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

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28 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

All Science Journal Classification (ASJC) codes

  • Nephrology

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    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. (2014). Interdialytic weight gain and cardiovascular outcome in incident hemodialysis patients. American Journal of Nephrology, 39(5), 427-435. https://doi.org/10.1159/000362743