title: Clinical significance of multi-frequency bioimpedance spectroscopy in peritoneal dialysis patients: independent predictor of patient survival.
abstract: BACKGROUND
  It is becoming increasingly evident that the accurate assessment of hydration status is critical to care of a dialysis patient. Using the Body Composition Monitor, different parameters (overhydration (OH), extra-cellular water/total body water (ECW/TBW) or OH/ECW) have been proposed to indicate hydration status. We wished to determine which parameter (if any) was most predictive of all-cause mortality, and if this was independent of nutritional indices.
  
  
  METHODS
  We performed a single-centre retrospective analysis of prospectively collected data of all peritoneal dialysis (PD) patients between 1 January 2008 and 30 March 2012. Record review was undertaken to establish patient survival, clinical and demographic data. Follow-up was continued even after PD technique failure (transfer to haemodialysis) and transplantation.
  
  
  RESULTS
  The study included 529 patients. OH index (OH and OH/ECW) was the independent predictor of mortality in multi-variate analysis. ECW/TBW as a continuous variable was not associated with increased risk of death. In contrast, patients that were severely overhydrated (highest 33%) had hazard ratios (HRs) that were statistically significant irrespective of the parameter used to define hydration. Using OH, severely overhydrated patients had an HR of 1.83 [95% confidence interval (CI) 1.19-2.82, P < 0.01], OH/ECW: 2.09 (95% CI 1.36-3.20, P < 0.001) and ECW/TBW: 2.05 (95% CI 1.31-3.22, P < 0.005).
  
  
  CONCLUSIONS
  Our results also indicated that there was no influence of body mass index (BMI) on the hydration parameter OH/ECW. OH/ECW remained an independent predictor of mortality when the BMI and lean tissue index were included in multivariate model. However, it remains to be determined if correcting the OH status of a patient will lead to improvement in mortality.
authors.affiliation: Department of Renal Medicine and Transplantation, The Royal London Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Emma L
authors.initials: EL
authors.lastname: O'Lone
authors.affiliation: Department of Nutrition and Dietetics, Barts Health NHS Trust, London, UK.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Visser
authors.affiliation: Department of Clinical Biochemistry, Barts Health NHS Trust, London, UK.
authors.forename: Hazel
authors.initials: H
authors.lastname: Finney
authors.affiliation: Department of Renal Medicine and Transplantation, The Royal London Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Stanley L
authors.initials: SL
authors.lastname: Fan
mesh_terms: D000328:Adult; D000368:Aged; D048909:Diabetes Complications / Q000209:etiology / Q000401:mortality*; D017097:Electric Impedance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D011446:Prospective Studies; D012189:Retrospective Studies; D013057:Spectrum Analysis / Q000379:methods*; D015996:Survival Rate; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000401:mortality
keywords: bioimpedance; fluid status; mortality; overhydration; peritoneal dialysis