Fluid retention is associated with cardiovascular mortality in patients undergoing long-term hemodialysis

Kamyar Kalantar-Zadeh, Deborah L. Regidor, Csaba Kovesdy, David Van Wyck, Suphamai Bunnapradist, Tamara B. Horwich, Gregg C. Fonarow

Research output: Contribution to journalArticle

307 Citations (Scopus)

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 <1.0 kg and ≥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. 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.

Original languageEnglish (US)
Pages (from-to)671-679
Number of pages9
JournalCirculation
Volume119
Issue number5
DOIs
StatePublished - Feb 10 2009
Externally publishedYes

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Renal Dialysis
Weight Gain
Mortality
Heart Failure
Survival
Dialysis
Cause of Death
Risk Adjustment
Nutritional Status
Chronic Renal Insufficiency
Serum Albumin
Malnutrition
Body Mass Index
Therapeutics
Demography
Confidence Intervals
Inflammation
Weights and Measures
Research
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Kalantar-Zadeh, K., Regidor, D. L., Kovesdy, C., Van Wyck, D., Bunnapradist, S., Horwich, T. B., & Fonarow, G. C. (2009). Fluid retention is associated with cardiovascular mortality in patients undergoing long-term hemodialysis. Circulation, 119(5), 671-679. https://doi.org/10.1161/CIRCULATIONAHA.108.807362

Fluid retention is associated with cardiovascular mortality in patients undergoing long-term hemodialysis. / Kalantar-Zadeh, Kamyar; Regidor, Deborah L.; Kovesdy, Csaba; Van Wyck, David; Bunnapradist, Suphamai; Horwich, Tamara B.; Fonarow, Gregg C.

In: Circulation, Vol. 119, No. 5, 10.02.2009, p. 671-679.

Research output: Contribution to journalArticle

Kalantar-Zadeh, K, Regidor, DL, Kovesdy, C, Van Wyck, D, Bunnapradist, S, Horwich, TB & Fonarow, GC 2009, 'Fluid retention is associated with cardiovascular mortality in patients undergoing long-term hemodialysis', Circulation, vol. 119, no. 5, pp. 671-679. https://doi.org/10.1161/CIRCULATIONAHA.108.807362
Kalantar-Zadeh, Kamyar ; Regidor, Deborah L. ; Kovesdy, Csaba ; Van Wyck, David ; Bunnapradist, Suphamai ; Horwich, Tamara B. ; Fonarow, Gregg C. / Fluid retention is associated with cardiovascular mortality in patients undergoing long-term hemodialysis. In: Circulation. 2009 ; Vol. 119, No. 5. pp. 671-679.
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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 <1.0 kg and ≥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. 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.",
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AU - Bunnapradist, Suphamai

AU - Horwich, Tamara B.

AU - Fonarow, Gregg C.

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