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Study analyzes association between fluid overload and interdialytic weight gain
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Pre-dialysis and post-dialysis fluid overload were associated with increasing patient age, a lower BMI and multiple comorbidities and strongly predicted all-cause mortality, according to a study published in Nephrology Dialysis Transplantation. The findings question long-held thoughts that higher interdialytic weight gain is worse for outcomes and needs to be expanded.
“In the current study, we found that patients with high levels of fluid volume overload but low levels of interdialytic weight gain have the highest associated all-cause mortality risk,” study co-author Manfred Hecking, MD, of the Medical University of Vienna in the clinical division of nephrology and dialysis Währinger Gürtel 18-20, told Healio Nephrology. “Of note, our statistical model employed the joint bivariate exposure of time-varying interdialytic weight gain and fluid overload, aggregated as 1-month moving averages, and thereby depicts the short-term mortality risk, which may be influenced by protein-energy wasting. We also looked into the relationship between interdialytic weight gain and fluid overload pre- vs. post-dialysis.”
Pre-dialysis (FOpre) and post-dialysis fluid overload (FOpost) were consistently positive risk factors for mortality, and low interdialytic weight gain (IDWG) was associated with short-term mortality.
The retrospective cohort study aimed to disentangle the relationship between fluid overload and discrete IDWG components for the dynamic fluid balance in hemodialysis. Researchers analyzed 38,614 incident patients with one or more bioimpedance spectroscopy measurement within 90 days of hemodialysis initiation. Both fluid overload markers showed a weak association with IDWG, but in opposing ways — IDWG “increased” with increasing FOpre, but “decreased” with increased FOpost, according to the researchers.
“Fluid volume overload post-dialysis reflected the volume status without IDWG, which implies that this clinically most intuitive fluid marker may be best suited to guide volume management in dialysis patients," Hecking said.
Disclosures: Heckling has received a financial remuneration for three talks that were held for Fresenius Medical Care during the years 2015 to 2017 as well as for chairing on symposium, organized by Fresenius Medical Care, at the ERA-EDTA 2017. Please see the study for all other authors’ relevant financial disclosures.
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