AUTHOR=Costa Fabiana Lourenço , Reis Nayrana Soares do Carmo , Reis Fabricio Moreira , Oliveira Rogério Carvalho de , Zanati Bazan Silméia Garcia , Canedo da Silva Maryanne Zilli , Martin Luis Cuadrado , Barretti Pasqual 

TITLE=Multifrequency bioimpedance by spectroscopy vs. routine methods in the management of hydration status in peritoneal dialysis patients: A randomized control trial

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.911047

DOI=10.3389/fmed.2022.911047

ISSN=2296-858X

ABSTRACT=Background: Overhydration (OH) is common in peritoneal dialysis (PD) and  increases the   cardiovascular risk. Multifrequency bioimpedance spectroscopy (BIS) has been proposed  to  estimate the hydration in dialysis. Our objective was to evaluate if BIS is superior  than  control based on clinical assessment plus single-frequency bioimpedance (SF-BIA) on the  fluid control and  intermediate cardiovascular outcomes.  Methods: Randomized controlled study in adult PD patients, with a nine-month follow-up, allocated into two groups: control and BIS. Data  were collected from medical records. SF-BIA and BIS, laboratory exams, ambulatory blood pressure monitoring, echocardiography and pulse wave velocity were evaluated. The BIS data were available to the medical team only in BIS group. Results: 34 patients completed the study, 17  in each group. At the endpoint the BIS goup had a significant (p<0,05) greater proportion of patients with  OH/ extracellular water (OH/ECW%) ≤ 15%  than the control (94,1% vs 52,9%), and a  lower  OH mean (2,1 ± 1,6 vs 0,9 ± 1,1 L).  The control group has a significant increase in the  tumor necrosis factor alpha  median concentration from baseline to six  [11,9 (6,0 - 24,1) vs 44,7 (9,4 - 70,6) pg/ml] and nine months [11,9 (6,0 - 24,1) vs 39,4 (27,9 - 62,6) pg/ml], and in the  N-terminal fragment of pro-B-type natriuretic peptide median  [239 (171,5 - 360,5) vs 356 (219 - 1555) pg/ml ]. For cardiovascular parameters, BIS group presented a significant reduction in radial PWV [7,7 (6,9 - 9,2) vs 6.5 (5,5 - 8,4) m/s] at nine month, while in the control  presented a significant increase in mean central systolic blood pressure (BP) (106,8 ± 11,2 vs 117,6 ± 16,5 mmHg) and in central diastolic BP (90, 4 ± 9,8 vs 103,3 ± 12,5 mmHg) at nine months. The left ventricular mass (LVM)/body surface presented a  significant reduction in the control (109,6 ± 30,8 vs 101,2 ± 28,9 g/m²) and BIS group (107,7 ± 24,9 vs 96,1 ± 27,0 g/m²) at nine months.
Conclusions: The results suggest BIS is superior than the clinical evaluation plus SF-BIA for the fluid control of PD patients.