Abstract: FR-PO796

Relationship between Hydration Status (HS), Blood Pressure (BP), and Survival in Hemodialysis (HD) Patients (Pts)

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Ferder, Marcelo D, Fresenius Medical Care Argentina, Buenos Aires, Argentina
  • Guinsburg, Adrian M., Fresenius Medical Care Argentina, Buenos Aires, Argentina
  • Marelli, Cristina, Fresenius Medical Care Argentina, Buenos Aires, Argentina
Background

HS and BP are key factors to control in HD pts due both are closely related to mortality. We aimed to study their association with mortality in a large HD pts cohort from Fresenius Medical Care Latinamerica (FMCLA).

Methods

Pts undergoing HD at FMCLA between 09/2008 and 12/2016 were included. HS was assessed by multifrequency bioimpedance spectroscopy using a body composition monitor device (BCM©, FME Deutschland GmbH). Predialysis systolic BP (pSBP) was obtained as mean of 6 consecutive treatments prior to HS assessment (baseline). Lab data at baseline was used. Values expressed as mean±SD. All pts were assigned to one of five groups (G) based on pSBP and overhydration (OH). G1: Hypertensive-Overhydrated (OH>=1+pSBP>=140); G2: Hypertensive-Normo/Dehydrated (OH<1+pSBP>=140); G3: Hypotensive-Normo/Dehydrated (OH<-1+pSBP<140) or (OH<1+pSBP<100); G4: Hypotensive-Overhydrated (OH>=1+pSBP<140); G5 (Ref): Normotensive-Normohydrated (-1=<OH<1+100=<pSBP<140). Time at risk was counted between HS assessment and death or Dec 31, 2016. A Cox model was constructed to analyze independent relationship between groups and mortality.

Results

43,786 pts were included. Age 57.9±16.1 yrs, vintage 3.1±4.3 yrs, male 58.2%, OH 1.76±2.15 lts, pSBP 140.4±23.4 mmHg, Alb 3.8±0.5 (g/dl), Hgb 10.8±1.9 g/dl, serum Ca 8.8±0.9 mg/dl, serum P 4.7±1.4 mg/dl, serum Na 137.8±4.0 mEq/l, eKt/V 1.36±0.30, DBT 30.9%, CVD 8.0%, Cancer 1.0%.
Mean follow up time was 4.45 yrs and 5,864 death events were observed. After controlling for demographic, comorbid and lab values, RR of death was G1 1.50 (1.38-1.64), G2 1.14 (1.02-1.28), G3 1.29 (1.14-1.46) and G4 1.57 (1.45-1.70).

Conclusion

Our study suggests that any combination of OH and pSBP outside the box of reference (-1<OH<1 and 100<pSBP<140) increases risk of death. Excesive OH (OH>=1) combined with pSBP<140 (G4) as well as >140 (G1) are groups at higher risk.