title: Is fluid overload more important than diabetes in renal progression in late chronic kidney disease?
abstract: Fluid overload is one of the major presentations in patients with late stage chronic kidney disease (CKD). Diabetes is the leading cause of renal failure, and progression of diabetic nephropathy has been associated with changes in extracellular fluid volume. The aim of the study was to assess the association of fluid overload and diabetes in commencing dialysis and rapid renal function decline (the slope of estimated glomerular filtration rate (eGFR) less than -3 ml/min per 1.73 m(2)/y) in 472 patients with stages 4-5 CKD. Fluid status was determined by bioimpedance spectroscopy method, Body Composition Monitor. The study population was further classified into four groups according to the median of relative hydration status (△HS =fluid overload/extracellular water) and the presence or absence of diabetes. The median level of relative hydration status was 7%. Among all patients, 207(43.9 %) were diabetic. 71 (15.0%) subjects had commencing dialysis, and 187 (39.6%) subjects presented rapid renal function decline during a median 17.3-month follow-up. Patients with fluid overload had a significantly increased risk for commencing dialysis and renal function decline independent of the presence or absence of diabetes. No significantly increased risk for renal progression was found between diabetes and non-diabetes in late CKD without fluid overload. In conclusion, fluid overload has a higher predictive value of an elevated risk for renal progression than diabetes in late 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: 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: Hung-Tien
authors.initials: HT
authors.lastname: Kuo
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: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
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.
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; D000369:Aged, 80 and over; D003920:Diabetes Mellitus; D018450:Disease Progression; D045604:Extracellular Fluid; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D012307:Risk Factors