title: Interdialytic weight gain and cardiovascular outcome in incident hemodialysis patients.
abstract: BACKGROUND
  Interdialytic weight gain (IDWG) has been regarded as a surrogate of volume overload, but also as a marker of a better nutritional status in end-stage renal disease (ESRD) patients on hemodialysis (HD). This paradoxical meaning of IDWG requires further investigation, particularly in adverse cardiovascular outcomes.
  
  
  METHODS
  A prospective cohort of 1,013 incident HD patients from 36 HD centers of the Clinical Research Center for ESRD in Korea was included. Patients were categorized into five groups according to the IDWG%, a ratio of absolute IDWG to dry weight: <1.0, ≥4.0, and every 1.0 increment in between. Primary outcome was major adverse cardiac and cerebrovascular events (MACCE).
  
  
  RESULTS
  During a mean follow-up of 18.7 months, primary outcome was observed in 104 patients (10.3%). In multivariate analysis, compared to patients with IDWG% of 1.0-1.9 (reference group), the hazard ratios (HRs) for primary outcome in the IDWG% <1.0, 2.0-2.9, 3.0-3.9, and ≥4.0 groups were 1.10 [95% confidence interval (CI) 0.55-2.20, p = 0.80], 1.15 (95% CI 0.59-2.27, p = 0.68), 1.80 (95% CI 0.95-3.41, p = 0.07), and 1.93 (95% CI 1.02-3.64, p = 0.04), respectively. Furthermore, even when residual renal function and 24-hour urine volume were adjusted, IDWG% ≥4.0 remained as a significant predictor of primary outcome (HR 2.03, 95% CI 1.02-4.02, p = 0.04).
  
  
  CONCLUSIONS
  Increased IDWG% is a significant independent predictor of MACCE in incident HD patients. It could be helpful to prevent excessive IDWG for improving clinical outcomes in incident HD patients.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Mi Jung
authors.initials: MJ
authors.lastname: Lee
authors.forename: Fa Mee
authors.initials: FM
authors.lastname: Doh
authors.forename: Chan Ho
authors.initials: CH
authors.lastname: Kim
authors.forename: Hyang Mo
authors.initials: HM
authors.lastname: Koo
authors.forename: Hyung Jung
authors.initials: HJ
authors.lastname: Oh
authors.forename: Jung Tak
authors.initials: JT
authors.lastname: Park
authors.forename: Seung Hyeok
authors.initials: SH
authors.lastname: Han
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yoo
authors.forename: Yong-Lim
authors.initials: YL
authors.lastname: Kim
authors.forename: Yon Su
authors.initials: YS
authors.lastname: Kim
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
authors.forename: Nam-Ho
authors.initials: NH
authors.lastname: Kim
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000401:mortality; D002318:Cardiovascular Diseases / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis; D020521:Stroke / Q000401:mortality; D015430:Weight Gain; D055815:Young Adult