Fluid overload in hemodialysis patients: a cross-sectional study to determine its association with cardiac biomarkers and nutritional status

BMC Nephrology

Marcus D Säemann¹  Walter H Hörl¹  Diana Bonderman²  Manfred Eigner³  Gernot Paul⁴  Johannes J Kovarik¹  Johannes Werzowa¹  Michael Haidinger¹  Manfred Hecking¹  Marlies Antlanger¹ 

[1] Department of Internal Medicine III - Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna Austria;Department of Internal Medicine II - Clinical Division of Cardiology, Medical University of Vienna, Vienna Austria;Department of Internal Medicine I, Sozialmedizinisches Zentrum Süd - Kaiser-Franz-Josef-Spital mit Gottfried von Preyer’schem Kinderspital, Vienna Austria;Department of Internal Medicine III, Donauspital KH SMZ Ost, Vienna Austria

关键词: Bioimpedance;    Inflammation;    Cardiovascular;    Fuid overload;    Hemodialysis;   

Others  :  1082773
DOI  :  10.1186/1471-2369-14-266

 received in 2013-03-23, accepted in 2013-11-26,  发布年份 2013

【 摘 要 】

Background

Chronic fluid overload is associated with higher mortality in dialysis patients; however, the link with cardiovascular morbidity has not formally been established and may be influenced by subclinical inflammation. We hypothesized that a relationship exists between fluid overload and [i] cardiovascular laboratory parameter as well as between fluid overload and [ii] inflammatory laboratory parameters. In addition, we aimed to confirm whether volume status correlates with nutritional status.

Methods

We recorded baseline characteristics of 244 hemodialysis patients at three hemodialysis facilities in Vienna (Austria) and determined associations with volume measurements using the body composition monitor (Fresenius/Germany). In one facility comprising 126 patients, we further analyzed cardiovascular, inflammatory and nutritional parameters.

Results

We detected predialysis fluid overload (FO) in 39% of all patients (n = 95) with FO defined as ≥15% of extracellular water (ECW). In this subgroup, the absolute FO was 4.4 +/-1.5 L or 22.9 ± 4.8% of ECW. A sub-analysis of patients from one center showed that FO was negatively associated with body mass index (r = -0.371; p = <0.001), while serum albumin was significantly lower in fluid overloaded patients (p = 0.001). FO was positively associated with D-Dimer (r = 0.316; p = 0.001), troponin T (r = 0.325; p < 0.001), and N-terminal pro-B-type natriuretic peptide (r = 0.436; p < 0.001), but not with investigated inflammatory parameters.

Conclusions

Fluid overload in HD patients was found to be lower in patients with high body mass index, indicating that dry weight was inadequately prescribed and/or difficult to achieve in overweight patients. The association with parameters of cardiovascular compromise and/or damage suggests that fluid overload is a biomarker for cardiovascular risk. Future studies should determine if this applies to patients prior to end-stage renal disease.

【 授权许可】

   
2013 Antlanger et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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