Yi-Chun Tsai1, Yi-Wen Chiu2, Jer-Chia Tsai2, Hung-Tien Kuo2, Chi-Chih Hung2, Shang-Jyh Hwang3, Tzu-Hui Chen4, Mei-Chuan Kuo5, Hung-Chun Chen2. 1. Graduate Institute of Clinical Medicine and Division of Nephrology and Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan; 2. Division of Nephrology and Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan; 3. Graduate Institute of Clinical Medicine and Division of Nephrology and Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan; Institute of Population Sciences, National Health Research Institutes, Miaoli, Taiwan. 4. Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; and. 5. Graduate Institute of Clinical Medicine and Division of Nephrology and Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan; mechku@cc.kmu.edu.tw.
Abstract
BACKGROUND AND OBJECTIVES: Fluid overload is a common characteristic associated with renal progression in CKD. Additionally, fluid overload is an independent predictor of all-cause or cardiovascular mortality in patients on dialysis, but its influence on patients not on dialysis is uncertain. The aim of the study was to assess the relationship between the severity of fluid status and clinical outcomes in an advanced CKD cohort. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In total, 478 predialysis patients with stages 4 and 5 CKD in the integrated CKD care program were enrolled from January of 2011 to December of 2011 and followed-up until August of 2013. The clinical outcomes included cardiovascular morbidity and all-cause mortality. The relative hydration status (overhydration/extracellular water) was used as the presentation of the severity of fluid status and measured using a body composition monitor. Overhydration/extracellular water >7% was defined as fluid overload. RESULTS: Over a median follow-up period of 23.2 (12.6-26.4) months, 66 (13.8%) patients reached all-cause mortality or cardiovascular morbidity. The adjusted hazard ratio of the combined outcome of all-cause mortality or cardiovascular morbidity for every 1% higher overhydration/extracellular water was 1.08 (95% confidence interval, 1.04 to 1.12; P<0.001). The adjusted overhydration/extracellular water for the combined outcome of all-cause mortality or cardiovascular morbidity in participants with overhydration/extracellular water ≥7% compared with those with overhydration/extracellular water <7% was 1.93 (95% confidence interval, 1.01 to 3.69; P=0.04). In subgroup analysis, higher overhydration/extracellular water was consistently associated with increased risk for the combined outcome independent of diabetes, cardiovascular disease, and serum albumin. There was no significant interaction between all subgroups. CONCLUSIONS: These findings suggest that fluid overload is an independent risk factor of the combined outcome of all-cause mortality or cardiovascular morbidity in patients with advanced CKD.
BACKGROUND AND OBJECTIVES: Fluid overload is a common characteristic associated with renal progression in CKD. Additionally, fluid overload is an independent predictor of all-cause or cardiovascular mortality in patients on dialysis, but its influence on patients not on dialysis is uncertain. The aim of the study was to assess the relationship between the severity of fluid status and clinical outcomes in an advanced CKD cohort. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In total, 478 predialysis patients with stages 4 and 5 CKD in the integrated CKD care program were enrolled from January of 2011 to December of 2011 and followed-up until August of 2013. The clinical outcomes included cardiovascular morbidity and all-cause mortality. The relative hydration status (overhydration/extracellular water) was used as the presentation of the severity of fluid status and measured using a body composition monitor. Overhydration/extracellular water >7% was defined as fluid overload. RESULTS: Over a median follow-up period of 23.2 (12.6-26.4) months, 66 (13.8%) patients reached all-cause mortality or cardiovascular morbidity. The adjusted hazard ratio of the combined outcome of all-cause mortality or cardiovascular morbidity for every 1% higher overhydration/extracellular water was 1.08 (95% confidence interval, 1.04 to 1.12; P<0.001). The adjusted overhydration/extracellular water for the combined outcome of all-cause mortality or cardiovascular morbidity in participants with overhydration/extracellular water ≥7% compared with those with overhydration/extracellular water <7% was 1.93 (95% confidence interval, 1.01 to 3.69; P=0.04). In subgroup analysis, higher overhydration/extracellular water was consistently associated with increased risk for the combined outcome independent of diabetes, cardiovascular disease, and serum albumin. There was no significant interaction between all subgroups. CONCLUSIONS: These findings suggest that fluid overload is an independent risk factor of the combined outcome of all-cause mortality or cardiovascular morbidity in patients with advanced CKD.
Authors: Frank M van der Sande; Esther R van de Wal-Visscher; Stefano Stuard; Ulrich Moissl; Jeroen P Kooman Journal: Blood Purif Date: 2019-12-18 Impact factor: 2.614
Authors: Mihály B Tapolyai; Mária Faludi; Klára Berta; Tibor Szarvas; Zsolt Lengvárszky; Miklos Z Molnar; Neville R Dossabhoy; Tibor Fülöp Journal: Int Urol Nephrol Date: 2016-04-28 Impact factor: 2.370