Fluid overload, pulse wave velocity, and ratio of brachial pre-ejection period to ejection time in diabetic and non-diabetic chronic kidney disease.
Fluid overload is one of the characteristics in chronic kidney disease (CKD). Changes in extracellular fluid volume are associated with progression of diabetic nephropathy. Not only diabetes but also fluid overload is associated with cardiovascular risk factors The aim of the study was to assess the interaction between fluid overload, diabetes, and cardiovascular risk factors, including arterial stiffness and left ventricular function in 480 patients with stages 4-5 CKD. Fluid status was determined by bioimpedance spectroscopy method, Body Composition Monitor. Brachial-ankle pulse wave velocity (baPWV), as a good parameter of arterial stiffness, and brachial pre-ejection period (bPEP)/brachial ejection time (bET), correlated with impaired left ventricular function were measured by ankle-brachial index (ABI)-form device. Of all patients, 207 (43.9%) were diabetic and 240 (50%) had fluid overload. For non-diabetic CKD, fluid overload was associated with being female (β = -2.87, P = 0.003), heart disease (β = 2.69, P = 0.04), high baPWV (β = 0.27, P = 0.04), low hemoglobin (β = -1.10, P < 0.001), and low serum albumin (β = -5.21, P < 0.001) in multivariate analysis. For diabetic CKD, fluid overload was associated with diuretics use (β = 3.69, P = 0.003), high mean arterial pressure (β = 0.14, P = 0.01), low bPEP/ET (β = -0.19, P = 0.03), low hemoglobin (β = -1.55, P = 0.001), and low serum albumin (β = -9.46, P < 0.001). In conclusion, baPWV is associated with fluid overload in non-diabetic CKD and bPEP/bET is associated with fluid overload in diabetic CKD. Early and accurate assessment of these associated cardiovascular risk factors may improve the effects of entire care in late CKD.
Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan.
Yi-Chun
YC
Tsai
Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan.
Yi-Wen
YW
Chiu
Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan.
Hung-Tien
HT
Kuo
Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.
Szu-Chia
SC
Chen
Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan; Institute of Population Sciences, National Health Research Institutes, Miaoli, Taiwan.
Shang-Jyh
SJ
Hwang
Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Tzu-Hui
TH
Chen
Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan.
Mei-Chuan
MC
Kuo
Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan.
Hung-Chun
HC
Chen
D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000473:pathology; D003920:Diabetes Mellitus / Q000503:physiopathology*; D004487:Edema / Q000503:physiopathology*; D045604:Extracellular Fluid / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D013318:Stroke Volume / Q000502:physiology; D059289:Vascular Stiffness / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*