Fluid overload in hemodialysis patients: a cross-sectional study to determine its association with cardiac biomarkers and nutritional status

作者：Antlanger Marlies; Hecking Manfred; Haidinger Michael; Werzowa Johannes; Kovarik Johannes J; Paul Gernot; Eigner Manfred; Bonderman Diana; Hoeri Walter H; Saeemann Marcus D

来源：BMC Nephrology, 2013, 14: 266.

DOI：10.1186/1471-2369-14-266

• Hemodialysis
• Fuid overload
• Cardiovascular
• Inflammation
• Bioimpedance

Background: Chronic fluid overload is associated with higher mortality in dialysis patients; however, the link with cardiovascular morbidity has not formally been established and may be influenced by subclinical inflammation. We hypothesized that a relationship exists between fluid overload and [i] cardiovascular laboratory parameter as well as between fluid overload and [ii] inflammatory laboratory parameters. In addition, we aimed to confirm whether volume status correlates with nutritional status. %26lt;br%26gt;Methods: We recorded baseline characteristics of 244 hemodialysis patients at three hemodialysis facilities in Vienna (Austria) and determined associations with volume measurements using the body composition monitor (Fresenius/Germany). In one facility comprising 126 patients, we further analyzed cardiovascular, inflammatory and nutritional parameters. %26lt;br%26gt;Results: We detected predialysis fluid overload (FO) in 39% of all patients (n = 95) with FO defined as = 15% of extracellular water (ECW). In this subgroup, the absolute FO was 4.4+/-1.5 L or 22.9 +/- 4.8% of ECW. A sub-analysis of patients from one center showed that FO was negatively associated with body mass index (r = -0.371; p = %26lt; 0.001), while serum albumin was significantly lower in fluid overloaded patients (p = 0.001). FO was positively associated with D-Dimer (r = 0.316; p = 0.001), troponin T (r = 0.325; p %26lt; 0.001), and N-terminal pro-B-type natriuretic peptide (r = 0.436; p %26lt; 0.001), but not with investigated inflammatory parameters. %26lt;br%26gt;Conclusions: Fluid overload in HD patients was found to be lower in patients with high body mass index, indicating that dry weight was inadequately prescribed and/or difficult to achieve in overweight patients. The association with parameters of cardiovascular compromise and/or damage suggests that fluid overload is a biomarker for cardiovascular risk. Future studies should determine if this applies to patients prior to end-stage renal disease.

• 出版日期2013-12-2