title: Baseline hydration status in incident peritoneal dialysis patients: the initiative of patient outcomes in dialysis (IPOD-PD study)†.
abstract: BACKGROUND
  Non-euvolaemia in peritoneal dialysis (PD) patients is associated with elevated mortality risk. There is an urgent need to collect data to help us understand the association between clinical practices and hydration and nutritional status, and their effects on patient outcome.
  
  
  METHODS
  The aim of this prospective international, longitudinal observational cohort study is to follow up the hydration and nutritional status, as measured by bioimpedance spectroscopy using the body composition monitor (BCM) of incident PD patients for up to 5 years. Measures of hydration and nutritional status and of clinical, biochemical and therapy-related data are collected directly before start of PD treatment, at 1 and 3 months, and then every 3 months. This paper presents the protocol and a pre-specified analysis of baseline data of the cohort.
  
  
  RESULTS
  A total of 1092 patients (58.1% male, 58.0 ± 15.3 years) from 135 centres in 32 countries were included. Median fluid overload (FO) was 2.0 L (males) and 0.9 L (females). Less than half of the patients were normohydrated (38.7%), whereas FO > 1.1 L was seen in 56.5%. Systolic and diastolic blood pressure were 139.5 ± 21.8 and 80.0 ± 12.8 mmHg, respectively, and 25.1% of patients had congestive heart failure [New York Heart Association (NYHA) 1 or higher]. A substantial number of patients judged to be not overhydrated on clinical judgement appeared to be overhydrated by BCM measurement. Overhydration at baseline was independently associated with male gender and diabetic status.
  
  
  CONCLUSIONS
  The majority of patients starting on PD are overhydrated already at start of PD. This may have important consequences on clinical outcomes and preservation of residual renal function. Substantial reclassification of hydration status by BCM versus on a clinical basis was necessary, especially in patients who were not overtly overhydrated. Both clinical appreciation and bioimpedance should be combined in clinical decision-making on hydration status.
authors.affiliation: Department of Nephrology, Ospedale S. Bortolo, Vicenza, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
authors.affiliation: Centre Hospitalier René Dubos, Pontoise, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Verger
authors.affiliation: Department of Nephrology, Ospedale S. Bortolo, Vicenza, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Crepaldi
authors.affiliation: Clinical Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany.
authors.forename: Jenny
authors.initials: J
authors.lastname: Pham
authors.affiliation: Clinical Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany.
authors.forename: Tatiana
authors.initials: T
authors.lastname: De Los Ríos
authors.affiliation: Clinical Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany.
authors.forename: Adelheid
authors.initials: A
authors.lastname: Gauly
authors.affiliation: Clinical Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Wabel
authors.affiliation: Renal Division, Ghent University Hospital, Ghent, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Van Biesen
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001823:Body Composition; D048909:Diabetes Complications; D017097:Electric Impedance; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009752:Nutritional Status; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance
keywords: bioimpedance; end-stage renal disease; hydration status; peritoneal dialysis; prospective cohort study; volaemia