Overhydration as a modifiable cardio-vascular risk factor in patients undergoing hemodialysis

Abstract

What's new?Mortality in end-stage renal disease is exceptionally high comparing to age-and sex-matched general population with cardio-vascular events as the leading cause of death. Chronic fluid overload, a non-traditional cardio-vascular risk factor, seems to have a critical contribution to this dramatic outcome. This study aimed at providing statistical evidence for the relation between overhydration and high cardio-vascular mortality in end-stage renal disease. We confirmed that fluid overload is an independent mortality risk factor in this group of patients. Furthermore, we were able to identify other interesting elements leading to poor prognosis (eg, male gender, diabetes, heart insufficiency, smoking and cerebrovascular incidents) as well as provide additional data promoting the use of bioimpedance for proper fluid balance in end-stage renal disease. We hope that by highlighting some of the less known issues, our work will help to improve the medical care of patients undergoing hemodialysis.

On Whether Ca-125 Is the Answer for Diagnosing Overhydration, Particularly in End-Stage Kidney Disease Patients—A Systematic Review

“…This natriuretic peptide tends to increase in PD patients when compared to a healthy population, and scientists point out that the dialysis method has no influence on its level in the blood [59]. NT-pro-BNP tends to increase in individuals with fluid excess during clinical studies on various methods of estimating hydration status [22,30,32,[42][43][44]49,60,61]. It was elevated during the increase in protein clearance during peritoneal dialysis [44], associated with pleural effusion and IVC diameter [30,61] and ECW/TBW ratio [32,42,43,60] but not with peripheral edema [19,30].…”

“…In a research study involving 179 non-dialysis CKD patients in all stages, OH measured by BCM correlated with urinary protease activity and progression of renal dysfunction, as well as with increases in NT-pro-BNP and systolic blood pressure [42]. Schwermer et al indicated that male gender, smoking, diabetes, and cardiovascular incidences were connected to OH [49]. Scientists noticed also that OH induced an increase in NT-pro-BNP and troponin concentration which was interpreted as cardiovascular toxicity of water surplus.…”

Relative superiority of the Lund–Malmö revised equation for glomerular filtration rate estimation in patients with end-stage renal disease not on dialysis among 23 equations

“…End-stage renal disease (ESRD) can increase mortality, impose financial burden and reduce the quality of life [4][5]. Nevertheless, studies evaluating the performance of eGFR equations in patients with ESRD not on dialysis remain scarce.…”