Fluid Status in Peritoneal Dialysis Patients: The European Body Composition Monitoring (EuroBCM) Study Cohort

BACKGROUND: Euvolemia is an important adequacy parameter in peritoneal dialysis (PD) patients. However, accurate tools to evaluate volume status in clinical practice and data on volume status in PD patients as compared to healthy population, and the associated factors, have not been available so far. METHODS: We used a bio-impedance spectroscopy device, the Body Composition Monitor (BCM) to assess volume status in a cross-sectional cohort of prevalent PD patients in different European countries. The results were compared to an age and gender matched healthy population. RESULTS: Only 40% out of 639 patients from 28 centres in 6 countries were normovolemic. Severe fluid overload was present in 25.2%. There was a wide scatter in the relation between blood pressure and volume status. In a multivariate analysis in the subgroup of patients from countries with unrestricted availability of all PD modalities and fluid types, older age, male gender, lower serum albumin, lower BMI, diabetes, higher systolic blood pressure, and use of at least one exchange per day with the highest hypertonic glucose were associated with higher relative tissue hydration. Neither urinary output nor ultrafiltration, PD fluid type or PD modality were retained in the model (total R² of the model = 0.57). CONCLUSIONS: The EuroBCM study demonstrates some interesting issues regarding volume status in PD. As in HD patients, hypervolemia is a frequent condition in PD patients and blood pressure can be a misleading clinical tool to evaluate volume status. To monitor fluid balance, not only fluid output but also dietary input should be considered. Close monitoring of volume status, a correct dialysis prescription adapted to the needs of the patient and dietary measures seem to be warranted to avoid hypervolemia

Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study.

Acute antibody-mediated rejection (AMR) remains a challenge after kidney transplantation (KT). As there is no clear-cut treatment recommendation, accurate information on current therapeutic strategies in real-life practice is needed. KT recipients from the multicenter Swiss Transplant Cohort Study treated for acute AMR during the first post-transplant year were included retrospectively. We aimed at describing the anti-rejection protocols used routinely, as well as patient and graft outcomes, with focus on infectious complications. Overall, 65/1669 (3.9%) KT recipients were treated for 75 episodes of acute AMR. In addition to corticosteroid boluses, most common therapies included plasmapheresis (56.0%), intravenous immunoglobulins (IVIg) (38.7%), rituximab (25.3%), and antithymocyte globulin (22.7%). At least one infectious complication occurred within 6 months from AMR treatment in 63.6% of patients. Plasmapheresis increased the risk of overall (hazard ratio [HR]: 2.89; P-value = 0.002) and opportunistic infection (HR: 5.32; P-value = 0.033). IVIg exerted a protective effect for bacterial infection (HR: 0.29; P-value = 0.053). The recovery of renal function was complete at 3 months after AMR treatment in 67% of episodes. One-year death-censored graft survival was 90.9%. Four patients (6.2%) died during the first year (two due to severe infection). In this nationwide cohort we found significant heterogeneity in therapeutic approaches for acute AMR. Infectious complications were common, particularly among KT recipients receiving plasmapheresis

Standardized Photography of Pinguicula Blossoms

Volume: 7Start Page: 43End Page: 5

Pale-flowered Varieties of Pinguicula grandiflora

Volume: 16Start Page: 104End Page: 10

The Pinguicula Species of the Temperate Growth Type and Their Cultivation

Volume: 4Start Page: 8End Page: 1

Tissue hydration related to percentiles of the normal reference population stratified for the use of polyglucose or not.

<p>Tissue hydration related to percentiles of the normal reference population stratified for the use of polyglucose or not.</p

Demographic, clinical and fluid status data of the EuroBCM study cohort (N = 639).

§<p>after exclusion of patients from countries where polyglucose and APD are not liberally available due to logistical reasons.</p

Box and whisker plots (median, 25^th and 75^th quartile, outliers) of Absolute ΔTissue Hydration (in liters) in the different transport categories.

<p>n.d.: no peritoneal transport characteristics available in the 4 months before the BCM measurement.</p

Multivariate linear regression for Relative ΔTissue Hydration from the subgroup of patients from Belgium, France and UK.

<p>Model adjusted for country effects (Belgium, France and UK), total R² of the model = 0.57, n = 299.</p><p>NYHA = New York Heart Association classification of heart failure.</p

Scatter plot of the relation between absolute Δtissue hydration (litres) in the X-axis and systolic blood pressure (mmHg) in the Y-axis in the individual patients of the EuroBCM study cohort.

<p>Dotted vertical lines indicate the 10^th and 90^th percentile of absolute Δtissue hydration in the healthy population (−1.1 and +1.1 liter respectively), representing thus the limits of “normohydration”. Dotted horizontal lines indicate the “normotensive range” for systolic blood pressure.</p