Inflammation and extracellular volume expansion are related to sodium and water removal in patients on peritoneal dialysis.
BACKGROUND
Inflammation is an important risk for mortality in dialysis patients. Extracellular fluid volume (ECFv) expansion, a condition commonly seen in peritoneal dialysis (PD) patients, may be associated with inflammation. However, published support for this relationship is scarce.


OBJECTIVE
To quantify the proportion of patients on PD with inflammation and to analyze the role of ECFv expansion and the factors related to these conditions.


METHODS
A prospective, multicenter cross-sectional study in six hospitals with a PD program.


METHODS
Adult patients on PD were studied. Clinical data, body composition, and sodium and fluid intake were recorded. Biochemical analysis, C-reactive protein (CRP), and peritoneal and urinary fluid and sodium removal were also measured.


RESULTS
CRP values positive (>or=3.0 mg/L) for inflammation were found in 147 (80.3%) and negative in 36 patients. Patients with positive CRP had higher ECFv/total body water (TBW) ratio (women 47.69 +/- 0.69 vs 47.36 +/- 0.65, men 43.15 +/- 1.14 vs 42.84 +/- 0.65; p < 0.05), higher serum glucose (125.09 +/- 81.90 vs 103.28 +/- 43.30 mg/dL, p < 0.03), and lower serum albumin (2.86 +/- 0.54 vs 3.17 +/- 0.38 g/dL, p < 0.001) levels. They also had lower ultrafiltration (1003 +/- 645 vs 1323 +/- 413 mL/day, p < 0.005) and total fluid removal (1260 +/- 648 vs 1648 +/- 496 mL/day, p < 0.001), and less peritoneal (15.59 +/- 162.14 vs 78.11 +/- 110.70 mEq/day, p < 0.01) and total sodium removal (42.06 +/- 142.49 vs 118.60 +/- 69.73 mEq/day, p < 0.001). In the multivariate analysis, only ECFv/TBW was significantly (p < 0.04) and independently associated with inflammation. ECFv/TBW was correlated with fluid removal (r = 0.16, p < 0.03) and renal sodium removal (r = 0.2, p < 0.01).


CONCLUSIONS
The data suggest that ECFv expansion may have a significant role as an inflammatory stimulus. The results disclose a relationship between the two variables, ECFv expansion and inflammation, identified as independent risk factors for mortality in PD patients.
Avila-Díaz
Marcela
M
Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, México. cramav@yahoo.com.mx
Ventura
María-de-Jesús
MD
Valle
Delfilia
D
Vicenté-Martínez
Marlén
M
García-González
Zuzel
Z
Cisneros
Alejandra
A
Furlong
María-Del-Carmen
MD
Gómez
Ana María
AM
Prado-Uribe
María-Del-Carmen
MD
Amato
Dante
D
Paniagua
Ramón
R
D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D045604:Extracellular Fluid / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000209:etiology* / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D012964:Sodium / Q000378:metabolism*
D002097:C-Reactive Protein; D012964:Sodium