title: The impact of sub-clinical over-hydration on left ventricular mass in peritoneal dialysis patients.
abstract: OBJECTIVE
  Left ventricular hypertrophy (LVH) represents a major predictor of the development of cardiovascular (CV) complications. Over-hydration (OH) is an important uremic risk factor associated with LVH and increased CV morbidity and mortality in peritoneal dialysis (PD) patients. In the present study we evaluated the prevalence of sub-clinical OH (SCOH) among PD patients and its effects on left ventricular mass (LVM).
  
  
  METHODS
  In this cross sectional study hydration status, blood pressure, glucose load, systemic inflammation and LVM were evaluated in 43 clinically stable patients on maintenance PD for 24-76 months. The hydration status was assessed by whole-body bio-impedance spectroscopy (BIS). Peripheral edema and any evidence of pulmonary congestion were considered clinical signs of OH.
  
  
  RESULTS
  OH ≥ 1.5 L was detected in 26 (60.5%) of the study participants; the OH in 19 (73.1%) of them was sub-clinical. Only 23.5% (4/17) of patients with OH < 1.5 L had LVH compared to 68.4% (13/19) of those with SCOH ≥ 1.5 L (P = 0.007). Compared to patients with OH < 1.5 L, patients with SCOH ≥ 1.5 L had higher levels of blood pressure, peritoneal glucose load, plasma brain natriuretic peptide, high sensitive C-reactive protein, interleukin-6 and LVMI; and lower levels of serum albumin (P < 0.001). No significant differences were found between patients with clinical OH or SCOH with OH ≥ 1.5 L.
  
  
  CONCLUSIONS
  SCOH is highly prevalent among PD patients and may contribute to the development of LVH. Considering the poor prognosis associated with over-hydrated PD patients, periodic assessment of hydration status using accurate BIS is suggested.
authors.affiliation: Faculty of Medicine in The Galilee, Bar-Ilan University Safed, Israel ; Peritoneal Dialysis Unit-Western Galilee Hospital Nahariya, Israel.
authors.forename: Kamal
authors.initials: K
authors.lastname: Hassan
authors.affiliation: Women's Health Wing-Western Galilee Hospital Nahariya, Israel.
authors.forename: Dunia
authors.initials: D
authors.lastname: Hassan
authors.affiliation: Department of Cardiology-Western Galilee Hospital Nahariya, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Shturman
authors.affiliation: Peritoneal Dialysis Unit-Western Galilee Hospital Nahariya, Israel.
authors.forename: Irina
authors.initials: I
authors.lastname: Rubinchik
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel.
authors.forename: Hassan
authors.initials: H
authors.lastname: Fadi
authors.affiliation: Internal Medicine Department-Carmel Medical Center Haifa, Israel.
authors.forename: Hassan
authors.initials: H
authors.lastname: Shadi
authors.affiliation: Faculty of Medicine in The Galilee, Bar-Ilan University Safed, Israel ; Department of Cardiology-Western Galilee Hospital Nahariya, Israel.
authors.forename: Shaul
authors.initials: S
authors.lastname: Atar
keywords: Peritoneal dialysis; blood pressure; fluid overload; inflammation; left ventricular mass; over-hydration