American journal of kidney diseases : the official journal of the National Kidney Foundation · 2021
Impact of Bioelectrical Impedance-Guided Fluid Management and Vitamin D Supplementation on Left Ventricular Mass in Patients Receiving Peritoneal Dialysis: A Randomized Controlled Trial.
СтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Brimble K Scott, Ganame Javier, Margetts Peter, Jain Arsh, Perl Jeffrey, Walsh Michael, Bosch Jackie, Yusuf Salim, Beshay Samy, Su Winnie, Zimmerman Deborah, Lee Shun Fu, Gangji Azim S
Аннотация
RATIONALE & OBJECTIVE: Hypervolemia and vitamin D deficiency occur frequently in patients receiving peritoneal dialysis and may contribute to left ventricular (LV) hypertrophy. The effect of bioelectrical impedance analysis (BIA)-guided volume management or vitamin D supplementation on LV mass among those receiving peritoneal dialysis is uncertain.
STUDY DESIGN: Two-by-two factorial randomized controlled trial.
SETTING & PARTICIPANTS: Sixty-five patients receiving maintenance peritoneal dialysis.
INTERVENTION: BIA-guided volume management versus usual care and oral cholecalciferol 50,000 U weekly for 8 weeks followed by 10,000 U weekly for 44 weeks or matching placebo.
OUTCOME: Change in LV mass at 1 year measured by cardiac magnetic resonance imaging.
RESULTS: Total body water decreased by 0.9 + 2.4 (SD) L in the BIA group compared with a 1.5 ± 3.4 L increase in the usual care group (adjusted between-group difference: -2.4 [95% CI, -4.1 to -0.68] L, P = 0.01). LV mass increased by 1.3 ± 14.3 g in the BIA group and decreased by 2.4 ± 37.7 g in the usual care group (between-group difference: +2.2 [95% CI, -13.9 to 18.3] g, P = 0.8). Serum 25-hydroxyvitamin D concentration increased by a mean of 17.2 ± 30.8 nmol/L in the cholecalciferol group and declined by 8.2 ± 24.3 nmol/L in the placebo group (between-group difference: 28.3 [95% CI, 17.2-39.4] nmol/L, P < 0.001). LV mass decreased by 3.0 ± 28.1 g in the cholecalciferol group and increased by 2.0 ± 31.2 g in the placebo group (between-group difference: -4.5 [95% CI, -20.4 to 11.5] g, P = 0.6).
LIMITATIONS: Relatively small sample size with larger than expected variation in change in LV mass.
CONCLUSIONS: BIA-guided volume management had a modest impact on volume status with no effect on the change in LV mass. Vitamin D supplementation increased serum vitamin D concentration but had no effect on LV mass.
FUNDING: Unrestricted Baxter International extramural grant and the Kidney Foundation of Canada.
TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT01045980.
STUDY DESIGN: Two-by-two factorial randomized controlled trial.
SETTING & PARTICIPANTS: Sixty-five patients receiving maintenance peritoneal dialysis.
INTERVENTION: BIA-guided volume management versus usual care and oral cholecalciferol 50,000 U weekly for 8 weeks followed by 10,000 U weekly for 44 weeks or matching placebo.
OUTCOME: Change in LV mass at 1 year measured by cardiac magnetic resonance imaging.
RESULTS: Total body water decreased by 0.9 + 2.4 (SD) L in the BIA group compared with a 1.5 ± 3.4 L increase in the usual care group (adjusted between-group difference: -2.4 [95% CI, -4.1 to -0.68] L, P = 0.01). LV mass increased by 1.3 ± 14.3 g in the BIA group and decreased by 2.4 ± 37.7 g in the usual care group (between-group difference: +2.2 [95% CI, -13.9 to 18.3] g, P = 0.8). Serum 25-hydroxyvitamin D concentration increased by a mean of 17.2 ± 30.8 nmol/L in the cholecalciferol group and declined by 8.2 ± 24.3 nmol/L in the placebo group (between-group difference: 28.3 [95% CI, 17.2-39.4] nmol/L, P < 0.001). LV mass decreased by 3.0 ± 28.1 g in the cholecalciferol group and increased by 2.0 ± 31.2 g in the placebo group (between-group difference: -4.5 [95% CI, -20.4 to 11.5] g, P = 0.6).
LIMITATIONS: Relatively small sample size with larger than expected variation in change in LV mass.
CONCLUSIONS: BIA-guided volume management had a modest impact on volume status with no effect on the change in LV mass. Vitamin D supplementation increased serum vitamin D concentration but had no effect on LV mass.
FUNDING: Unrestricted Baxter International extramural grant and the Kidney Foundation of Canada.
TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT01045980.