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Perit Dial Int 27(Supplement_3): 11- 2007
© 2007 International Society for Peritoneal Dialysis
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Adequacy

Vector Bioelectrical Impedance Analysis (BIA) Improves Fluid Management in Peritoneal Dialysis (PD) Patients

L. Pillon1,2, J.K. Leypoldt3, A. Guillaume1, K. Odedosu1, M. Germain4, M.T. Nejad1 and C.H. Tseng1

Medicine,1 New York Univ School of Med; VA NY Harbor Health Care Sys,2 New York, New York; Univ of Utah,3 Salt Lake City, Utah; TUFTS Baystate Med Cntr,4 Springfield, Massachusetts, USA.

Objective: In the hemodialysis (HD) population, patient (pt) survival is poorer with shorter vectors and smaller phase angles determined by vector BIA. We determined whether alterations in PD prescription (Rx) based on the vector length and angle can help guide fluid management and blood pressure (BP) control in the PD pt. Methods: 15 pts (2 F, 13 M) age 60±12 undergoing CAPD for at least 3 months, were studied before and after data from vector BIA was used to alter PD Rxs. Pts were followed monthly for 3–6 months. Measurements of whole body, single frequency (50 kHz) BIA were made with both empty (after fluid removal) and filled peritoneal cavity (after dialysate inflow) at baseline. Vector distribution was compared with that from 726 healthy pts. Based on these measurements, the PD Rx was adjusted by changing the number, volume, or frequency of hypertonic dwells such that the pt's vector was taken into the healthy range [50% tolerance interval (TI)]. Results: There were reductions in weight and BP post intervention (Table 1). 8/15 pts were dehydrated (crossing the upper pole of the 75% TI) and temporarily lost urine volume, which returned after they were rehydrated. One pt lost urine output permanently. Clinical edema became apparent with shorter vectors and smaller phase angles outside the healthy range (outside of the 75% TI).

End Points Before and After Intervention Baseline Post-intervention End points Mean SD Mean SD p Value Systolic BP (mmHg) 142 16 130 17 0.002 Diastolic BP (mmHg) 85 10 78 12 0.014 Weight (kg) 74 14 70 13 <0.001 Hemoglobin (g/dL) 10.22 2.07 10.69 1.03 0.043 Vector length (Ohm/m) 461 47 555 64 <0.001 Phase angle (degrees) 4.47 0.93 5.46 1.03 <0.001

Conclusions: The use of vector BIA leads to a reduction in fluid weight and BP. Dehydration and edema can be predicted by pt's vector length and angle. These data suggest that use of vector BIA improves fluid management in PD pts.






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