Relations between malnutrition-inflammation-atherosclerosis and volume status. The usefulness of bioimpedance analysis in peritoneal dialysis patients
Relations between malnutrition-inflammation-atherosclerosis and volume status. The usefulness of bioimpedance analysis in peritoneal dialysis patients
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DOI：
10.1093/ndt/gfq588
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发表时间：
2011-05-01
影响因子：
6.1
通讯作者：
Ozkahya, Mehmet
中科院分区：
文献类型：
--
作者：
Demirci, Meltem Sezis;Demirci, Cenk;Ozkahya, Mehmet
背景。慢性液体过载（FO）常见于腹膜透析（PD）患者，并与高血压、左心室肥厚和功能障碍相关，是透析患者死亡的重要预测因素。在本研究中，我们研究了PD患者营养、炎症、动脉粥样硬化与多频生物阻抗分析（m-BIA）测量的体液量之间的关系。此外，我们分析了m-BIA的细胞外体积值与超声心动图参数的关系，以确定其作为fo测量的有效性。95例PD患者（平均年龄50 +/- 13岁，其中10例为糖尿病患者）入组。采用m-BIA法测定细胞外水分（ECW）、全身水分（TBW）、干瘦质量（DLM）和相位角（PA）。通过测量左心房直径（LAD）和左心室舒张末期直径（LVEDD）来确定容量状态。测量颈动脉内膜-中膜厚度（CA-IMT）用于评估亚临床动脉粥样硬化的存在。血清白蛋白作为营养指标，血清c反应蛋白（CRP）作为炎症指标。全组平均ECW/height为10.0 +/- 1.0 L/m，临床水合参数正常的患者平均ECW/height为9.3 +/- 0.6 L/m。在相关分析中，营养、炎症和动脉粥样硬化指标与m-BIA参数相关性良好。当我们使用超声测量的LAD （> 40 mm）或LVEDD （> 55 mm）作为验证参数时，在诊断FO的ROC分析中发现截断值为10.48 L/m ECW/高度（78%特异性，LAD敏感性为77%，72%特异性，LVEDD敏感性为70%）。FO患者年龄较大，收缩压、心胸指数、血清CRP水平和平均CA-IMT均高于无FO患者。炎症患者CA-IMT值较高。在多变量分析中，只有两个因素-低尿量和ECW/身高-与炎症的存在独立相关。m-BIA定义的FO与PD患者营养不良、炎症、动脉粥样硬化等指标显著相关。从m-BIA获得的指标，特别是ECW/高度，与超声心动图评估的容量过载有很好的相关性，可能是一个值得在适当设计的临床研究中测试的指标。
Background. Chronic fluid overload (FO) is frequently present in peritoneal dialysis (PD) patients and is associated with hypertension and left ventricular hypertrophy and dysfunction, which are important predictors of death in dialysis patients. In the present study, we investigated the relationship between nutrition, inflammation, atherosclerosis and body fluid volumes measured by multifrequency bioimpedance analysis (m-BIA) in PD patients. In addition, we analysed the relationship of extracellular volume values by m-BIA to echocardiographic parameters in order to define its usefulness as a measure of FO.Methods. Ninety-five prevalent PD patients (mean age 50 +/- 13 years, 10 of them diabetic) were enrolled. Extracellular water (ECW), total body water (TBW), dry lean mass (DLM) and phase angle (PA) were measured by m-BIA. Volume status was determined by measuring left atrium diameter (LAD) and left ventricular end-diastolic diameter (LVEDD). Measurement of carotid artery intima-media thickness (CA-IMT) was used to assess the presence of subclinical atherosclerosis. Serum albumin was used as a nutritional marker, and serum C-reactive protein (CRP) was used as an inflammatory marker.Results. Mean ECW/height was 10.0 +/- 1.0 L/m for whole group and 9.3 +/- 0.6 L/m in patients with normal clinical hydration parameters. In correlation analysis, markers of nutrition, inflammation and atherosclerosis correlated well with m-BIA parameters. When we used echographically measured LAD (> 40 mm) or LVEDD (> 55 mm) as a confirmatory parameter, a cut-off value of 10.48 L/m ECW/height (78% specificity, with a sensitivity of 77% for LAD and 72% specificity, with a sensitivity of 70% for LVEDD) was found in ROC analysis for the diagnosis of FO. Patients with FO were older and had higher systolic blood pressure, cardiothoracic index, serum CRP level and mean CA-IMT than patients without FO. Patients with inflammation had higher CA-IMT values. In multivariate analysis, only two factors-low urine output and ECW/height-were independently associated with the presence of inflammation.Conclusions. FO defined by m-BIA is significantly correlated with markers of malnutrition, inflammation and atherosclerosis in PD patients. The indices obtained from m-BIA, especially ECW/height, correlated well with volume overload as assessed by echocardiography and might be a measure worth testing in a properly designed clinical study.