Fluid Retention Is Associated With Cardiovascular Mortality in Patients Undergoing Long-Term Hemodialysis
Top Cited Papers
- 10 February 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 119 (5), 671-679
- https://doi.org/10.1161/circulationaha.108.807362
Abstract
Background— Patients with chronic kidney disease (stage 5) who undergo hemodialysis treatment have similarities to heart failure patients in that both populations retain fluid frequently and have excessively high mortality. Volume overload in heart failure is associated with worse outcomes. We hypothesized that in hemodialysis patients, greater interdialytic fluid gain is associated with poor all-cause and cardiovascular survival. Methods and Results— We examined 2-year (July 2001 to June 2003) mortality in 34 107 hemodialysis patients across the United States who had an average weight gain of at least 0.5 kg above their end-dialysis dry weight by the time the subsequent hemodialysis treatment started. The 3-month averaged interdialytic weight gain was divided into 8 categories of 0.5-kg increments (up to ≥4.0 kg). Eighty-six percent of patients gained >1.5 kg between 2 dialysis sessions. In unadjusted analyses, higher weight gain was associated with better nutritional status (higher protein intake, serum albumin, and body mass index) and tended to be linked to greater survival. However, after multivariate adjustment for demographics (case mix) and surrogates of malnutrition-inflammation complex, higher weight-gain increments were associated with increased risk of all-cause and cardiovascular death. The hazard ratios (95% confidence intervals) of cardiovascular death for weight gain Conclusions— In hemodialysis patients, greater fluid retention between 2 subsequent hemodialysis treatment sessions is associated with higher risk of all-cause and cardiovascular death. The mechanisms by which fluid retention influences cardiovascular survival in hemodialysis may be similar to those in patients with heart failure and warrant further research.Keywords
This publication has 43 references indexed in Scilit:
- Nutritional and Anti-Inflammatory Interventions in Chronic Heart FailureThe American Journal of Cardiology, 2008
- Contemporary Trends in the Pharmacological and Extracorporeal Management of Heart FailureCirculation, 2008
- Are diuretics overused in the treatment of chronic heart failure?Nature Clinical Practice Cardiovascular Medicine, 2008
- A proposed nomenclature and diagnostic criteria for protein–energy wasting in acute and chronic kidney diseaseKidney International, 2008
- Association of Traditional Risk Factors With Cardiovascular Death Across 0 to 10, 10 to 20, and >20 Years Follow-Up in Men and WomenThe American Journal of Cardiology, 2008
- Racial and survival paradoxes in chronic kidney diseaseNature Clinical Practice Nephrology, 2007
- Reverse Epidemiology of Hypertension and Cardiovascular Death in the Hemodialysis PopulationHypertension, 2005
- Monitoring of blood volume during haemodialysis treatment of acute renal and multiple organ failuresNephrology Dialysis Transplantation, 1996
- Clinical assessment of dry weightNephrology Dialysis Transplantation, 1996
- Importance of hemodynamic response to therapy in predicting survival with ejection fraction ≤ 20% secondary to ischemic or nonischemic dilated cardiomyopathyThe American Journal of Cardiology, 1990