title: Interdialytic weight gain, systolic blood pressure, serum albumin, and C-reactive protein levels change in chronic dialysis patients prior to death.
abstract: Reports from a United States cohort of chronic hemodialysis patients suggested that weight loss, a decline in pre-dialysis systolic blood pressure, and decreased serum albumin may precede death. However, no comparative studies have been reported in such patients from other countries. Here we analyzed dynamic changes in these parameters in hemodialysis patients and included 3593 individuals from 5 Asian countries; 35,146 from 18 European countries; 8649 from Argentina; and 4742 from the United States. In surviving prevalent patients, these variables appeared to have notably different dynamics than in patients who died. While in all populations the interdialytic weight gain, systolic blood pressure, and serum albumin levels were stable in surviving patients, these indicators declined starting more than a year ahead in those who died with the dynamics similar irrespective of gender and geographic region. In European patients, C-reactive protein levels were available on a routine basis and indicated that levels of this acute-phase protein were low and stable in surviving patients but rose sharply before death. Thus, relevant fundamental biological processes start many months before death in the majority of chronic hemodialysis patients. Longitudinal monitoring of these dynamics may help to identify patients at risk and aid the development of an alert system to initiate timely interventions to improve outcomes.
authors.affiliation: Renal Research Institute, New York, New York 10128, USA.
authors.forename: Len A
authors.initials: LA
authors.lastname: Usvyat
authors.forename: Claudia
authors.initials: C
authors.lastname: Barth
authors.forename: Inga
authors.initials: I
authors.lastname: Bayh
authors.forename: Michael
authors.initials: M
authors.lastname: Etter
authors.forename: Gero D
authors.initials: GD
authors.lastname: von Gersdorff
authors.forename: Aileen
authors.initials: A
authors.lastname: Grassmann
authors.forename: Adrian M
authors.initials: AM
authors.lastname: Guinsburg
authors.forename: Maggie
authors.initials: M
authors.lastname: Lam
authors.forename: Daniele
authors.initials: D
authors.lastname: Marcelli
authors.forename: Cristina
authors.initials: C
authors.lastname: Marelli
authors.forename: Laura
authors.initials: L
authors.lastname: Scatizzi
authors.forename: Mathias
authors.initials: M
authors.lastname: Schaller
authors.forename: Adam
authors.initials: A
authors.lastname: Tashman
authors.forename: Ted
authors.initials: T
authors.lastname: Toffelmire
authors.forename: Stephan
authors.initials: S
authors.lastname: Thijssen
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Kooman
authors.forename: Frank M
authors.initials: FM
authors.lastname: van der Sande
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Levin
authors.forename: Yuedong
authors.initials: Y
authors.lastname: Wang
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
mesh_terms: D000368:Aged; D001118:Argentina; D001208:Asia; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism*; D016208:Databases, Factual; D018450:Disease Progression; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*; D000075462:Serum Albumin, Human; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D015430:Weight Gain
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D012709:Serum Albumin; D002097:C-Reactive Protein; D000075462:Serum Albumin, Human