Interdialytic weight gain and cardiovascular outcome in incident hemodialysis patients

Mi Jung Lee, Fa Mee Doh, Chan Ho Kim, Hyang Mo Koo, Hyung Jung Oh, Jung Tak Park, Seung Hyeok Han, Tae Hyun Yoo, Yong Lim Kim, Yon Su Kim, Chul Woo Yang, Nam Ho Kim, Shin Wook Kang

Research output: Contribution to journalArticle

24 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)427-435
Number of pages9
JournalAmerican Journal of Nephrology
Volume39
Issue number5
DOIs
Publication statusPublished - 2014 Jun

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Weight Gain
Renal Dialysis
Confidence Intervals
Chronic Kidney Failure
Korea
Nutritional Status
Multivariate Analysis
Urine
Kidney
Weights and Measures
Research

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Lee, Mi Jung ; Doh, Fa Mee ; Kim, Chan Ho ; Koo, Hyang Mo ; Oh, Hyung Jung ; Park, Jung Tak ; Han, Seung Hyeok ; Yoo, Tae Hyun ; Kim, Yong Lim ; Kim, Yon Su ; Yang, Chul Woo ; Kim, Nam Ho ; Kang, Shin Wook. / Interdialytic weight gain and cardiovascular outcome in incident hemodialysis patients. In: American Journal of Nephrology. 2014 ; Vol. 39, No. 5. pp. 427-435.
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title = "Interdialytic weight gain and cardiovascular outcome in incident hemodialysis patients",
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.",
author = "Lee, {Mi Jung} and Doh, {Fa Mee} and Kim, {Chan Ho} and Koo, {Hyang Mo} and Oh, {Hyung Jung} and Park, {Jung Tak} and Han, {Seung Hyeok} and Yoo, {Tae Hyun} and Kim, {Yong Lim} and Kim, {Yon Su} and Yang, {Chul Woo} and Kim, {Nam Ho} and Kang, {Shin Wook}",
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Lee, MJ, Doh, FM, Kim, CH, Koo, HM, Oh, HJ, Park, JT, Han, SH, Yoo, TH, Kim, YL, Kim, YS, Yang, CW, Kim, NH & Kang, SW 2014, 'Interdialytic weight gain and cardiovascular outcome in incident hemodialysis patients', American Journal of Nephrology, vol. 39, no. 5, pp. 427-435. https://doi.org/10.1159/000362743

Interdialytic weight gain and cardiovascular outcome in incident hemodialysis patients. / Lee, Mi Jung; Doh, Fa Mee; Kim, Chan Ho; Koo, Hyang Mo; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae Hyun; Kim, Yong Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam Ho; Kang, Shin Wook.

In: American Journal of Nephrology, Vol. 39, No. 5, 06.2014, p. 427-435.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Interdialytic weight gain and cardiovascular outcome in incident hemodialysis patients

AU - Lee, Mi Jung

AU - Doh, Fa Mee

AU - Kim, Chan Ho

AU - Koo, Hyang Mo

AU - Oh, Hyung Jung

AU - Park, Jung Tak

AU - Han, Seung Hyeok

AU - Yoo, Tae Hyun

AU - Kim, Yong Lim

AU - Kim, Yon Su

AU - Yang, Chul Woo

AU - Kim, Nam Ho

AU - Kang, Shin Wook

PY - 2014/6

Y1 - 2014/6

N2 - 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.

AB - 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.

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