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Interdialytic Weight Gain and Cardiovascular Outcome in Incident Hemodialysis Patients

Authors
 Lee M.J.  ;  Doh F.M.  ;  Kim C.H.  ;  Koo H.M.  ;  Oh H.J.  ;  Park J.T.  ;  Han S.H.  ;  Yoo T.-H.  ;  Kim Y.-L.  ;  Kim Y.S.  ;  Yang C.W.  ;  Kim N.-H.  ;  Kang S.-W. 
Citation
 AMERICAN JOURNAL OF NEPHROLOGY, Vol.39(5) : 427-435, 2014 
Journal Title
 AMERICAN JOURNAL OF NEPHROLOGY 
ISSN
 0250-8095 
Issue Date
2014
MeSH
Aged ; Aged, 80 and over ; Angina, Unstable/mortality ; Cardiovascular Diseases/mortality* ; Female ; Heart Failure/mortality ; Hospitalization ; Humans ; Kidney Failure, Chronic/therapy* ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/mortality ; Predictive Value of Tests ; Prospective Studies ; Renal Dialysis* ; Stroke/mortality ; Weight Gain* ; Young Adult
Keywords
Cardiovascular outcome ; Hemodialysis ; Interdialytic weight gain
Abstract
BACKGROUND: Interdialytic weight gain (IDWG) has been regarded as a surrogate of volume overload, but also as a marker of a better nutritional status in end-stage renal disease (ESRD) patients on hemodialysis (HD). This paradoxical meaning of IDWG requires further investigation, particularly in adverse cardiovascular outcomes. METHODS: A prospective cohort of 1,013 incident HD patients from 36 HD centers of the Clinical Research Center for ESRD in Korea was included. Patients were categorized into five groups according to the IDWG%, a ratio of absolute IDWG to dry weight: <1.0, ≥4.0, and every 1.0 increment in between. Primary outcome was major adverse cardiac and cerebrovascular events (MACCE). RESULTS: During a mean follow-up of 18.7 months, primary outcome was observed in 104 patients (10.3%). In multivariate analysis, compared to patients with IDWG% of 1.0-1.9 (reference group), the hazard ratios (HRs) for primary outcome in the IDWG% <1.0, 2.0-2.9, 3.0-3.9, and ≥4.0 groups were 1.10 [95% confidence interval (CI) 0.55-2.20, p = 0.80], 1.15 (95% CI 0.59-2.27, p = 0.68), 1.80 (95% CI 0.95-3.41, p = 0.07), and 1.93 (95% CI 1.02-3.64, p = 0.04), respectively. Furthermore, even when residual renal function and 24-hour urine volume were adjusted, IDWG% ≥4.0 remained as a significant predictor of primary outcome (HR 2.03, 95% CI 1.02-4.02, p = 0.04). CONCLUSION: Increased IDWG% is a significant independent predictor of MACCE in incident HD patients. It could be helpful to prevent excessive IDWG for improving clinical outcomes in incident HD patients.
Files in This Item:
T201401215.pdf Download
DOI
10.1159/000362743
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Koo, Hyang Mo(구향모)
Kim, Chan Ho(김찬호)
Doh, Fa Mee(도화미) ORCID logo https://orcid.org/0000-0002-4780-6728
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Oh, Hyung Jung(오형중)
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Lee, Mi Jung(이미정)
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/98656
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