD and those on PD. In the initial study, the differences in the nutritional parameters evaluated (TP, transferrin) and bioelectrical impedance (ICW, LTM, TCM, and phase angle) can be attributed to the younger age, less time on dialysis, and better nutritional state in the group on PD. Despite this, a significant weight gain is evident over the six-month observation period among patients on PD, which is not produced in patients on HD. The weight gain is primarily in the form of fat mass. These data could indicate on the one hand that the glucose input from PD could be responsible for the fat increase in these patients, and that it is more difficult to control extracellular volume in PD than in HD, as a consequence of the progressive reduction in RRF.</p><p class="elsevierStylePara">Patients on HD experienced a decrease in ECW with no variations in the other parameters measured over the six-month period.</p><p class="elsevierStylePara">LTM decreases in patients on PD, probably secondary to the more sedentary lifestyle associated to dialysis, which could contribute to the increase in fat content in PD patients, and also probably indicates the need for a physical exercise regimen. We were surprised that the decrease in LTM was not significant in HD patients, which we believe could be due to the short time span between the two measurements. We will continue with more prolonged follow-up times.</p><p class="elsevierStylePara">In our study, 22% of the HD patients and 10% of the PD patients were overhydrated, according to the criteria established by other publications.<span class="elsevierStyleSup">4</span> We did not perform post-dialysis bioelectrical impedance analysis, since it requires at least 30 minutes to carry out the procedure and the patients would not consent. Even so, in the case of HD, we evaluated the level of overhydration in the patients’ maximum state of overhydration (pre-HD), and we doubt that the two situations would be comparable.</p><p class="elsevierStylePara">When pre and post-HD measurements were available, and overhydration was calculated over the mean at centres that took similar care to reach dry weight in each dialysis session, 10% of patients were overhydrated,<span class="elsevierStyleSup">11</span> similar to our patients on PD.</p><p class="elsevierStylePara">Our results indicate that our patients on PD gain weight above all due to fat increase. Additionally, a slight increase in ECW, probably due to a slight decrease in diuresis, contributes to the weight gain observed, although these changes were not statistically significant.</p><p class="elsevierStylePara">In our patients on PD, the prevalence of overhydration (10%) was lower than reported from other centres.<span class="elsevierStyleSup">15,16</span></p><p class="elsevierStylePara">As has been shown, BP control is harder on automated PD than CAPD due to a worse negative sodium balance on APD resulting from a sodium sieving coefficient in the peritoneal membrane.<span class="elsevierStyleSup">17,18</span> The use of icodextrin can favour improved control of the volume situation and reduce left ventricular mass.<span class="elsevierStyleSup">19</span> In our experience,<span class="elsevierStyleSup">20</span> there is no difference in controlling BP or residual renal function between the two types of PD, probably due to the insistence in restricting salt from the diet and ample use of icodextrin.</p><p class="elsevierStylePara">The tendency in our patients on APD was for a lower increase in fat, despite a greater glucose load than in CAPD, perhaps due to the reduced time the glucose spends in the peritoneal cavity and thus lower total absorption.</p><p class="elsevierStylePara">The high prevalence of arterial hypertension and volume overload in HD centres and the difficulty for establishing dry weight in dialysis patients<span class="elsevierStyleSup">21</span> situates bioelectrical impedance as another tool for evaluating the changes suffered in body composition that can orient the physician to establish dry weight in HD patients and to introduce changes in the liquids provided to PD patients.</p><p class="elsevierStylePara"><a href="grande/10938_16025_25393_en_t110938.jpg" class="elsevierStyleCrossRefs"><img src="10938_16025_25393_en_t110938.jpg" alt="Clinical, biochemical, and bioelectrical impedance parameters from the initial analysis "></img></a></p><p class="elsevierStylePara">Table 1. Clinical, biochemical, and bioelectrical impedance parameters from the initial analysis </p><p class="elsevierStylePara"><a href="grande/10938_16025_25394_en_t210938.jpg" class="elsevierStyleCrossRefs"><img src="10938_16025_25394_en_t210938.jpg" alt="Evolution after 6 months in the 14 patients on peritoneal dialysis"></img></a></p><p class="elsevierStylePara">Table 2. Evolution after 6 months in the 14 patients on peritoneal dialysis</p><p class="elsevierStylePara"><a href="grande/10938_16025_25395_en_t310938.jpg" class="elsevierStyleCrossRefs"><img src="10938_16025_25395_en_t310938.jpg" alt="Evolution after 6 months in the 49 patients on haemodialysis"></img></a></p><p class="elsevierStylePara">Table 3. Evolution after 6 months in the 49 patients on haemodialysis</p>" "pdfFichero" => "P1-E532-S3378-A10938-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439209" "palabras" => array:1 [ 0 => "Hemodiálisis" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439211" "palabras" => array:1 [ 0 => "Sobrehidratación" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439213" "palabras" => array:1 [ 0 => "Composición corporal" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439215" "palabras" => array:1 [ 0 => "Bioimpedancia por espectroscopia" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439217" "palabras" => array:1 [ 0 => "Diálisis peritoneal" ] ] ] "en" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439210" "palabras" => array:1 [ 0 => "Haemodialysis" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439212" "palabras" => array:1 [ 0 => "Overhydration" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439214" "palabras" => array:1 [ 0 => "Body composition" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439216" "palabras" => array:1 [ 0 => "Bioimpedance spectroscopy" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439218" "palabras" => array:1 [ 0 => "Peritoneal dialysis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducción:</span> La normohidratación es uno de los mayores objetivos en hemodiálisis (HD) y diálisis peritoneal (DP). La bioimpedancia por espectroscopia (BIS) se postula como el método más prometedor para la evaluación y seguimiento del estado de hidratación en pacientes en diálisis. <span class="elsevierStyleBold">Objetivo:</span> Comparar la composición corporal de pacientes prevalentes en HD y DP en un intervalo de seis meses. <span class="elsevierStyleBold">Pacientes y métodos:</span> Estudio observacional de 62 pacientes en HD y 19 en DP comparando los parámetros clínicos, bioquímicos y de bioimpedancia. <span class="elsevierStyleBold">Resultados:</span> En el estudio comparativo, los pacientes en DP fueron más jóvenes (50 ± 10 vs. 57 ± 14 años, p = 0,031). El índice de comorbilidad de Charlson (4,8 ± 3 vs. 7,5 ± 3, p < 0,001), tiempo en diálisis (16,9 ± 18,01 vs. 51,88 ± 68,79 meses, p = 0,020) y proteína C reactiva [3 (3-9,3) vs. 5,25 (1-76,4)] fueron menores. Los niveles de proteínas totales (7,46 ± 0,44 vs. 7,04 ± 0,55 g/dl, p = 0,005), y transferrina (205 ± 41 vs. 185 ± 29 mg/dl, p = 0,024) fueron más elevados. BIS: agua intracelular (AIC) (19,67 ± 3,61 vs. 16,51 ± 3,36 litros, p = 0,010), masa muscular total (MM) (37,20 ± 8,65 vs. 32,57 ± 8,72 kg, p = 0,029), masa celular total (MCT) (20,53 ± 5,65 vs. 17,56 ± 5,91 kg, p = 0,033) y ángulo de fase (Phi 50) (5,81 ± 0,86 vs. 4,74 ± 0,98, p = 0,000) fueron más elevados que en HD. Sobrehidratados 22% en HD y 10% en DP, en las condiciones referidas en métodos. A los seis meses en DP observamos aumento de peso (73,75 ± 12,27 vs. 75,22 ± 11,87 kg, p = 0,027), grasa total (MG) (26,88 ± 10 vs. 30,02 ± 10 kg, p = 0,011) y relativa (MG %) (35,75 ± 9,87 vs. 39,34 ± 9,12, p = 0,010); disminución de AIC (18,56 ± 3,45 vs. 17,65 ± 3,69 l, p = 0,009), MM (36,95 ± 8,88 vs. 34 ± 9,70 kg, p = 0,008) y MM relativa (MM %) (50,85 ± 12,33 vs. 45,40 ± 11,95%, p = 0,012). En el análisis multivariante, la variación (¿) de peso guarda relación con el ¿ de grasa (p < 0,001). Encontramos correlación entre el incremento de grasa y el decremento de masa muscular (p = 0,01). A los seis meses en HD no se observaron cambios en estos parámetros, salvo una reducción en el agua extracelular (15,11± 2,45 vs. 14,00 ± 2,45, p = 0,001). <span class="elsevierStyleBold">Conclusiones:</span> BIS permite valorar los cambios en la composición corporal y ayuda a establecer el peso seco e introducir cambios en las pautas de tratamiento.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction:</span> Proper hydration is one of the major aims in haemodialysis (HD) and peritoneal dialysis (PD). Bioimpedance spectroscopy appears to be a promising method for the evaluation and follow up of the hydration status in dialysis patients (P). <span class="elsevierStyleBold">Objectives:</span> We compared body composition between stable patients on HD and PD after six months. <span class="elsevierStyleBold">Patients and method:</span> An observational study with 62 P on HD and 19 P on PD was performed. Clinical, biochemical and bioimpedance parameters were analysed. <span class="elsevierStyleBold">Results:</span> In the comparative study, PD P were younger (50±10 vs 57±14 years, <span class="elsevierStyleItalic">P=</span>.031). The Charlson Comorbidity Index (4.8±3 vs 7.5±3, <span class="elsevierStyleItalic">P<.</span>001), time on dialysis (16.9±18.01 vs 51.88±68.79 months, <span class="elsevierStyleItalic">P=</span>.020) and C-Reactive Protein [3 (3-9.3) vs 5.25 (1-76.4)] were lower. Total protein levels (7.46±0.44 vs 7.04±0.55 g/dl, <span class="elsevierStyleItalic">P=</span>.005) and transferrin levels (205±41 vs 185±29 mg/dl, <span class="elsevierStyleItalic">P=</span>.024) were higher. BIS: Intracellular water (19.67±3.61 vs 16.51±3.36 litres, <span class="elsevierStyleItalic">P=</span>.010), lean tissue mass (LTM) (37.20±8.65 vs 32.57±8.72 kg, <span class="elsevierStyleItalic">P=</span>.029), total cellular mass (TCM) (20.53±5.65 vs 17.56±5.91 kg, <span class="elsevierStyleItalic">P=</span>.033), and bioelectrical impedance phase angle (Phi 50) (5.81±0.86 vs 4.74±0.98, <span class="elsevierStyleItalic">P=</span>.000) were higher than in HD P. Overhydration: 22% in HD y 10% in PD, in conditions referred to in methods. Six months later, PD P increased in weight (73.75±12.27 vs 75.22±11.87 kg, <span class="elsevierStyleItalic">P=</span>.027), total fat (FAT) (26.88±10 vs 30.02±10 kg, <span class="elsevierStyleItalic">P=</span>.011) and relative fat (Rel FAT) (35.75±9.87 vs 39.34±9.12, <span class="elsevierStyleItalic">P=</span>.010); and decreased in ICW (18.56±3.45 vs 17.65±3.69 l, <span class="elsevierStyleItalic">P=.</span>009), LTM (36.95±8.88 vs 34±9.70 kg, <span class="elsevierStyleItalic">P=</span>.008) and relative LTM (Rel LTM) (50.85±12.33 vs 45.40±11.95%, <span class="elsevierStyleItalic">P=</span>.012). In the multivariate analysis, weight variation (¿) was related to ¿ FAT (<span class="elsevierStyleItalic">P</span><.001). We found a correlation between fat increase and lean tissue mass decrease. Six months later, in HD P, we observed a reduction in ECW (15.11±2.45 vs 14.00±2.45, <span class="elsevierStyleItalic">P</span>.001), without changes in other parameters. <span class="elsevierStyleBold">Conclusions:</span> Bioelectrical impedance analysis facilitates the assessment of changes in body composition so as to correct dry weight and to introduce changes in treatment schedule.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10938_16025_25393_en_t110938.jpg" "Alto" => 1663 "Ancho" => 2158 "Tamanyo" => 1120501 ] ] "descripcion" => array:1 [ "en" => "Clinical, biochemical, and bioelectrical impedance parameters from the initial analysis" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10938_16025_25394_en_t210938.jpg" "Alto" => 771 "Ancho" => 2163 "Tamanyo" => 529445 ] ] "descripcion" => array:1 [ "en" => "Evolution after 6 months in the 14 patients on peritoneal dialysis" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10938_16025_25395_en_t310938.jpg" "Alto" => 508 "Ancho" => 2141 "Tamanyo" => 394222 ] ] "descripcion" => array:1 [ "en" => "Evolution after 6 months in the 49 patients on haemodialysis" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Charra B. ¿Dry weight¿ in dialysis: the history of a concept. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 9 | 13 |
| 2024 October | 40 | 61 | 101 |
| 2024 September | 56 | 71 | 127 |
| 2024 August | 116 | 103 | 219 |
| 2024 July | 43 | 35 | 78 |
| 2024 June | 88 | 57 | 145 |
| 2024 May | 74 | 52 | 126 |
| 2024 April | 73 | 60 | 133 |
| 2024 March | 52 | 36 | 88 |
| 2024 February | 46 | 45 | 91 |
| 2024 January | 36 | 36 | 72 |
| 2023 December | 35 | 26 | 61 |
| 2023 November | 39 | 36 | 75 |
| 2023 October | 63 | 47 | 110 |
| 2023 September | 77 | 38 | 115 |
| 2023 August | 49 | 25 | 74 |
| 2023 July | 61 | 43 | 104 |
| 2023 June | 45 | 28 | 73 |
| 2023 May | 58 | 30 | 88 |
| 2023 April | 40 | 33 | 73 |
| 2023 March | 61 | 40 | 101 |
| 2023 February | 52 | 39 | 91 |
| 2023 January | 50 | 34 | 84 |
| 2022 December | 65 | 32 | 97 |
| 2022 November | 54 | 39 | 93 |
| 2022 October | 135 | 41 | 176 |
| 2022 September | 57 | 47 | 104 |
| 2022 August | 76 | 38 | 114 |
| 2022 July | 37 | 54 | 91 |
| 2022 June | 59 | 40 | 99 |
| 2022 May | 72 | 32 | 104 |
| 2022 April | 41 | 50 | 91 |
| 2022 March | 62 | 50 | 112 |
| 2022 February | 34 | 37 | 71 |
| 2022 January | 73 | 33 | 106 |
| 2021 December | 63 | 32 | 95 |
| 2021 November | 65 | 43 | 108 |
| 2021 October | 62 | 49 | 111 |
| 2021 September | 71 | 44 | 115 |
| 2021 August | 62 | 45 | 107 |
| 2021 July | 55 | 40 | 95 |
| 2021 June | 70 | 35 | 105 |
| 2021 May | 80 | 34 | 114 |
| 2021 April | 169 | 43 | 212 |
| 2021 March | 67 | 54 | 121 |
| 2021 February | 129 | 27 | 156 |
| 2021 January | 72 | 27 | 99 |
| 2020 December | 50 | 15 | 65 |
| 2020 November | 33 | 16 | 49 |
| 2020 October | 16 | 80 | 96 |
| 2020 September | 36 | 16 | 52 |
| 2020 August | 49 | 16 | 65 |
| 2020 July | 49 | 16 | 65 |
| 2020 June | 46 | 25 | 71 |
| 2020 May | 53 | 18 | 71 |
| 2020 April | 62 | 18 | 80 |
| 2020 March | 43 | 16 | 59 |
| 2020 February | 63 | 25 | 88 |
| 2020 January | 55 | 40 | 95 |
| 2019 December | 58 | 28 | 86 |
| 2019 November | 54 | 28 | 82 |
| 2019 October | 35 | 11 | 46 |
| 2019 September | 42 | 23 | 65 |
| 2019 August | 51 | 17 | 68 |
| 2019 July | 53 | 33 | 86 |
| 2019 June | 43 | 28 | 71 |
| 2019 May | 39 | 19 | 58 |
| 2019 April | 100 | 37 | 137 |
| 2019 March | 59 | 35 | 94 |
| 2019 February | 44 | 22 | 66 |
| 2019 January | 41 | 26 | 67 |
| 2018 December | 88 | 58 | 146 |
| 2018 November | 68 | 22 | 90 |
| 2018 October | 79 | 23 | 102 |
| 2018 September | 78 | 22 | 100 |
| 2018 August | 53 | 29 | 82 |
| 2018 July | 65 | 21 | 86 |
| 2018 June | 71 | 15 | 86 |
| 2018 May | 60 | 30 | 90 |
| 2018 April | 82 | 11 | 93 |
| 2018 March | 77 | 17 | 94 |
| 2018 February | 55 | 8 | 63 |
| 2018 January | 77 | 8 | 85 |
| 2017 December | 82 | 18 | 100 |
| 2017 November | 69 | 17 | 86 |
| 2017 October | 53 | 9 | 62 |
| 2017 September | 53 | 11 | 64 |
| 2017 August | 42 | 16 | 58 |
| 2017 July | 49 | 16 | 65 |
| 2017 June | 46 | 8 | 54 |
| 2017 May | 59 | 11 | 70 |
| 2017 April | 41 | 11 | 52 |
| 2017 March | 33 | 14 | 47 |
| 2017 February | 40 | 10 | 50 |
| 2017 January | 39 | 12 | 51 |
| 2016 December | 67 | 10 | 77 |
| 2016 November | 82 | 11 | 93 |
| 2016 October | 141 | 10 | 151 |
| 2016 September | 171 | 15 | 186 |
| 2016 August | 213 | 12 | 225 |
| 2016 July | 190 | 16 | 206 |
| 2016 June | 145 | 0 | 145 |
| 2016 May | 142 | 0 | 142 |
| 2016 April | 105 | 0 | 105 |
| 2016 March | 111 | 0 | 111 |
| 2016 February | 131 | 0 | 131 |
| 2016 January | 127 | 0 | 127 |
| 2015 December | 162 | 0 | 162 |
| 2015 November | 130 | 0 | 130 |
| 2015 October | 111 | 0 | 111 |
| 2015 September | 101 | 0 | 101 |
| 2015 August | 92 | 0 | 92 |
| 2015 July | 68 | 0 | 68 |
| 2015 June | 45 | 0 | 45 |
| 2015 May | 57 | 0 | 57 |
| 2015 April | 9 | 0 | 9 |
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