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NDT Advance Access originally published online on January 7, 2009
Nephrology Dialysis Transplantation 2009 24(5):1574-1579; doi:10.1093/ndt/gfn707
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© The Author [2009].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org


The mortality risk of overhydration in haemodialysis patients

Volker Wizemann1, Peter Wabel2, Paul Chamney2, Wojciech Zaluska3, Ulrich Moissl2, Christiane Rode1, Teresa Malecka-Masalska3 and Daniele Marcelli2

1 Georg-Haas Dialysezentrum Giessen 2 Fresenius Medical Care, Germany 3 University of Lublin, Poland

Correspondence and offprint requests to: Peter Wabel, Daimlerstrasse 15 61352 Bad Homburg. Tel: +00496172-6097942; Fax: +0049-6172-6097888; E-mail: peter.wabel{at}fmc-ag.com



  Abstract

Background. While cardiovascular events remain the primary form of mortality in haemodialysis (HD) patients, few centres are aware of the impact of the hydration status (HS). The aim of this study was to investigate how the magnitude of the prevailing overhydration influences long-term survival.

Methods. We measured the hydration status in 269 prevalent HD patients (28% diabetics, dialysis vintage = 41.2 ± 70 months) in three European centres with a body composition monitor (BCM) that enables quantitative assessment of hydration status and body composition. The survival of these patients was ascertained after a follow-up period of 3.5 years. The cut off threshold for the definition of hyperhydration was set to 15% relative to the extracellular water (ECW), which represents an excess of ECW of ~2.5 l. Cox-proportional hazard models were used to compare survival according to the baseline hydration status for a set of demographic data, comorbid conditions and other predictors.

Results. The median hydration state (HS) before the HD treatment ({Delta}HSpre) for all patients was 8.6 ± 8.9%. The unadjusted gross annual mortality of all patients was 8.5%. The hyperhydrated subgroup (n = 58) presented {Delta}HSpre = 19.9 ± 5.3% and a gross mortality of 14.7%. The Cox adjusted hazard ratios (HRs) revealed that age (HRage = 1.05, 1/year; P < 0.001), systolic blood pressure (BPsys) (HRBPsys = 0.986 1/mmHg; P = 0.014), diabetes (HRDia = 2.766; P < 0.001), peripheral vascular disease (PVD) (HRPVD = 1.68; P = 0.045) and relative hydration status ({Delta}HSpre) (HR{Delta}HSpre = 2.102 P = 0.003) were the only significant predictors of mortality in our patient population.

Conclusion. The results of our study indicate that the hydration state is an important and independent predictor of mortality in chronic HD patients secondary only to the presence of diabetes. We believe that it is essential to measure the hydration status objectively and quantitatively in order to obtain a more clearly defined assessment of the prognosis of haemodialysis patients.

Keywords: bioimpedance; fluid status; haemodialysis; mortality; overhydration

Received for publication: 25. 7.08
Accepted in revised form: 24.11.08


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