title: Inflammation and extracellular volume expansion are related to sodium and water removal in patients on peritoneal dialysis.
abstract: 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.
authors.affiliation: Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, México. cramav@yahoo.com.mx
authors.forename: Marcela
authors.initials: M
authors.lastname: Avila-Díaz
authors.forename: María-de-Jesús
authors.initials: MD
authors.lastname: Ventura
authors.forename: Delfilia
authors.initials: D
authors.lastname: Valle
authors.forename: Marlén
authors.initials: M
authors.lastname: Vicenté-Martínez
authors.forename: Zuzel
authors.initials: Z
authors.lastname: García-González
authors.forename: Alejandra
authors.initials: A
authors.lastname: Cisneros
authors.forename: María-Del-Carmen
authors.initials: MD
authors.lastname: Furlong
authors.forename: Ana María
authors.initials: AM
authors.lastname: Gómez
authors.forename: María-Del-Carmen
authors.initials: MD
authors.lastname: Prado-Uribe
authors.forename: Dante
authors.initials: D
authors.lastname: Amato
authors.forename: Ramón
authors.initials: R
authors.lastname: Paniagua
mesh_terms: 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*
chemical_list: D002097:C-Reactive Protein; D012964:Sodium