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Fluid Retention Is Associated With Cardiovascular Mortality in Patients Undergoing Long-Term Hemodialysis

Circulation (New York, N.Y.), 2009-02, Vol.119 (5), p.671-679 [Peer Reviewed Journal]

2009 INIST-CNRS ;ISSN: 0009-7322 ;EISSN: 1524-4539 ;DOI: 10.1161/CIRCULATIONAHA.108.807362 ;PMID: 19171851 ;CODEN: CIRCAZ

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Title:
Fluid Retention Is Associated With Cardiovascular Mortality in Patients Undergoing Long-Term Hemodialysis
Author: KALANTAR-ZADEH, Kamyar ; REGIDOR, Deborah L ; KOVESDY, Csaba P ; VAN WYCK, David ; BUNNAPRADIST, Suphamai ; HORWICH, Tamara B ; FONAROW, Gregg C
Subjects: Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Volume ; Body Fluids ; Cardiology. Vascular system ; Cardiovascular system ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Edema - mortality ; Female ; Heart Failure - mortality ; Humans ; Kidney Failure, Chronic - mortality ; Kidney Failure, Chronic - therapy ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Obesity - mortality ; Pharmacology. Drug treatments ; Predictive Value of Tests ; Proportional Hazards Models ; Renal Dialysis - mortality ; Risk Factors ; United States - epidemiology ; Vasodilator agents. Cerebral vasodilators ; Weight Gain
Is Part Of: Circulation (New York, N.Y.), 2009-02, Vol.119 (5), p.671-679
Description: 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. 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 > or =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 <1.0 kg and > or =4.0 kg (compared with 1.5 to 2.0 kg as the reference) were 0.67 (0.58 to 0.76) and 1.25 (1.12 to 1.39), respectively. 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.
Publisher: Hagerstown, MD: Lippincott Williams & Wilkins
Language: English
Identifier: ISSN: 0009-7322
EISSN: 1524-4539
DOI: 10.1161/CIRCULATIONAHA.108.807362
PMID: 19171851
CODEN: CIRCAZ
Source: GFMER Free Medical Journals
MEDLINE

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Fluid Retention Is Associated With Cardiovascular Mortality in Patients Undergoing Long-Term Hemodialysis

2009 INIST-CNRS ;ISSN: 0009-7322 ;EISSN: 1524-4539 ;DOI: 10.1161/CIRCULATIONAHA.108.807362 ;PMID: 19171851 ;CODEN: CIRCAZ

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