The Association of Interdialytic Weight Gain With Nutritional Parameters and Mortality Risk in Hemodialysis Patients

Abstract

High interdialytic weight gain (IDWG) is considered as an indicator of noncompliance but could also be interpreted as an index of appetite. This study was designed to investigate the relationship IDWG with malnutrition and mortality risk in hemodialysis (HD) patients through a follow-up of 24 months. We divided HD patients into two groups according to their IDWG as Group I (IDWG < 3% of dry weight/day) (27 patients; age 46.8 +/- 21.1 years; HD duration: 28.3 +/- 39.5 months) and Group II (IDWG > or = 3% of dry weight/day) (41 patients; age 40.9 +/- 11.3 years; HD duration: 54.7 +/- 38.7 months). We investigated malnutrition through biochemical analysis (albumin, prealbumin, total cholesterol, creatinine, predialysis potassium and phosphorus levels), normalized protein catabolic rate (nPCR), anthropometric measurements. On initial assessment, group I had significantly lower predialysis creatinine, prealbumin and potassium levels than Group II (p < 0.0001, p < 0.01 and p < 0.001, respectively). At the 24th month, there were significantly lower creatinine, prealbumin, potassium and phosphorus levels in the low-IDWG group. Group I had significantly lower nPCR, body weight, body mass index and triceps skinfold thickness during the follow-up. Over the 24 months, 13 (48.1%) Group I patients and nine (21.9%) Group II patients exhibited loss of dry weight (p < 0.02). According to the survival curves prognosis was significantly poorer for Group I than Group II (2-year survival 74.0% and 92.6%, p < 0.03). Group I individuals with low albumin levels had the worst survival rate (57.1%). In conclusion there is a strong association of IDWG with nutritional parameters in HD patients. Our study draws attention for a possible risk of developing malnutrition in a HD patient with low IDWG.

Relationship Between Interdialytic Weight Gain and Blood Pressure Among Prevalent Hemodialysis Patients

“…5,8,9,12,21 In addition, although retrospective analyses suggested that a large percentage of IDWG was associated with increased risk of mortality, 6,7 recent investigations noted an increased percentage of IDWG to be associated with improved nutritional parameters and improved mortality. 10,[22][23][24] Thus, some postulated that the lack of relationship between moderate hypertension and outcomes may be caused by the benefit of additional volume and caloric intake, which can increase BP parameters. However, in our investigation, the impact of day-to-day volume intake on BP was modest, suggesting that intake volume may not have a significant role in the lack of association between moderate hypertension and clinical outcomes.…”

“…Whereas the available epidemiological evidence suggested that moderate hypertension likely was well tolerated in hemodialysis patients, 5,9,11,12,21 the relationship between BP and outcomes is confounded by such factors as day-to-day variations in fluid intake that are associated with nutritional status and subsequent clinical outcomes. 10,[21][22][23][24][25] Thus, defining the independent relationship between IDWG and BP has important clinical implications.…”

Significance of Interdialytic Weight Gain versus Chronic Volume Overload: Consensus Opinion

“…(3) IDWG as a marker of better nutrition: Several studies have found that IDWG was associated with better nutritional status [51,52,53,54,55,56,57], suggesting a role of greater appetite and higher food and fluid intake.…”

Fatores relacionados ao ganho de peso interdialítico em pacientes em hemodiálise

“…Estes achados são discordantes em relação à maioria dos trabalhos disponíveis na literatura, nos quais o maior GPID foi encontrado em pacientes com melhor estado nutricional. 8,18 Apesar de não termos avaliado a ingestão alimentar dos pacientes estudados, podemos supor que no nosso grupo de pacientes, o %GPID esteve mais associado à ingestão de sódio e líquidos em si do que ao consumo energético-proteico total. Além disso, é comum encontrarmos preferência por alimentos líquidos ou semilíquidos em pacientes com desnutrição.…”