Cardiovascular conditions in hemodialysis patients may be worsened by extensive interdialytic weight gain

Holmberg, Benny; Stegmayr, Bernd

doi:10.1111/j.1542-4758.2009.00335.x

Cited by 39 publications

(46 citation statements)

References 19 publications

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“…Ultrafiltration rate (UFR) is determined by both the amount of fluid removed, which at steady state is equivalent to interdialytic weight gain (IDWG), and the time over which this fluid is removed (dialysis session length [DSL]). Prior studies have demonstrated that both shorter DSL and larger IDWG (both of which would increase UFR) are associated with increased mortality (3,(7)(8)(9)(10)(11)(12)(13)(14). However, because DSL and IDWG are highly inter-related, it is unclear whether the association of each with mortality is independent of the other.…”

Section: Introductionmentioning

confidence: 86%

Disentangling the Ultrafiltration Rate–Mortality Association

Flythe

Curhan

Brunelli

2013

Clinical Journal of the American Society of Nephrology

103

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SummaryBackground and objectives Rapid ultrafiltration rate is associated with increased mortality among hemodialysis patients. Ultrafiltration rates are determined by interdialytic weight gain and session length. Although both interdialytic weight gain and session length have been linked to mortality, the relationship of each to mortality, independent of the other, is not adequately defined. This study was designed to evaluate whether shorter session length independent of weight gain and larger weight gain independent of session length are associated with increased mortality.Design, setting, participants, & measurements Data were taken from a national cohort of 14,643 prevalent, thriceweekly, in-center hemodialysis patients dialyzing from 2005 to 2009 (median survival time, 25 months) at a single dialysis organization. Patients with adequate urea clearance and delivered dialysis session $240 and ,240 minutes were pair-matched on interdialytic weight gain (n=1794), and patients with weight gain #3 and .3 kg were pair-matched on session length (n=2114); mortality associations were estimated separately.Results Compared with delivered session length $240, session length ,240 minutes was associated with increased all-cause mortality (adjusted hazard ratio [95% confidence interval], 1.32 [1.03 to 1.69]). Compared with weight gain #3, weight gain .3 kg was associated with increased mortality (1.29 [1.01 to 1.65]). The associations were consistent across strata of age, sex, weight, and weight gain and session length. Secondary analyses demonstrated dose-response relationships between both and mortality.Conclusions Among patients with adequate urea clearance, shorter dialysis session length and greater interdialytic weight gain are associated with increased mortality; thus, both are viable targets for directed intervention.

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Section: Introductionmentioning

confidence: 86%

Disentangling the Ultrafiltration Rate–Mortality Association

Flythe

Curhan

Brunelli

2013

Clinical Journal of the American Society of Nephrology

103

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“…However, it is seen as an unfit measure since dry weight can only be estimated. Nevertheless, the researchers continue to agree that IDWG should be defined as a percentage of dry weight (38,53). Furthermore, the point which defines fluid adherence is different in literature (54).…”

Section: Methods Of Measuring Adherencementioning

confidence: 99%

“…Furthermore, the point which defines fluid adherence is different in literature (54). However, research based practice states that IDWG should be less than 2.5 kg or 3.5% of dry body weight so as to reduce the excess fluid during dialysis sessions (53).…”

Section: Methods Of Measuring Adherencementioning

confidence: 99%

Adherence of adult Chronic Kidney Disease patients with regard to their dialysis, medication, dietary and fluid restriction

Chironda¹,

Bhengu²,

Manwere³

2017

Research Journal of Health Sciences

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Objective: Chronic Kidney Disease (CKD) has become a major health problem as a result of complicated interrelationships with diabetes mellitus, hypertension and other associated diseases. Effective management of CKD depends on patient's adherence to their dialysis plan, medications, dietary and fluid restrictions. This study aimed at systematically reviewing the adherence of adult Chronic Kidney Disease (CKD) patients with regard to their dialysis, medication, dietary and fluid restriction.Methods: Key words were used for the search in various data bases: "adherence", "Chronic Kidney Disease", "dialysis", "medication", "dietary" and "fluid restriction". Online data bases namely Medline, PubMed, Ebsco Host, CINAHL, google scholar and grey literature were used to identify published research from 1993 -2016. Forty three (43) articles were identified regarding adherence of CKD patients to dialysis, medication, dietary and fluid restriction.Results: Medication non adherence ranged from 3 to 80% through self-report, structured interview and biological markers. Fluid non-adherence was 10-74%. Using self-report and biological markers, nonadherence to diet was 2-39% and 19-57% respectively. With regards to dialysis, skipping and shortening hemodialysis adherence ranged from 2.5% -19% and 20.3% -32.3 % respectively. Globally, adherence rates to CAPD are not well documented in literature. Conclusion:Non-adherence to dialysis, medication, dietary and fluid restriction is an area of concern internationally in CKD population. Furthermore, non-adherence rates are not well researched and documented in African literature. Therefore, Nephrology professionals in clinical practice are agents of improving adherence of CKD patients to ensure effective management of the disease.Keywords: Adherence and non-adherence to medication, fluid, diet and dialysis, Chronic Ambulatory Peritoneal Dialysis (CAPD), Chronic Kidney Disease (CKD) and hemodialysis. Méthodes: Les mots clés suivants ont été utilisés pour la recherche: l'observance, la maladie rénale chronique, la dialyse, la médication, la restriction alimentaire et la restriction des fluides. La recherche a identifié 47 articles qui quantifient l 'adhérence des patients CKD à la dialyse, à la médication, à la restriction alimentaire et à la restriction des fluides.Résultats: La non-adhésion aux médicaments variait de 3 à 80% grâce à l'auto-évaluation, à l'entrevue structurée et aux marqueurs biologiques. La non-adhésion fluide de 30-74% en utilisant l'auto-rapport et de 10 à 60% sur la base d'un gain de poids interdialytique inapproprié. À l'aide de marqueurs biologiques et d'auto-évaluation, la nonadhésion à l'alimentation était respectivement de 2 à 39% et de 19 à 57%. En ce qui concerne la dialyse, le saut et le raccourcissement de l'hémodialyse ont varié respectivement de 2,5% à 19% et de 20,3% à 32,3%. Globalement, les taux d'adhésion à la CAPD ne sont pas bien documentés dans la littérature. Conclusion:Des preuves documentées ont révélé une non-adhésion à la dialyse, aux m...

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“…This retention is quantified as interdialytic weight gain (IDWG). High IDWG is associated with hypertension (1), intradialytic hypotension (2), and adverse cardiovascular outcomes (3,4), including increased all-cause mortality (5). It is well accepted that the degree of IDWG is influenced by dietary sodium intake (6,7), and for this reason, guidelines suggest that individuals with CKD restrict dietary sodium intake (8,9).…”

Section: Introductionmentioning

confidence: 99%

Effect of Tenapanor on Interdialytic Weight Gain in Patients on Hemodialysis

Block

Rosenbaum

Leonsson-Zachrisson

et al. 2016

CJASN

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Background and objectives Interdialytic weight gain in patients on hemodialysis is associated with adverse cardiovascular outcomes and increased mortality. The degree of interdialytic weight gain is influenced by sodium intake. We evaluated the effects of tenapanor (AZD1722 and RDX5791), a minimally systemically available inhibitor of the sodium/hydrogen exchanger isoform 3, on interdialytic weight gain in patients with CKD stage 5D treated with hemodialysis.Design, setting, participants, & measurements This phase 2, randomized, double-blind study (NCT01764854; conducted January to September of 2013) enrolled adults on maintenance hemodialysis with interdialytic weight gain $3.0% of postdialysis weight and $2 kg. Patients were randomly assigned (1:1) to receive tenapanor or placebo. The primary end point was change in mean interdialytic weight gain (percentage of baseline postdialysis weight) from baseline (mean across a 2-week run-in period) to week 4. In a subgroup of inpatients, 24-hour stool sodium and stool weight were assessed for 1 week.Results Sixteen patients received 1 week of inpatient treatment (tenapanor, eight; placebo, eight), and 72 patients received 4 weeks of treatment in an outpatient setting (tenapanor, 37; placebo, 35; completers: tenapanor, 31; placebo, 33). In the outpatient cohort, no significant effect on interdialytic weight gain was detected; least squares mean changes in relative interdialytic weight gain from baseline to week 4 were tenapanor, 20.26% (95% confidence interval, 20.57% to 0.06%) and placebo, 20.23% (95% confidence interval, 20.54% to 0.07%; P=0.46). During week 1 (inpatient cohort only), compared with placebo, tenapanor treatment resulted in higher stool sodium content (mean [6SD]: tenapanor, 36.6 [621.8] mmol/d; placebo, 2.8 [62.7] mmol/d; P,0.001) and higher stool weight (tenapanor, 172.5 [668.1] g/d; placebo, 86.3 [630.0] g/d; P,0.01). A similar safety profile was observed across treatment groups with the exception of diarrhea, which occurred more frequently with tenapanor treatment.Conclusions Tenapanor treatment increased stool sodium and weight over placebo in patients undergoing hemodialysis. However, over 4 weeks of treatment, there was no difference in interdialytic weight gain between patients treated with tenapanor and those receiving placebo.

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Cardiovascular conditions in hemodialysis patients may be worsened by extensive interdialytic weight gain

Cited by 39 publications

References 19 publications

Disentangling the Ultrafiltration Rate–Mortality Association

Disentangling the Ultrafiltration Rate–Mortality Association

Adherence of adult Chronic Kidney Disease patients with regard to their dialysis, medication, dietary and fluid restriction

Effect of Tenapanor on Interdialytic Weight Gain in Patients on Hemodialysis

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