Diminishing dry weight is strongly associated with all-cause mortality among long-term maintenance prevalent dialysis patients

Abstract

ObjectivesTo investigate the relationship between dry weight (DW) change and survival in long-term maintenance prevalent dialysis patients.MethodsWe conducted a prospective data collection study with retrospective analysis of the registered data. Patients were followed up for 5 years (1-year observation of DW changes and subsequent 4-year follow-up). The outcome was all-cause mortality. The predictors were 1-year DW change rates. The hazard ratios (HRs) for all-cause mortality were calculated using multivariable Cox regression analysis, fully adjusted for age, sex, basal kidney disease, dialysis vintage, current smoking, past cardiovascular events, serum albumin, DW at enrollment, serum creatinine, mean predialysis systolic blood pressure, and cardiothoracic ratio or 1-year cardiothoracic ratio change rate. Propensity score (PS) analysis was also conducted using the same covariates of Cox regression analysis.ResultsIn total, 899 dialysis patients (mean dialysis vintage: 101.2 months) were followed up, and 180 deaths were recorded, of which 90 were of cardiovascular origin. Each 2% decrement of DW showed adjusted HR, and the 95% confidence interval was 1.24 [1.16–1.33]. According to the 1-year DW change rate, participants were divided into five groups (group A, ≥+3%; group B, +1 to +2.9%; group C, -0.9 to +0.9%; group D, -2.9 to -1.0%; and group E, ≤-3%). For survival curves based on grouping, group B had the best and group E had the worst survival rate (p<0.01, log-rank test). Therefore, we set group B as a reference; adjusted risks for death of groups D and E were 2.16 [1.23–3.79] and 2.66 [1.54–4.58], respectively. However, this relation was blunted in patients of heavier DW. The PS-matched cohort showed a poorer prognosis in patients with diminishing DW divided by DW change rate at -0.635% (mean value of DW change rate).ConclusionIn the long-term maintenance hemodialysis cohort, 1-year DW decrement, especially ≤-3.0%, was significantly associated with all-cause mortality, and cardiovascular disease-related death was prominent in these patients.

Nutrition and quality of life in chronic kidney disease patients: a practical approach for salt restriction

“…We showed that in chronic HD patients, risk factors for death differed according to shortterm (≤3 years) or long-term (>3 years) observation. Sato et al [76] showed that the DW obtained from the 1-year observation was a strong predictor of overall death. Kalantar et al [77] investigated weight changes after initiation of dialysis and found that chronic baseline weight loss had a greater impact on mortality than acute weight loss.…”

Long-term Weight Loss as a Predictor of Mortality in Hemodialysis Patients

“…Few studies have evaluated the association between BW change and mortality among chronic HD patients. 7,[13][14][15] Further, the previous studies have primarily aimed to clarify the impact of obesity on the outcome, as evidenced by the high prevalence of obese patients in those studies. 14,16 Moreover, the slope of BW in these previous studies was generated using a maximum of 6-12 months data, which may not be long enough to exclude the impact of acute disease.…”

“…2,22 A limited number of studies captured long-term weight changes as prognosis predictors in maintenance HD patients, and their timeframe of weight change was generally 6-12 months. 7,13,15 Notably, fluctuations in seasonal BW change were reported to be small (around 0.5 kg) in the Japanese dialysis population. 23 Although the association between long-term BW change and mortality in HD patients seems clinically intuitive, the underlying mechanisms of this relationship remain to be elucidated.…”

Influence of dry weight reduction on anemia in patients undergoing hemodialysis

“…Attainment of actual dry weight can improve patient cardiovascular status and quality of life. 10,11…”

“…Attainment of actual dry weight can improve patient cardiovascular status and quality of life. 10,11 Volume overload is not only a major risk factor for cardio-cerebrovascular complications in dialysis patients but is also associated with other adverse effects. For example, chronic volume overload is a risk factor for a microinflammatory state, in which the levels of inflammatory factors or markers, such as CRP, interleukin-6 (IL-6), transforming growth factor-b1, and brain natriuretic peptide, are markedly higher compared with patients that have no volume overload.…”