The mortality risk of overhydration in haemodialysis patients

Wizemann, V.; Wabel, Peter; Chamney, Paul; Załuska, Wojciech; Moissl, Ulrich; Rode, Christiane; Malecka-Masalska, Teresa; Marcelli, Daniele

doi:10.1093/ndt/gfn707

Cited by 571 publications

(614 citation statements)

References 37 publications

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“…Based on a series of analyses presented herein, we believe that the association is most likely related to an increase in extracellular water. This interpretation remains speculative, but the association of increased V m with mortality does agree with the relation between bioimpedance-derived evidence of fluid overload and mortality recently published by others (26).…”

Section: Discussionsupporting

confidence: 85%

Modeled Urea Distribution Volume and Mortality in the HEMO Study

Daugirdas

Greene

Depner

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives In the Hemodialysis (HEMO) Study, observed small decreases in achieved equilibrated Kt/V urea were noncausally associated with markedly increased mortality. Here we examine the association of mortality with modeled volume (V m ), the denominator of equilibrated Kt/V urea .Design, setting, participants, & measurements Parameters derived from modeled urea kinetics (including V m ) and blood pressure (BP) were obtained monthly in 1846 patients. Case mix-adjusted time-dependent Cox regressions were used to relate the relative mortality hazard at each time point to V m and to the change in V m over the preceding 6 months. Mixed effects models were used to relate V m to changes in intradialytic systolic BP and to other factors at each follow-up visit.Results Mortality was associated with V m and change in V m over the preceding 6 months. The association between change in V m and mortality was independent of vascular access complications. In contrast, mortality was inversely associated with V calculated from anthropometric measurements (V ant ). In case mix-adjusted analysis using V m as a time-dependent covariate, the association of mortality with V m strengthened after statistical adjustment for V ant . After adjustment for V ant , higher V m was associated with slightly smaller reductions in intradialytic systolic BP and with risk factors for mortality including recent hospitalization and reductions in serum albumin concentration and body weight. ConclusionsAn increase in V m is a marker for illness and mortality risk in hemodialysis patients.

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Section: Discussionsupporting

confidence: 85%

Modeled Urea Distribution Volume and Mortality in the HEMO Study

Daugirdas

Greene

Depner

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…When measured by bioimpedance (26) or inferred from slopes of intradialytic relative plasma volume (27), there are markedly higher mortality risks for overhydration (HR, 1.7) (26) or hypervolemia (HR, 2.1) (27) than for IDWG (21,24).…”

Section: Discussionmentioning

confidence: 99%

Dialysate Sodium Concentration and the Association with Interdialytic Weight Gain, Hospitalization, and Mortality

Hecking

Karaboyas

Saran³

et al. 2012

Clinical Journal of the American Society of Nephrology

137

109

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SummaryBackground and objectives Recommendations to decrease the dialysate sodium (DNa) prescription demand analyses of patient outcomes. We analyzed morbidity and mortality at various levels of DNa, simultaneously accounting for interdialytic weight gain (IDWG) and for the mortality risk associated with lower predialysis serum sodium (SNa) levels.Design, setting, participants, & measurements We used multiply-adjusted linear mixed models to evaluate the magnitude of IDWG and Cox proportional hazards models to assess hospitalizations and deaths in 29,593 patients from the Dialysis Outcomes and Practice Patterns Study with baseline DNa and SNa as predictors, categorized according to lowest to highest levels.Results IDWG increased with higher DNa across all SNa categories, by 0.17% of body weight per 2 mEq/L higher DNa; however, higher DNa was not associated with higher mortality in a fully adjusted model (also adjusted for SNa; hazard ratio [HR]=0.98 per 2 mEq/L higher DNa, 95% confidence interval [CI] 0.95-1.02). Instead, higher DNa was associated with lower hospitalization risk (HR=0.97 per 2 mEq/L higher DNa, 95% CI 0.95-1.00, P=0.04). Additional adjustments for IDWG did not change these results. In sensitivity analyses restricted to study facilities, in which 90%-100% of patients have the same DNa (56%), the adjusted HR for mortality was 0.88 per 2 mEq/L higher DNa (95% CI 0.83-0.94). These analyses represented a pseudo-randomized experiment in which the association between DNa and mortality is unlikely to have been confounded by indication. ConclusionsIn the absence of randomized prospective studies, the benefit of reducing IDWG by decreasing DNa prescriptions should be carefully weighed against an increased risk for adverse outcomes.

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“…Bioimpedance‐derived parameters had a prognostic significance25 not only in hemodialysis, but also in early stages of CKD,26 including correlations between fluid imbalance and severity of CAD 27…”

Section: Methodsmentioning

confidence: 99%

Atherosclerotic Renal Artery Stenosis Prevalence and Correlations in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions: Data From Nonrandomized Single‐Center Study (REN‐ACS)—A Single Center, Prospective, Observational Study

Burlacu¹,

Siriopol

Voroneanu

et al. 2015

JAHA

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BackgroundWe are the first to evaluate the prevalence of renal artery stenosis (RAS) in consecutive patients with acute myocardial infarction (AMI) referred for primary percutaneous coronary intervention from a single tertiary center. As a novelty, we assessed hydration and metabolic status and measured arterial stiffness. We elaborated a predicting model for RAS in AMI.Methods and ResultsOne hundred and eighty‐one patients with AMI underwent concomitantly primary percutaneous coronary intervention and renal angiography. We obtained data on demographics, medical history, cardiovascular risk factors, echocardiography, Killip class, and blood tests. In the first 24 hours post–primary percutaneous coronary intervention, we assessed bioimpedance through Body Composition Monitoring® and arterial stiffness through pulsed‐wave velocity, SphygmoCor®. Significant RAS (>50% lumen narrowing, RAS+) was present in 16.6% patients. In the RAS+ group we recorded significantly higher stiffness, CRUSADE score and dehydration, and more women with higher prevalence of multivascular coronary artery disease and heart failure. In our multivariate models, variables independently associated with RAS+ were previous percutaneous coronary intervention, low estimated glomerular filtration rate, multivascular coronary artery disease, and total/extracellular body water. These models had good specificity and low sensitivity.ConclusionsWe observed that RAS+ AMI patients have a particular hydration, metabolic, and endothelial profile that could generate more future major adverse cardiac events. Hence, renal angiography in AMI should be considered in specific subsets of patients.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02388139.

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The mortality risk of overhydration in haemodialysis patients

Cited by 571 publications

References 37 publications

Modeled Urea Distribution Volume and Mortality in the HEMO Study

Modeled Urea Distribution Volume and Mortality in the HEMO Study

Dialysate Sodium Concentration and the Association with Interdialytic Weight Gain, Hospitalization, and Mortality

Atherosclerotic Renal Artery Stenosis Prevalence and Correlations in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions: Data From Nonrandomized Single‐Center Study (REN‐ACS)—A Single Center, Prospective, Observational Study

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