Michelle M Y Wong1, Keith P McCullough2, Brian A Bieber2, Juergen Bommer3, Manfred Hecking4, Nathan W Levin5, William M McClellan6, Ronald L Pisoni2, Rajiv Saran7, Francesca Tentori2, Tadashi Tomo8, Friedrich K Port9, Bruce M Robinson9. 1. Arbor Research Collaborative for Health, Ann Arbor, MI; Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Electronic address: michellemywong@gmail.com. 2. Arbor Research Collaborative for Health, Ann Arbor, MI. 3. Universität Heidelberg, Heidelberg, Germany. 4. Department of Internal Medicine III-Nephrology, Medical University of Vienna, Vienna, Austria. 5. Renal Research Institute, New York, NY. 6. Department of Medicine, Emory University, Atlanta, GA; Department of Epidemiology, Emory University, Atlanta, GA. 7. Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI. 8. Department of Nephrology, Faculty of Medicine, Oita University Hospital, Oita, Japan; Department of Internal Medicine II, Faculty of Medicine, Oita University Hospital, Oita, Japan. 9. Arbor Research Collaborative for Health, Ann Arbor, MI; Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Abstract
BACKGROUND: High interdialytic weight gain (IDWG) is associated with adverse outcomes in hemodialysis (HD) patients. We identified temporal and regional trends in IDWG, predictors of IDWG, and associations of IDWG with clinical outcomes. STUDY DESIGN: Analysis 1: sequential cross-sections to identify facility- and patient-level predictors of IDWG and their temporal trends. Analysis 2: prospective cohort study to assess associations between IDWG and mortality and hospitalization risk. SETTING & PARTICIPANTS: 21,919 participants on HD therapy for 1 year or longer in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 2 to 5 (2002-2014). PREDICTORS: Analysis 1: study phase, patient demographics and comorbid conditions, HD facility practices. Analysis 2: relative IDWG, expressed as percentage of post-HD weight (<0%, 0%-0.99%, 1%-2.49%, 2.5%-3.99% [reference], 4%-5.69%, and ≥5.7%). OUTCOMES: Analysis 1: relative IDWG as a continuous variable using linear mixed models; analysis 2: mortality; all-cause and cause-specific hospitalization using Cox regression, adjusting for potential confounders. RESULTS: From phase 2 to 5, IDWG declined in the United States (-0.29kg; -0.5% of post-HD weight), Canada (-0.25kg; -0.8%), and Europe (-0.22kg; -0.5%), with more modest declines in Japan and Australia/New Zealand. Among modifiable factors associated with IDWG, the most notable was facility mean dialysate sodium concentration: every 1-mEq/L greater dialysate sodium concentration was associated with 0.13 (95% CI, 0.11-0.16) greater relative IDWG. Compared to relative IDWG of 2.5% to 3.99%, there was elevated risk for mortality with relative IDWG≥5.7% (adjusted HR, 1.23; 95% CI, 1.08-1.40) and elevated risk for fluid-overload hospitalization with relative IDWG≥4% (HRs of 1.28 [95% CI, 1.09-1.49] and 1.64 [95% CI, 1.27-2.13] for relative IDWGs of 4%-5.69% and ≥5.7%, respectively). LIMITATIONS: Possible residual confounding. No dietary salt intake data. CONCLUSIONS: Reductions in IDWG during the past decade were partially explained by reductions in dialysate sodium concentration. Focusing quality improvement strategies on reducing occurrences of high IDWG may improve outcomes in HD patients.
BACKGROUND:High interdialytic weight gain (IDWG) is associated with adverse outcomes in hemodialysis (HD) patients. We identified temporal and regional trends in IDWG, predictors of IDWG, and associations of IDWG with clinical outcomes. STUDY DESIGN: Analysis 1: sequential cross-sections to identify facility- and patient-level predictors of IDWG and their temporal trends. Analysis 2: prospective cohort study to assess associations between IDWG and mortality and hospitalization risk. SETTING & PARTICIPANTS: 21,919 participants on HD therapy for 1 year or longer in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 2 to 5 (2002-2014). PREDICTORS: Analysis 1: study phase, patient demographics and comorbid conditions, HD facility practices. Analysis 2: relative IDWG, expressed as percentage of post-HD weight (<0%, 0%-0.99%, 1%-2.49%, 2.5%-3.99% [reference], 4%-5.69%, and ≥5.7%). OUTCOMES: Analysis 1: relative IDWG as a continuous variable using linear mixed models; analysis 2: mortality; all-cause and cause-specific hospitalization using Cox regression, adjusting for potential confounders. RESULTS: From phase 2 to 5, IDWG declined in the United States (-0.29kg; -0.5% of post-HD weight), Canada (-0.25kg; -0.8%), and Europe (-0.22kg; -0.5%), with more modest declines in Japan and Australia/New Zealand. Among modifiable factors associated with IDWG, the most notable was facility mean dialysate sodium concentration: every 1-mEq/L greater dialysate sodium concentration was associated with 0.13 (95% CI, 0.11-0.16) greater relative IDWG. Compared to relative IDWG of 2.5% to 3.99%, there was elevated risk for mortality with relative IDWG≥5.7% (adjusted HR, 1.23; 95% CI, 1.08-1.40) and elevated risk for fluid-overload hospitalization with relative IDWG≥4% (HRs of 1.28 [95% CI, 1.09-1.49] and 1.64 [95% CI, 1.27-2.13] for relative IDWGs of 4%-5.69% and ≥5.7%, respectively). LIMITATIONS: Possible residual confounding. No dietary salt intake data. CONCLUSIONS: Reductions in IDWG during the past decade were partially explained by reductions in dialysate sodium concentration. Focusing quality improvement strategies on reducing occurrences of high IDWG may improve outcomes in HDpatients.
Authors: Indranil Dasgupta; G Neil Thomas; Joanne Clarke; Alice Sitch; James Martin; Brian Bieber; Manfred Hecking; Angelo Karaboyas; Ronald Pisoni; Friedrich Port; Bruce Robinson; Hugh Rayner Journal: Clin J Am Soc Nephrol Date: 2019-02-05 Impact factor: 8.237
Authors: Richard V Remigio; Hao He; Jochen G Raimann; Peter Kotanko; Frank W Maddux; Amy Rebecca Sapkota; Xin-Zhong Liang; Robin Puett; Xin He; Amir Sapkota Journal: Sci Total Environ Date: 2021-12-16 Impact factor: 7.963
Authors: Richard V Remigio; Rodman Turpin; Jochen G Raimann; Peter Kotanko; Frank W Maddux; Amy Rebecca Sapkota; Xin-Zhong Liang; Robin Puett; Xin He; Amir Sapkota Journal: Environ Res Date: 2021-09-25 Impact factor: 6.498