Marijke Dekker1,2, Constantijn Konings2, Bernard Canaud3, Paola Carioni3, Adrian Guinsburg4, Magdalena Madero5, Jeroen van der Net1, Jochen Raimann6, Frank van der Sande1, Stefano Stuard3, Len Usvyat6,7, Yuedong Wang8, Xiaoqi Xu9, Peter Kotanko6,10, Jeroen Kooman1. 1. Department of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands. 2. Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. 3. Fresenius Medical Care, Bad Homburg, Germany. 4. Fresenius Medical Care Latin America, Buenos Aires, Argentina. 5. Department of Nephrology, National Heart Institute, Mexico City, Mexico. 6. Renal Research Institute, New York, NY, USA. 7. Fresenius Medical Care North America, Waltham, MA, USA. 8. Department of Statistics and Applied Probability, University of California-Santa Barbara, Santa Barbara, CA, USA. 9. Department of Nephrology, Fresenius Medical Care Asia Pacific and. 10. Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Abstract
Background: Pre-dialysis fluid overload (FO) associates with mortality and causes elevated pre-dialysis systolic blood pressure (pre-SBP). However, low pre-SBP is associated with increased mortality in haemodialysis patients. The objective of this study was to investigate the interaction between pre-dialysis fluid status (FS) and pre-SBP in association with mortality. Methods: We included all patients from the international Monitoring Dialysis Outcome Initiative (MONDO) database with a pre-dialysis multifrequency bioimpedance spectroscopy measurement in the year 2011. We used all parameters available during a 90-day baseline period. All-cause mortality was recorded during 1-year follow-up. Associations with outcome were assessed with Cox models and a smoothing spline Cox analysis. Results: We included 8883 patients. In patients with pre-dialysis FO (>+1.1 to +2.5 L), pre-SBP <110 mmHg was associated with an increased risk of death {hazard ratio (HR) 1.52 [95% confidence interval (CI) 1.06-2.17]}. An increased risk of death was also associated with pre-dialysis fluid depletion (FD; <-1.1 L) combined with a pre-SBP <140 mmHg. In normovolemic (NV) patients, low pre-SBP <110 mmHg was associated with better survival [HR 0.46 (95% CI 0.23-0.91)]. Also, post-dialysis FD associated with a survival benefit. Results were similar when inflammation was present. Only high ultrafiltration rate could not explain the higher mortality rates observed. Conclusion: The relation between pre-SBP and outcome is dependent on pre-dialysis FS. Low pre-SBP appears to be disadvantageous in patients with FO or FD, but not in NV patients. Post-dialysis FD was found to associate with improved survival. Therefore, we suggest interpreting pre-SBP levels in the context of FS and not as an isolated marker.
Background: Pre-dialysis fluid overload (FO) associates with mortality and causes elevated pre-dialysis systolic blood pressure (pre-SBP). However, low pre-SBP is associated with increased mortality in haemodialysis patients. The objective of this study was to investigate the interaction between pre-dialysis fluid status (FS) and pre-SBP in association with mortality. Methods: We included all patients from the international Monitoring Dialysis Outcome Initiative (MONDO) database with a pre-dialysis multifrequency bioimpedance spectroscopy measurement in the year 2011. We used all parameters available during a 90-day baseline period. All-cause mortality was recorded during 1-year follow-up. Associations with outcome were assessed with Cox models and a smoothing spline Cox analysis. Results: We included 8883 patients. In patients with pre-dialysis FO (>+1.1 to +2.5 L), pre-SBP <110 mmHg was associated with an increased risk of death {hazard ratio (HR) 1.52 [95% confidence interval (CI) 1.06-2.17]}. An increased risk of death was also associated with pre-dialysis fluid depletion (FD; <-1.1 L) combined with a pre-SBP <140 mmHg. In normovolemic (NV) patients, low pre-SBP <110 mmHg was associated with better survival [HR 0.46 (95% CI 0.23-0.91)]. Also, post-dialysis FD associated with a survival benefit. Results were similar when inflammation was present. Only high ultrafiltration rate could not explain the higher mortality rates observed. Conclusion: The relation between pre-SBP and outcome is dependent on pre-dialysis FS. Low pre-SBP appears to be disadvantageous in patients with FO or FD, but not in NV patients. Post-dialysis FD was found to associate with improved survival. Therefore, we suggest interpreting pre-SBP levels in the context of FS and not as an isolated marker.
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: Jeroen P Kooman; Len A Usvyat; Marijke J E Dekker; Dugan W Maddux; Jochen G Raimann; Frank M van der Sande; Xiaoling Ye; Yuedong Wang; Peter Kotanko Journal: Blood Purif Date: 2018-11-16 Impact factor: 2.614
Authors: Hanjie Zhang; Priscila Preciado; Yuedong Wang; Anna Meyring-Wosten; Jochen G Raimann; Jeroen P Kooman; Frank M van der Sande; Len A Usvyat; Dugan Maddux; Franklin W Maddux; Peter Kotanko Journal: Nephrol Dial Transplant Date: 2020-09-01 Impact factor: 5.992
Authors: Xiaoling Ye; Jeroen P Kooman; Frank M van der Sande; Jochen G Raimann; Len A Usvyat; Yuedong Wang; Franklin W Maddux; Peter Kotanko Journal: Clin Kidney J Date: 2019-12-05
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