Low Intracellular Water, Overhydration, and Mortality in Hemodialysis Patients
Abstract
:1. Introduction
2. Patients and Methods
2.1. Patients
2.2. Biochemistry
2.3. Body Composition, Fluid Volume Parameters, and Nutritional Status
2.4. Statistical Analyses
3. Results
3.1. Patient Characteristics
3.2. Baseline Post-Dialysis Body Composition Parameters
Variables | Mean ± SD% (n) or Median (IQR) | Variables | Mean ± SD% (n) or Median (IQR) |
---|---|---|---|
Age (years) | 64 ± 13 | Serum C Reactive Protein (mg/dL) | 1.3 ± 0.6 |
Women (% n) | 45 (49) | Serum albumin (g/dL) | 3.8 ± 0.4 |
Diabetes (% n) | 21 (23) | nPCR (g/kg/day) | 0.7 ± 0.3 |
Vintage (months) | 59 ± 79 | Plasma BNP (pg/mL) | 6090 (2407–14900) |
Cardiovascular disease (% n) | 40 (44) | Plasma total CO2 (mmol/L) | 20 ± 3 |
Predialytic systolic blood pressure | 132 ± 24 | Total Body Water (L) | 32.8 ± 6.8 |
Predialytic diastolic blood pressure | 67 ± 14 | Extracellular Water (ECW) (L) | 14.4 ± 2.6 |
Protein Energy Wasting (% n) | 44 (41%) | Intracellular Water (ICW) (L) | 18.5 ± 4.5 |
kTv | 1.42 ± 0.18 | ECW/ICW | 0.79 ± 0.13 |
Hemoglobin (g/dL) | 11.6 ± 1.4 | Lean Tissue Mass (kg) | 58 ± 16 |
Plasma iPTH (pg/mL) | 250 (127–454) | Adipose Tissue Mass (kg) | 30 ± 11 |
Serum calcium (mg/dL) | 8.8 ± 0.8 | Overhydration (L) | −0.70 ± 1.67 |
Serum phosphate (mg/dL) | 4.8 ± 1.3 | Interdialytic weigh gain (Kg) | 2.6 ± 0.8 kg |
3.3. Changes in Body Composition Over Time
3.4. Variables Associated with Low Post-Dialysis ICW
3.5. Overhydration and Mortality: Low ICW as an Independent Risk Factor
4. Discussion
Author Contributions
Funding
Conflicts of Interest
References
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Variable | r | p |
---|---|---|
Serum creatinine (mg/dL) | 0.32 | 0.004 |
Mid upper arm muscle circumference (MUAMC) | 0.41 | <0.0001 |
The normalized protein catabolic rate (nPCR) | 0.42 | <0.0001 |
25 OH vitamin D | 0.39 | 0.001 |
Interdialytic weight gain (IDWG) | 0.46 | <0.0001 |
Lean tissue mass (LTM) | 0.56 | <0.0001 |
Lean tissue index (LTI) | 0.86 | <0.0001 |
Age | −0.30 | 0.007 |
Serum C Reactive Protein (CRP) | −0.28 | 0.014 |
pro-brain natriuretic peptide (pro BNP) | −0.22 | 0.051 |
Variable | Subgroups | p-Value | |
---|---|---|---|
Sex | Women (n = 33) | Men (n = 44) | <0.0001 |
Baseline post-dialysis ICF (L) | 15.6 ± 3.0 | 20.8 ± 4.2 | |
Malnutrition (presence PEW) | Yes (n = 31) | No (n = 45) | 0.021 |
Baseline post-dialysis ICF (L) | 17.1 ± 4.7 | 19.6 ± 4.1 | |
Hypotension during dialysis | Yes (n = 24) | No (n = 51) | <0.0001 |
Baseline post-dialysis ICF (L) | 15.7 ± 3.7 | 19.8 ± 4.4 | |
Dizziness during dialysis | Yes (n = 22) | No (n = 53) | 0.02 |
Baseline post-dialysis ICF (L) | 16.6 ± 4.3 | 19.3 ± 4.5 |
Model/Variables | β Coefficient | SE of the Estimate | 95% CI | p-Value |
---|---|---|---|---|
Model 1 (R2 = 0.834) | ||||
Lean tissue mass | 0.162 | 0.014 | 0.132–0.189 | <0.0001 |
Mid upper arm muscle circumference | 0.74 | 0.067 | 0.606–0.875 | <0.0001 |
Sex | 3.001 | 0.465 | 2.072–3.930 | <0.0001 |
Model 2 (R2 = 0.845) | ||||
Lean tissue mass | 0.152 | 0.014 | 0.123–0.181 | <0.0001 |
Mid upper arm muscle circumference | 0.726 | 0.066 | 0.594–0.857 | <0.0001 |
Sex | 3.131 | 0.458 | 2.215–4.046 | <0.0001 |
C-Reactive Protein | −0.235 | 0.115 | (−0.465)–(−0.004) | 0.046 |
Variable | HR | p |
---|---|---|
Age | 1.197 (1.051–1.364) | 0.007 |
Male | 0.977 (0.119–8.044) | 0.983 |
Davies medium | 11.4 (0.419–312.8) | 0.149 |
Davies high | 1.213 (0.060–24.58) | 0.900 |
ICW | 0.627 (0.401–0.979) | 0.040 |
C-Reactive Protein | 1.150(0.803–1.647) | 0.446 |
Albumin ≤ 3.8 g/dL | 0.037(0.003–0.438) | 0.009 |
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Gracia-Iguacel, C.; González-Parra, E.; Mahillo, I.; Ortiz, A. Low Intracellular Water, Overhydration, and Mortality in Hemodialysis Patients. J. Clin. Med. 2020, 9, 3616. https://doi.org/10.3390/jcm9113616
Gracia-Iguacel C, González-Parra E, Mahillo I, Ortiz A. Low Intracellular Water, Overhydration, and Mortality in Hemodialysis Patients. Journal of Clinical Medicine. 2020; 9(11):3616. https://doi.org/10.3390/jcm9113616
Chicago/Turabian StyleGracia-Iguacel, Carolina, Emilio González-Parra, Ignacio Mahillo, and Alberto Ortiz. 2020. "Low Intracellular Water, Overhydration, and Mortality in Hemodialysis Patients" Journal of Clinical Medicine 9, no. 11: 3616. https://doi.org/10.3390/jcm9113616