Peritoneal Dialysis Clinical Trial
Official title:
Developing Bioimpedance (BIA) as a Tool for Fluid Management in Peritoneal Dialysis Patients: A Validation Study
Hypothesis: The investigators hypothesize that regular monitoring of BIA adds value to the
management of fluid status in PD patients
Objectives of the study: The objective is to show that in patients where the additional
information of body composition is available to the clinician that the ECFv is maintained
within pre-agreed limits, ~ 1 liter, over the observation period of 12 months.
SCIENTIFIC BACKGROUND:
Low peritoneal ultrafiltration, and by inference low sodium removal, is associated with
worse outcomes in PD. Equally, excessive fluid removal is a risk factor for dehydration and
loss of residual renal function. Current guidelines have advocated a daily UF volume of
1litre; their blunt application could lead to either inappropriate early loss of residual
function or modality transfer. There is a significant need for evidence on how to best
manage fluid status in PD patients, both in terms of an appropriate clinical strategy and
also a simple but reproducible tool to guide clinicians in how to apply this strategy.
It is likely that BIA will become the standard tool to aid clinicians in assessing fluid
status. It is simple to perform, intervention studies have demonstrated its ability to
identify changes in fluid status in response to changes in therapy and it is a powerful
predictor of patient survival. There is, however a clear need at this stage for proof of
principle studies to establish its true potential for added value in the routine management
of patients.
Body composition changes spontaneously with time on PD. Short term changes in hydration
(specifically extracellular fluid volume, ECFv) combined with medium term changes in muscle
and fat make it difficult for the clinician to be sure if fluid status is stable. It is
anticipated that regular BIA measurements will aid the clinician in managing this problem
over and above monitoring of weight and fluid status. By randomizing patients into two
groups who have regular BIA measurements, one of which the BIA data is available to the
clinician it will be possible to see if these spontaneous changes in body composition can be
accounted for.
n/a
Observational Model: Cohort, Time Perspective: Prospective
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