Interdialytic Weight Gain and Cardiovascular Outcome in Incident Hemodialysis Patients

Lee, Mi Jung; Doh, Fa Mee; Kim, Chan Ho; Koo, Hyang Mo; Oh, Hyung Jung; Park, Sun-Hee; Han, Seung Hyeok; Yoo, Tae‐Hyun; Kim, Yong Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam Ho; Kang, Shin Wook

doi:10.1159/000362743

Cited by 60 publications

(63 citation statements)

References 67 publications

(116 reference statements)

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“…Recently, overhydration measured by the Body Composition Monitor significantly correlated with UV but did not correlate with GFR-24U in patients on PD (27), supporting our observation. In patients on HD, UV was the largest in patients with low interdialytic weight gain (interdialytic weight gain/dry weight ,1.0%), despite comparable GFR-24U (33). However, unfortunately, objective assessments of volume status, such as relative plasma volume monitoring, bioelectrical impedance analyses, or echocardiography, were not performed, making it difficult to affirm a stronger relationship between volume overload and UV in this study.…”

Section: Discussionmentioning

confidence: 79%

Prognostic Value of Residual Urine Volume, GFR by 24-hour Urine Collection, and eGFR in Patients Receiving Dialysis

Lee

Park

et al. 2017

CJASN

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Background and objectives Residual kidney function can be assessed by simply measuring urine volume, calculating GFR using 24-hour urine collection, or estimating GFR using the proposed equation (eGFR). We aimed to investigate the relative prognostic value of these residual kidney function parameters in patients on dialysis.Design, setting, participants, & measurements Using the database from a nationwide prospective cohort study, we compared differential implications of the residual kidney function indices in 1946 patients on dialysis at 36 dialysis centers in Korea between August 1, 2008 and December 31, 2014. Residual GFR calculated using 24-hour urine collection was determined by an average of renal urea and creatinine clearance on the basis of 24-hour urine collection. eGFR-urea, creatinine and eGFR b 2 -microglobulin were calculated from the equations using serum urea and creatinine and b 2 -microglobulin, respectively. The primary outcome was all-cause death.Results During a mean follow-up of 42 months, 385 (19.8%) patients died. In multivariable Cox analyses, residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95% confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.98; 95% confidence interval, 0.95 to 0.99) were independently associated with all-cause mortality. In 1640 patients who had eGFR b 2 -microglobulin data, eGFR b 2 -microglobulin (hazard ratio, 0.98; 95% confidence interval, 0.96 to 0.99) was also significantly associated with all-cause mortality as well as residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95% confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.97; 95% confidence interval, 0.95 to 0.99). When each residual kidney function index was added to the base model, only urine volume improved the predictability for all-cause mortality (net reclassification index =0.11, P=0.01; integrated discrimination improvement =0.01, P=0.01).Conclusions Higher residual urine volume was significantly associated with a lower risk of death and exhibited a stronger association with mortality than GFR calculated using 24-hour urine collection and eGFR-urea, creatinine. These results suggest that determining residual urine volume may be beneficial to predict patient survival in patients on dialysis.

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Section: Discussionmentioning

confidence: 79%

Prognostic Value of Residual Urine Volume, GFR by 24-hour Urine Collection, and eGFR in Patients Receiving Dialysis

Lee

Park

et al. 2017

CJASN

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“…They found that the positive effect of higher IDWG (or fluid retention) on appetite and nutrition outweighs its negative effect on blood pressure. However, several studies have showed opposite results regarding associations between higher IDWG and mortality [17, 18]. In a study on non-adherence in HD patients using the international prospective DOPPS cohort, Saran et al [19] reported that IDWG over 5.7% of BW was associated with higher mortality (RR 1.12, p = 0.047) over a median of 1.8–3 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Association of Ultrafiltration Rate with Mortality in Incident Hemodialysis Patients

Kim

Chang

Kim

et al. 2018

Nephron

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Background/Aims: Ultrafiltration rate (UFR) appears to be associated with mortality in prevalent hemodialysis (HD) patients. However, the association of UFR with mortality in incident HD patients remains unknown. Methods: We examined a US cohort of 110,880 patients who initiated HD from 2007 to 2011. Baseline UFR was divided into 5 groups (<4, 4 to <6, 6 to <8, 8 to <10, and ≥10 mL/h/kg body weight [BW]). We examined predictors of higher baseline UFR using logistic regression and the association of baseline UFR and all-cause and cardiovascular (CV) mortality using Cox proportional hazard models with adjustments for demographics, comorbidities, and markers of malnutrition-inflammation-cachexia syndrome. Results: Patients were 63 ± 15 years, with 43% women, 32% African Americans, and had a mean baseline UFR of 7.5 ± 3.1 mL/h/kg BW. In the fully adjusted logistic regression models, factors associated with higher UFR (≥7.5 mL/h/kg BW) included Hispanic ethnicity, diabetes, and higher dietary protein intake. There was a linear association between UFR and all-cause and CV mortality, where UFR ≥10 mL/h/kg BW (reference UFR 6–<8 mL/h/kg BW) conferred the highest risk in both unadjusted (HR 1.15 [95% CI 1.10–1.19]) and adjusted models (HR 1.23 [95% CI 1.16–1.31]). The linear association with all-cause mortality remained consistent across strata of age, urine volume, and treatment time. Conclusions: Higher UFR is independently associated with higher all-cause and CV mortality in incident HD patients. Clinical trials are warranted to examine the effects of lowering UFR on outcomes.

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“…An anuric hemodialysis patient responding to salt-induced osmometric thirst will show about 1 kg of IDWG for every 8 g of salt consumed [8]. Some observational studies have reported an association between high mortality and high IDWG [11][12][13][14]. In a small selected sample, higher salt intake was independently associated with greater all-cause mortality [15].…”

Section: Introductionmentioning

confidence: 99%

Salt Intake and All-Cause Mortality in Hemodialysis Patients

Ikenoue¹,

Koike²,

Fukuma³

et al. 2018

Am J Nephrol

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Background: Although some clinical practice guidelines regarding hemodialysis recommend salt restriction, few studies have examined the association between salt intake and clinical outcomes in hemodialysis patients. This study aimed to clarify the association between salt intake and mortality in hemodialysis patients. Methods: This retrospective cohort study was based on the Japanese Society for Dialysis Therapy renal data registry database (2008) and included 88,115 adult patients who had received hemodialysis for at least 2 years. Estimated salt intake was the main predictor and was calculated from intra-dialytic weight loss and pre- and post-dialysis serum sodium levels. Nonlinear logistic regression was used to determine the association between salt intake and mortality, adjusting for potential confounders. The outcomes considered were all-cause mortality and cardiovascular death at 1 year. Results: The median (25–75th percentile) salt intake at baseline was 6.4 (4.6–8.3) g/day. At 1 year, all-cause mortality occurred in 1,845 (2.1%) patients, including 807 cardiovascular deaths. The low salt intake group (< 6 g/day) demonstrated the highest all-cause mortality and cardiovascular deaths. No association was observed between high salt intake, all-cause mortality and cardiovascular deaths. The lowest risk for all-cause mortality and cardiovascular death occurred among patients with an estimated salt intake of 9 g/day. Conclusion: Low salt intake, but not high salt intake, was associated with all-cause and cardiovascular mortality in Japanese hemodialysis patients. Further studies to justify including a lower limit of salt intake for hemodialysis patients are suggested.

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Interdialytic Weight Gain and Cardiovascular Outcome in Incident Hemodialysis Patients

Cited by 60 publications

References 67 publications

Prognostic Value of Residual Urine Volume, GFR by 24-hour Urine Collection, and eGFR in Patients Receiving Dialysis

Prognostic Value of Residual Urine Volume, GFR by 24-hour Urine Collection, and eGFR in Patients Receiving Dialysis

Association of Ultrafiltration Rate with Mortality in Incident Hemodialysis Patients

Salt Intake and All-Cause Mortality in Hemodialysis Patients

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