Extracellular fluid volume determined by bioelectric impedance and serum albumin in CAPD patients

To investigate the relationship between serum albumin and extracellular fluid volume, as measured by multifrequency bioelectrical impedance, in stable patients treated by CAPD.

Fifty-nine stable CAPD patients were assessed. Serum albumin (bromocresol green) and CRP, age, dialysate to plasma (D/P) creatinine ratio, normalized protein catabolic rate (nPCR), daily urine and peritoneal protein losses, and extracellular fluid volume (Vecf) were measured in each patient. Vecf was calculated as a percentage of actual body weight (Vecf% ABW), of lean body mass derived from anthropometry (Vecf% LBM) and of total body water (Vecf% Vtbw). Comparisons between those with a normal serum albumin (> or = 37 g/l) and those with a low serum albumin (< 37 g/l) were made by Mann-Whitney U test. Correlations with serum albumin were sought by Pearson's test.

The D/P creatinine ratio, daily peritoneal and urine protein losses, and extracellular fluid volume (Vecf% LBM and Vecf% Vtbw) were all significantly greater in patients with serum albumin < 37 g/l as compared to those > or = 37 g/l; P < 0.05. Age, CRP, and nPCR were not different. Serum albumin was negatively correlated with Vecf% LBM, r = -0.25; P = 0.05, Vecf% Vtbw, r = -0.39; P = 0.002, and daily urinary albumin loss, r = -0.25, P = 0.06.

Hypoalbuminaemia is partly dependent on subclinical overhydration in CAPD patients. Serum albumin is negatively correlated with increased extracellular fluid volume and the proportion of Vecf to Vtbw is increased in hypoalbuminaemic patients. Multifrequency bioelectrical impedance is able to identify these abnormalities.