Effect of Strict Volume Control on Renal Progression and Mortality in Non-Dialysis-Dependent Chronic Kidney Disease Patients: A Prospective Interventional Study

Abstract

Objective: The aim of this study was to examine the effect of volume status on the progressions of renal disease in normovolemic and hypervolemic patients with advanced non-dialysis-dependent chronic kidney disease (CKD) who were apparently normovolemic in conventional physical exam­ination. Materials and Methods: This was a prospective interventional study performed in a group of stage 3–5 CKD patients followed up for 1 year. Three measurements were made for volume and renal status for every patient. The fluid status was assessed by a bioimpedance spectroscopy method. A blood pressure (BP) value > 130/80 mm Hg prompted the initiation or dose increment of diuretic treatment in normovolemic patients. Result: Forty-eight patients (48%) were hypervolemic. At the end of the 1-year follow-up, hypervolemic patients were found to have a significantly lower estimated glomerular filtration rate and higher systolic BP compared to baseline. Hypervolemia was associated with an increased incidence of death. Conclusion: We have shown that maintenance of normovolemia with diuretic therapy in normovolemic patients was able to slow down and even improve the progression of renal disease. Volume overload leads to an increased risk for dialysis initiation and a decrease in renal function in advanced CKD. Volume overload exhibits a stronger association with mortality in CKD patients.

Overhydration Measured by Bioimpedance Spectroscopy and Urinary Serine Protease Activity Are Risk Factors for Progression of Chronic Kidney Disease

“…Faucon et al [18] found that extracellular fluid measured using a tracer dilution method was associated with progression to end-stage kidney disease and mortality in patients with stage 1-4 CKD. Strict volume control with use of diuretics showed a positive effect on progression of CKD and delayed initiation of RRT in advanced nondialysis CKD patients [19]. In our cohort, other parameters indicating fluid overload, such as blood pressure and plasma NT-pro-BNP, were significantly associated with OH and with progression of CKD, which confirms the robustness of the relationship between volume overload and progression.…”

Geriatric Nutritional Risk Index Is Associated with Unique Health Conditions and Clinical Outcomes in Chronic Kidney Disease Patients

“…The most striking finding of the present study was that the GNRI was correlated with several major risk factors for accelerated CKD progression and CVD including DM, hypertension, eGFR, UPCR, and inflammatory markers [16,17]. Interestingly, we observed a significant and inverse relationship between the GNRI and overhydration, which has also been reported to be independently predictive of an increased risk of adverse renal and CV outcomes in nondialysis CKD patients [14,18]. The underlying mechanisms linking the nutritional status, overhydration, and proteinuria are not clear.…”

Correlation of Kidney Size on Computed Tomography with GFR, Creatinine and HbA1C for an Accurate Diagnosis of Patients with Diabetes and/or Chronic Kidney Disease

“…Kidney volume, as stated in various studies, can be a significant prognostic biomarker for risk assessment and disease tracking, as CKD patients usually develop fluid overload associated with systemic inflammation [ 36 ]. This volume overload has been linked to a decrease in renal function in advanced CKD patients [ 37 ].…”