title: Impact of fluid status and inflammation and their interaction on survival: a study in an international hemodialysis patient cohort.
abstract: In hemodialysis patients extracellular fluid overload is a predictor of all-cause and cardiovascular mortality, and a relation with inflammation has been reported in previous studies. The magnitude and nature of this interaction and the effects of moderate fluid overload and extracellular fluid depletion on survival are still unclear. We present the results of an international cohort study in 8883 hemodialysis patients from the European MONDO initiative database where, during a three-month baseline period, fluid status was assessed using bioimpedance and inflammation by C-reactive protein. All-cause mortality was recorded during 12 months of follow up. In a second analysis a three-month baseline period was added to the first baseline period, and changes in fluid and inflammation status were related to all-cause mortality during six-month follow up. Both pre-dialysis estimated fluid overload and fluid depletion were associated with an increased mortality, already apparent at moderate levels of estimated pre-dialysis fluid overload (1.1-2.5L); hazard ratio 1.64 (95% confidence interval 1.35-1.98). In contrast, post-dialysis estimated fluid depletion was associated with a survival benefit (0.74 [0.62-0.90]). The concurrent presence of fluid overload and inflammation was associated with the highest risk of death. Thus, while pre-dialysis fluid overload was associated with inflammation, even in the absence of inflammation, fluid overload remained a significant risk factor for short-term mortality, even following improvement of fluid status.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, Netherlands; Department of Internal Medicine, Division of Nephrology, Catharina Hospital Eindhoven, Netherlands. Electronic address: mje.dekker@gmail.com.
authors.forename: Marijke J E
authors.initials: MJ
authors.lastname: Dekker
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marcelli
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Canaud
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Paola
authors.initials: P
authors.lastname: Carioni
authors.affiliation: University of California, Santa Barbara, Santa Barbara, California, USA.
authors.forename: Yuedong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Aileen
authors.initials: A
authors.lastname: Grassmann
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Catharina Hospital Eindhoven, Netherlands.
authors.forename: Constantijn J A M
authors.initials: CJ
authors.lastname: Konings
authors.affiliation: Renal Research Institute, New York, New York, USA; Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, Netherlands.
authors.forename: Karel M
authors.initials: KM
authors.lastname: Leunissen
authors.affiliation: Renal Research Institute, New York, New York, USA; Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA.
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Levin
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, Netherlands.
authors.forename: Frank M
authors.initials: FM
authors.lastname: van der Sande
authors.affiliation: Renal Research Institute, New York, New York, USA.
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Ye
authors.affiliation: Renal Research Institute, New York, New York, USA.
authors.forename: Vaibhav
authors.initials: V
authors.lastname: Maheshwari
authors.affiliation: Renal Research Institute, New York, New York, USA; Fresenius Medical Care North America, Waltham, Massachusetts, USA.
authors.forename: Len A
authors.initials: LA
authors.lastname: Usvyat
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, Netherlands.
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Kooman
mesh_terms: D000368:Aged; D001826:Body Fluids; D002097:C-Reactive Protein / Q000032:analysis; D017097:Electric Impedance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000150:complications* / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D014883:Water-Electrolyte Imbalance / Q000097:blood / Q000150:complications* / Q000401:mortality
chemical_list: D002097:C-Reactive Protein
keywords: body composition; fluid status; hemodialysis; inflammation