FREE WATER TRANSPORT AND ITS ASSOCIATION WITH CARDIOVASCULAR STATUS IN CHILDREN ON PERITONEAL DIALYSIS
Journal
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
ISSN
0896-8608
1718-4304
Date Issued
2019
Author(s)
Lilian Bolte
Maria Jose Ibacache
Francisco Cano
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:sec><jats:title>Background</jats:title><jats:p>Volume overload is one of the most important factors associated with left ventricular hypertrophy (LVH) and cardiovascular disease in chronic peritoneal dialysis (PD) patients. MiniPET is a reliable tool to evaluate free water transport (FWT). In a clinical setting, the significance of FWT has not been evaluated in terms of outcome in children on PD. The objective was to define a FWT value of clinical significance in children on PD, fixing its relationship to left ventricular mass index (LVMI) as a well-known outcome parameter.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>MiniPET was performed with 3.86% glucose, 1-h long, to measure FWT in PD patients > 6 years old. An echocardiogram (ECG) was performed within 2 months of the MiniPET. Left ventricular hypertrophy was defined as LVMI ≥ 38.6 g/height<jats:sup>2.7</jats:sup>(95th percentile). Receiver operating characteristic curve (ROC) analysis was used to determine the cut-off value of FWT searching the highest sensitivity and specificity to differentiate patients with normal/abnormal LVMI. A p < 0.05 was considered significant.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Forty-six studies were performed on 32 patients, 16 males; mean age 11.59 ± 3.07 years. Mean normalized FWT (nFWT) was 144.4 ± 84.8 mL/m<jats:sup>2</jats:sup>, corresponding to 46.7% of total ultrafiltration. Mean LVMI was 42 ± 11.3 g/m<jats:sup>2.7</jats:sup>with a negative correlation to nFWT ( p < 0.01). Eighteen out of 32 patients had LVH. The ROC analysis (nFWT vs LVMI) showed an area under the curve of 0.71 (95% confidence interval [CI], 0.53 – 0.89; p = 0.04), allowing a cut-off nFWT value of 110 mL/m<jats:sup>2</jats:sup>to be defined, dividing the population into 2 groups of patients according to the LVMI cut-off value of 38,6 g/m<jats:sup>2.7</jats:sup>.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The nFWT showed an inverse correlation to LVMI. A nFWT value < 110 mL/m<jats:sup>2</jats:sup>was significantly associated with LVH. The negative relationship observed between nFWT and LVMI, and the cut-off level for nFWT according to the 95th percentile of LVMI, suggest that the regular evaluation of nFWT could become a useful tool in assessing the capacity of PD treatment to keep patients’ volume status under control, avoiding cardiovascular impairment.</jats:p></jats:sec>
Subjects
minipet
;
adequacy
;
left ventricular hypertrophy
;
adolescent
;
biological transport
;
body water
;
cardiovascular diseases
;
child
;
cross-sectional studies
;
female
;
humans
;
male
;
peritoneal absorption
;
peritoneal dialysis
;
prospective studies
;
renal insufficiency, chronic
;
roc curve
;
glucose
;
anuria
;
article
;
blood pressure
;
cardiovascular disease
;
child
;
chronic kidney failure
;
clinical article
;
diagnostic test accuracy study
;
echocardiography
;
female
;
heart left ventricle hypertrophy
;
heart ventricle hypertrophy
;
human
;
hypertension
;
male
;
peritoneal dialysis
;
priority journal
;
receiver operating characteristic
;
school child
;
ultrafiltration
;
water transport
;
adolescent
;
adverse event
;
body water
;
cardiovascular disease
;
chronic kidney failure
;
complication
;
cross-sectional study
;
drug absorption
;
metabolism
;
peritoneal dialysis
;
physiology
;
prospective study
;
transport at the cellular level