title: Fluid overload in hemodialysis patients: a cross-sectional study to determine its association with cardiac biomarkers and nutritional status.
abstract: 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.
  
  
  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.
  
  
  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 = <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 < 0.001), and N-terminal pro-B-type natriuretic peptide (r = 0.436; p < 0.001), but not with investigated inflammatory parameters.
  
  
  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.
authors.forename: Marlies
authors.initials: M
authors.lastname: Antlanger
authors.forename: Manfred
authors.initials: M
authors.lastname: Hecking
authors.forename: Michael
authors.initials: M
authors.lastname: Haidinger
authors.forename: Johannes
authors.initials: J
authors.lastname: Werzowa
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Kovarik
authors.forename: Gernot
authors.initials: G
authors.lastname: Paul
authors.forename: Manfred
authors.initials: M
authors.lastname: Eigner
authors.forename: Diana
authors.initials: D
authors.lastname: Bonderman
authors.forename: Walter H
authors.initials: WH
authors.lastname: Hörl
authors.affiliation: Department of Internal Medicine III - Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna Austria. marcus.saemann@meduniwien.ac.at.
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Säemann
mesh_terms: D001317:Austria / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009752:Nutritional Status; D009765:Obesity / Q000401:mortality*; D010446:Peptide Fragments / Q000097:blood; D006435:Renal Dialysis / Q000401:mortality*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000032:analysis; D013223:Statistics as Topic; D015996:Survival Rate; D014883:Water-Electrolyte Imbalance / Q000097:blood / Q000401:mortality*
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; D012709:Serum Albumin; C036309:fibrin fragment D; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain