Correlation between volume overload, chronic inflammation, and left ventricular dysfunction in chronic kidney disease patients

Hassan, M.; Duarte, Raquel; Dix-Peek, Thérèse; Vachiat, Ahmed; Naidoo, Sagren; Dickens, Caroline; Grinter, Sacha; Manga, Pravin; Naicker, Saraladevi

doi:10.5414/cnp86s127

Cited by 39 publications

(40 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The association between FO and IL-6 was confirmed in a larger study also including HD and CKD patients not on dialysis. In this same study, an association between FO and other markers of inflammation, namely, endotoxin and C-reactive protein (CRP) was also found [21]. The association between CRP as a marker of inflammation and FO was further confirmed in a study of 59 PD patients [19] and in a single-center study, using segmental BIA, in CKD patients [22].…”

Section: Evidence For the Relation Between Fo And Inflammationmentioning

confidence: 55%

See 1 more Smart Citation

Fluid Overload and Inflammation Axis

et al. 2018

View full text Add to dashboard Cite

Extracellular fluid overload (FO), which is assessed using bioimpedance technologies, is an important predictor of outcome in dialysis patients and in patients with early stages of chronic kidney disease. While traditional cardiovascular abnormalities are assumed to mediate this risk, recently also, the importance of noncardiovascular factors, such as systemic inflammation and malnutrition has been shown. While both FO and inflammation are independent risk factors for mortality, recent studies have shown that their combined presence can lead to a cumulative risk profile. From a pathophysiologic viewpoint, FO and inflammation can also be mutually reinforcing. Inflammation could contribute to FO by hypoalbuminemia, capillary leakage, and a (unnoticed) decline in lean and/or fat tissue mass resulting in incorrect estimation of dry weight. Reciprocally, FO could lead to inflammation by the translocation of endotoxins through a congested bowel wall or by a proinflammatory effect of tissue sodium. The relative importance of these putative factors is, however, not clear yet and epidemiological studies have shown no clear temporal direction regarding the relationship between FO and inflammation. FO and inflammation appear to be part of (dynamic) clusters of risk factors, including malnutrition and hyponatremia. Technology-guided fluid management of the often vulnerable dialysis patient with FO and inflammation cannot yet be based on evidence from randomized controlled trials, in which these specific patients were in general not included. In the absence of those trials, treatment should be based on identifying actionable causes of inflammation and on the judicious removal of excess volume based on frequent clinical reassessment.

show abstract

Section: Evidence For the Relation Between Fo And Inflammationmentioning

confidence: 55%

“…Antlanger et al [30] did not observe a relation between the OH:ECW ratio and CRP levels in 126 dialysis patients. However, in the largest studies on this topic, this relation appears to be robust [10, 21]. …”

Section: Evidence For the Relation Between Fo And Inflammationmentioning

confidence: 99%

Fluid Overload and Inflammation Axis

et al. 2018

View full text Add to dashboard Cite

show abstract

“…One of the most important effects of HD is the removal of excess extracellular volume. Extracellular volume is associated with hypertension and cardiac congestion, but also with systemic inflammation and is a major risk factor for mortality in HD patients . However, due to the fact that this excess fluid has to be removed in short time periods, significant decreases in blood volume can occur, which can have pronounced hemodynamic consequences and lead to severe IDH …”

Section: Circulatory Stressmentioning

confidence: 99%

“…Extracellular volume is associated with hypertension and cardiac congestion, but also with systemic inflammation and is a major risk factor for mortality in HD patients. [4][5][6] However, due to the fact that this excess fluid has to be removed in short time periods, significant decreases in blood volume can occur, which can have pronounced hemodynamic consequences and lead to severe IDH. 7 In previously healthy subjects, a decline in blood volume above 15% is associated with classic type II hypovolemic shock (an [unspecified] decline in systolic blood pressure and increase in pulse rate >100 bpm).…”

Section: Circulatory Stressmentioning

confidence: 99%

Hemodialysis: A model for extreme physiology in a vulnerable patient population

Kooman

Katzarski

Sande

et al. 2018

Seminars in Dialysis

View full text Add to dashboard Cite

Hemodialysis (HD) is a lifesaving treatment for patients with end-stage renal disease, which is very efficient in the correction of abnormalities of the internal environment. However, this efficiency also induces significant hemodynamic, thermal, and respiratory stressors. These have parallels with the extreme physiologic demands which are normally mainly experienced by healthy subjects under adverse environmental conditions, with the difference that they must be endured by a vulnerable patient population. Hemodynamic stress induced by ultrafiltration leads to a decline in circulating blood volume, which may result in intradialytic hypotension (IDH) and changes in tissue perfusion, which may have long-term consequences for the function of vital organs such as the brain and the heart. Pronounced declines in central venous oxygen saturation have been observed during routine HD, which are related to the circulatory stress imposed upon the patient. Apart from patient-related factors, thermal stress induced by HD may lead to skin vasodilation, counteracting the normal hemodynamic response to hypovolemia, which has important pathophysiologic correlates in heat syncope. Lastly, respiratory stress is reflected by prolonged arterial hypoxemia during HD, which is both related to patient-related factors, but may also be partly because of the treatment itself, especially during the first 30-60 minutes. Whereas hypoxemia during HD is related to increased mortality, its role in the reduced tissue oxygen delivery during HD should be further defined. Treatment modifications, such as cool or temperature-controlled HD, may reduce circulatory and thermal stress, which also may translate into a reduced risk of long-term cardiac or cerebral damage. However, as circulatory stress is mainly time-dependent, prolonged, or more dialysis treatment may reduce the homeostatic burden on the patient.

show abstract

“…10 Recently, two important phenomena were added as factors intertwined with inadequate volume control and poor outcomes: chronic inflammation [11][12][13] frequently manifesting in malnutrition-inflammation complex syndrome 14 and myocardial stunning often seen in the setting of hemodynamic instability during the hemodialysis procedure. 13,15,16 The majority of studies exploring these relationships were performed in either predialysis 17,18 or peritoneal dialysis patients [19][20][21][22] or hemodialysis patients who were recently hospitalized or discharged and data on maintenance hemodiafiltration is scarce. 23,24 Here, studied the relationship between fluid overload, inflammatory markers, and serum albumin in stable end-stage renal disease (ESRD) patients on maintenance hemodiafiltration, who received bioimpedance spectroscopy analysis as part of their routine care.…”

Section: Introductionmentioning

confidence: 99%

The association of overhydration with chronic inflammation in chronic maintenance hemodiafiltration patients

Zsom¹,

Faludi

Fülöp

et al. 2019

Hemodialysis International

View full text Add to dashboard Cite

Introduction: Achieving euvolemia is one of the major challenges when treating end‐stage renal disease (ESRD) patients receiving maintenance renal replacement therapy. Fluid overload is recognized as an independent predictor of mortality in ESRD, but its association with chronic inflammation is less well explored especially in chronic maintenance hemodiafiltration. Methods: We performed a cross‐sectional study of 87 prevalent ESRD patients receiving chronic maintenance hemodiafiltration (vintage 66.5 ± 57.1 months) with bioimpedance analysis to characterize the degree of percent overhydration (OH%). We also compared the levels of inflammatory markers, including C‐reactive protein (CRP), serum albumin, neutrophil/lymphocyte ratio (NLR), and hemoglobin red cell distribution width (RDW) for the overhydrated (OH% ≥ 15%) versus euvolemic (OH% < 15%) groups. Linear regression analysis was performed to explore relationships between the degree of OH and inflammatory indicators. Findings: The cohort represented an all‐European population with a mean age of 60.9 ± 14.7 years and prevalence of diabetes mellitus of 27%. The entire cohort's OH% was 14.9% ± 5.1% (range −11.1% to 39.0%); further, the <15% group of patients’ OH% was 8.0% ± 8.5% versus 20.9% ± 5.1% in the OH% ≥ 15% group (P < 0.0001). Forty‐seven patients (53%) were overhydrated by traditional criteria (OH% ≥15%) and 20 patients (23%) were severely overhydrated (OH% > 20%). The euvolemic (OH% <15%) versus severely overhydrated (OH% > 20%) groups had significant differences in markers of inflammation: CRP (9.8 ± 10.6 vs. 21.5 ± 21.6 mg/L, P < 0.006), serum albumin (37.6 ± 02.9 vs. 34.5 ± 5.3 g/L, P < 0.004), and NLR (3.06 ± 1.25 vs. 3.92 ± 2.04; P < 0.004). On linear regression, significant correlations were found between OH% and CRP (r = 0.2899, P < 0.006), serum albumin (r = −0.3670; P < 0.0005), RDW (r = 0.2992; P < 0.005), and NLR (r = 0.2900; P < 0.006). Discussion: In a prevalent hemodiafiltration cohort, OH was common and correlated with several inflammatory markers.

show abstract

Correlation between volume overload, chronic inflammation, and left ventricular dysfunction in chronic kidney disease patients

Cited by 39 publications

References 0 publications

Fluid Overload and Inflammation Axis

Fluid Overload and Inflammation Axis

Hemodialysis: A model for extreme physiology in a vulnerable patient population

The association of overhydration with chronic inflammation in chronic maintenance hemodiafiltration patients

Contact Info

Product

Resources

About