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Impact of Bioelectrical Impedance–Guided Fluid Management and Vitamin D Supplementation on Left Ventricular Mass in Patients Receiving Peritoneal Dialysis: A Randomized Controlled Trial
American Journal of Kidney Diseases  (IF8.86),  Pub Date : 2021-10-14, DOI: 10.1053/j.ajkd.2021.08.022
K. Scott Brimble, Javier Ganame, Peter Margetts, Arsh Jain, Jeffrey Perl, Michael Walsh, Jackie Bosch, Salim Yusuf, Samy Beshay, Winnie Su, Deborah Zimmerman, Shun Fu Lee, Azim S. Gangji

Rationale & Objectives

Hypervolemia and vitamin D (Vit D) deficiency occur frequently in patients receiving peritoneal dialysis and may contribute to left ventricular hypertrophy (LVH). The effect of bioimpedance analysis-guided volume management or Vit 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 chronic peritoneal dialysis.

Intervention

BIA-guided volume management versus usual care and oral cholecalciferol 50,000u weekly for 8 weeks followed by 10,000u weekly for 44 weeks or matching placebo.

Outcomes

Change in left ventricular mass at one-year measured by cardiac magnetic resonance imaging.

Results

Total body water decreased by 0.9L (standard deviation: 2.4) in the BIA group compared to a 1.5L (± 3.4) increase in the usual care group (adjusted between group difference: -2.4L [95% confidence interval: -4.1, -0.68], p=0.01). Left ventricular mass increased by 1.3g (± 14.3) in the BIA group and decreased by 2.4g (±37.7) in the usual care group (between group difference; +2.2g [-13.9, 18.3], p=0.78). Serum 25-OH Vit D concentration increased by a mean of 17.2 nmol/L (standard deviation: 30.8 nmol/L) in the cholecalciferol group and declined by 8.2 nmol/L (±24.3 nmol/L) in the placebo group (between group difference: 28.3 nmol/L [95% confidence interval 17.2, 39.4]; p<0.001). Left ventricular mass decreased by 3.0g (± 28.1g) in the cholecalciferol group and increased by 2.0g (±31.2g) in the placebo group (between group difference; -4.5g [-20.4, 11.5], p=0.58).

Limitations

Relatively small sample size with larger than expected variation in change in left ventricular 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 Vit D concentration but had no effect on left ventricular mass.