Extracellular water/total body water ratio as predictor of mortality in hemodialysis patients

Abstract

Background: Overhydration is a predictor of mortality in hemodialysis (HD) patients. Bioimpedance spectroscopy (BIS) is used to determine the body composition. Extracellular Water/Total Body Water (ECW/TBW) ratio has been proposed to predict mortality. Methods: Multicenter, prospective, observational, proof-of-concept study to estimate the impact of ECW/TBW in global and cardiovascular mortality and the relationship with cardiovascular biomarkers. The study included 60 patients (mean age, 71.8 ± 11.4 years; mean time on HD, 52.3 ± 30.8 months) with a median follow-up of 30.5 months (IQ range, 17.2-34 months). Results: Post-dialysis ECW/TBW was directly associated with NT-proBNP and cTnT. During the study 28 patients died, most of them (43%) due to cardiovascular events. Compared to the survivors, these subjects had a higher post-dialysis ECW/TBW ratio (p ¼ 0.006), while for cardiovascular mortality the only significant difference was a higher pre-dialysis ECW/TBW. The ability of postdialysis ECW/TBW ratio to predict all-cause mortality had an area under the ROC curve (AUC) of 0.71 (CI 95%, 0.57-0.81; p ¼ 0.002), with a cutoff point of 0.5023. For cardiovascular mortality the AUC was 0.66 (CI 95%, 0.52-0.77; p ¼ 0.045), with a cutoff point of 0.4713. Conclusions: The post-dialysis ECW/TBW ratio measured by BIS can be a predictor of all-cause and cardiovascular mortality.

Annual change in the extracellular fluid/intracellular fluid ratio and mortality in patients undergoing maintenance hemodialysis

“…On the other hand, some previous studies reported that ECF/TBW ratio was a maker of the fluid volume status and was sometimes used to set dry weight in HD patients 19 , 20 . Recently, Kim et al 21 and Pérez-Morales et al 22 have demonstrated that volume overload assessed by BIA-measured ECF/TBW ratio was a predictor of all-cause and cardiovascular mortality. However, Kim et al 5 previously reported that ECF/ICF ratio but not ECF/TBW ratio was an independent predictor of all-cause and cardiovascular event.…”

Obesity and Body Mass Components Influence Exercise Tolerance and the Course of Hypertension in Perimenopausal Women

“…Significant differences were also observed in fat mass ( p = 0.01), fat-free mass ( p = 0.007), resting metabolic rate (RMR) ( p = 0.007), total body water ( p = 0.01) and extracellular water ( p = 0.004) between the groups [ 30 ]. In another study, the influence of ECW/TBW and cardiovascular mortality and the connection with cardiac biomarkers in hemodialysis patients was explored [ 31 ]. The study included 60 participants, 28 of whom died during the study period.…”

Bioimpedanciometria em avaliações nutricionais e de hidratação em um único centro de diálise

“…A relação AEC/ACT ajustada é um índice validado que tem sido associado à sobrevida 15 . Nongnuch et al 16 consideraram dois desvios padrão de AEC/ ACT pós-diálise para definir o excesso de fluido (≥ 0,41) e outros autores encontraram significância em relações ≥ 0,47 17 .…”

“…Perez-Morales et al 17 publicaram recentemente um estudo de prova de conceito que constatou que a AEC/ACT ≥ 0,47 está associada a maior risco de mortalidade usando a análise da curva ROC. No presente estudo, a AEC/ACT ≥ 0,47 foi também o valor de corte com melhor sensibilidade e especificidade para predizer mortalidade durante o acompanhamento.…”