Strong association between volume status and nutritional status in peritoneal dialysis patients

Background: Malnutrition is a strong predictor of mortality in maintenance peritoneal dialysis (PD) patients. Various factors have been identified to contribute to the development of malnutrition. The present study tried to investigate the possible role of fluid overload in the development of malnutrition. Methods: Twenty-eight PD patients were included in this study. Fluid status was evaluated by means of repeated bioimpedance analysis, and nutritional status was assessed by means of handgrip strength and subjective global assessment. All patients were followed up closely for 9 months. Based on changes in bioimpedance analysis data, patients were divided into group A (with continuous and steadily improved fluid status; n = 18) and group B (with consistent fluid overload; n = 10). Results: There were no differences in sex, age, and height between the 2 groups. In group A, patients' extracellular water (ECW) volume decreased significantly during follow-up, whereas intracellular water (ICW) volume increased significantly (both P < 0.001). In group B, ECW volume increased significantly, whereas ICW volume increased at an early stage and then decreased. The ratio of ECW to total-body water decreased significantly in group A, but increased significantly In group B. Along with the improvement in fluid status, nutritional status in group A also Improved significantly (the prevalence of malnutrition decreased from 66.7% to 11.1%; P < 0.01). However, In group B, nutritional status deteriorated significantly (handgrip strength decreased from 238.33 +/- 88.93 to 216.1 +/- 86.19 N; P < 0.05; and the prevalence of malnutrition increased from 40% to 50%). Conclusion: Our data suggest there is a strong association between fluid status and nutritional status. Improved fluid status is associated with improvement in nutritional status, whereas deterioration in fluid status is associated with the development of malnutrition.