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

Abstract

We aimed to investigate whether annual change in the extracellular fluid to intracellular fluid (ΔECF/ICF) ratio can accurately predict mortality in hemodialysis patients. Totally, 247 hemodialysis patients were divided into two groups according to the median baseline ECF/ICF ratio of 0.563 and ΔECF/ICF ≥ 0% or < 0% during the first year, respectively. Thereafter, they were divided into four groups according to each cutoff point and were followed up for mortality assessment. The ECF/ICF ratio increased from 0.566 ± 0.177 to 0.595 ± 0.202 in the first year (P = 0.0016). During the 3.4-year median follow-up, 93 patients died (42 cardiovascular-specific causes). The baseline ECF/ICF ≥ 0.563 and ΔECF/ICF ≥ 0% were independently associated with all-cause mortality (adjusted hazard ratio [aHR] 4.55, 95% confidence interval [CI] 2.60–7.98 and aHR 8.11, 95% CI 3.47–18.96, respectively). The aHR for ECF/ICF ≥ 0.563 and ΔECF/ICF ≥ 0% vs. ECF/ICF < 0.563 and ΔECF/ICF < 0% was 73.49 (95% CI 9.45–571.69). For model discrimination, adding the ΔECF/ICF (0.859) alone and both the baseline ECF/ICF and ΔECF/ICF (0.903) to the established risk model (0.746) significantly improved the C-index. Similar results were obtained for cardiovascular mortality. In conclusion, the ΔECF/ICF ratio could not only predict all-cause and cardiovascular mortality but also improve predictability of mortality in hemodialysis patients.

Combined Evaluation of Geriatric Nutritional Risk Index and Modified Creatinine Index for Predicting Mortality in Patients on Hemodialysis

“…PEW, a malnutritional state defined by a loss of fat and muscle mass because of catabolic inflammation, is prevalent in patients receiving HD and is also related to increased risks of mortality [4,[21][22][23][24]. The MIS proposed by Kalanter-Zadeh et al is the gold standard method for assessing the nutritional status of HD patients [2].…”

Tirzepatide Reduces Fat Mass and Provides Good Glycaemic Control in Type 2 Diabetes Patients Undergoing Haemodialysis: A Single‐Centre Retrospective Study

“…Given the suggested association of ECW/TBW ratio with proteinenergy wasting and the elevated mortality risk linked to a ratio surpassing 0.4 [13], our study delved into assessing this ratio within the study cohort. Induction of tirzepatide did not affect the ECW/TBW ratio (0.40 ± 0.01 vs. 0.40 ± 0.01; p = 0.172, Figure 5D).…”

“…The reduction in DW because of tirzepatide treatment was −3.5 ± 0.5 kg and was also observed over an extended period of time; however, the effect was observed mainly in body fat content, showing no discernible impact on skeletal muscle mass and SMI. Recent studies have demonstrated that a decrease in SMI, or the appearance of sarcopenia and frailty, is often observed in patients with CKD, which shortens their life expectancy [13]. In this regard, tirzepatide only reduces fat and does not affect muscle mass, thereby eliminating concerns regarding sarcopenia and frailty in patients with DKD undergoing HD.…”

“…PEW, the wasting of muscle and fat, is prevalent in patients undergoing HD and is strongly linked to mortality; the ECW/TBW ratio has been proposed as a possible marker for protein-energy wasting and mortality, as a ratio exceeding 0.4 correlates with an elevated risk of mortality associated with protein-energy wasting [13]. In our study, the ECW/TBW ratio with tirzepatide administration was 0.3, suggesting a low risk of protein-energy wasting or frailty [14].…”

Ratio of extracellular water to intracellular water and simplified creatinine index as predictors of all-cause mortality for patients receiving hemodialysis

“…Recently, the BIA-measured ratio of extracellular water (ECW) to intracellular water (ICW), which can simultaneously reflect fluid overload and malnutrition, has emerged as an indicator of PEW in patients receiving hemodialysis [24]. The ECW/ICW ratio can help predict cardiovascular mortality, cardiovascular events, and all-cause mortality in this population [24][25][26]. Park et al reported that ECW fluid overload was associated with sarcopenia in the general population [27].…”