title: Association of fluid overload with kidney disease progression in advanced CKD: a prospective cohort study.
abstract: BACKGROUND
  Fluid overload is a common phenomenon in patients in a late stage of chronic kidney disease (CKD). However, little is known about whether fluid overload is related to kidney disease progression in patients with CKD. Accordingly, the aim of the study was to assess the association of the severity of fluid status and kidney disease progression in an advanced CKD cohort.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  This cohort study enrolled 472 non-dialysis-dependent patients with CKD stages 4-5 who were in an integrated CKD care program from January 2011 to December 2011 and followed up until December 2012 or initiation of renal replacement therapy (RRT).
  
  
  METHODS
  Tertile of fluid overload, with cutoff values at 0.6 and 1.6 L.
  
  
  RESULTS
  RRT, rapid estimated glomerular filtration rate (eGFR) decline (faster than 3 mL/min/1.73 m(2) per year), and change in eGFR.
  
  
  METHODS
  The severity of fluid overload was measured by a bioimpedance spectroscopy method. eGFR was computed using the 4-variable MDRD (Modification of Diet in Renal Disease) Study equation.
  
  
  RESULTS
  During a median 17.3-month follow-up, 71 (15.0%) patients initiated RRT and 187 (39.6%) experienced rapid eGFR decline. The severity of fluid overload was associated with increased risk of RRT (tertile 3 vs tertile 1: adjusted HR, 3.16 [95% CI, 1.33-7.50]). Fluid overload value was associated with increased risk of rapid eGFR decline (tertile 3 vs tertile 1: adjusted OR, 4.68 [95% CI, 2.30-9.52]). Furthermore, the linear mixed-effects model showed that the reduction in eGFR over time was faster in tertile 3 than in tertile 1 (P=0.02).
  
  
  CONCLUSIONS
  The effect of fluid volume variation over time must be considered.
  
  
  CONCLUSIONS
  Fluid overload is an independent risk factor associated with initiation of RRT and rapid eGFR decline in patients with advanced CKD.
authors.affiliation: Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Tsai
authors.affiliation: Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Jer-Chia
authors.initials: JC
authors.lastname: Tsai
authors.affiliation: Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.
authors.forename: Szu-Chia
authors.initials: SC
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Yi-Wen
authors.initials: YW
authors.lastname: Chiu
authors.affiliation: Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.affiliation: Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chi-Chih
authors.initials: CC
authors.lastname: Hung
authors.affiliation: Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Tzu-Hui
authors.initials: TH
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: mechku@cc.kmu.edu.tw.
authors.forename: Mei-Chuan
authors.initials: MC
authors.lastname: Kuo
authors.affiliation: Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000368:Aged; D001826:Body Fluids / Q000502:physiology; D058266:Dielectric Spectroscopy / Q000379:methods; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013624:Taiwan / Q000453:epidemiology; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology
keywords: Fluid overload; chronic kidney disease; dialysis; kidney disease progression