Abstract: FR-PO848
Fluid Status (FS) as Predictor of Long Term Survival in Hemodialysis (HD) Patients
Session Information
- Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular - I
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular
Authors
- Guinsburg, Adrian M., Fresenius Medical Care, Moron, Argentina
- Ferder, Marcelo D, Fresenius Medical Care, Moron, Argentina
- Marelli, Cristina, Fresenius Medical Care, Moron, Argentina
Background
Extracellular fluid overload (FO) has been typically described as predictor of all-cause mortality in HD patients. A recent publication [Dekker et al, KI (2017), 91, 1214-1223] also demonstrated a beneficial effect of pre and postdialysis fluid depletion on survival. In this study we aim to analyze the relationship between FS and survival in a large cohort of patients from Fresenius Medical Care LatinAmerica (FMCLA)
Methods
Patients on HD at FMCLA between 09/2008 and 12/2016 were included. Body composition after 90 days of dialysis was assessed by multifrequency bioimpedance spectroscopy (BCM©, Fresenius Medical Care). Pre and postdialysis fluid status (FS) groups were defined according to overhydration (OH) as follow: fluid depletion (FD, <= -1.1 lts), normovolemia (NV, -1.1 to 1.1 lts), moderate FO (MFO, 1.1 to 2.5 lts), severe FO (SFO, 2.5 to 5 lts) and extreme FO (EFO, +5 lts). A Cox regression model was constructed to analyze independent relationship between FS and survival accounting for age, gender, vintage, diabetes, CVD, cancer, predialysis systolic blood pressure (preSBP), BMI, lean and fat tissue index, albumin, CRP, cholesterol, Hgb, Ca, P, Na and eKt/V. Values are expressed as mean±SD or [CI]
Results
43,786 patients were included into initial dataset but only 9,501 had available data on all variables. Age 57.9±16.1 yrs, vintage 3.1 [3.06-3.14] yrs, male 58.2%, OH 1.76 [1.74-1.78] lts, preSBP 140.4±23.4 mmHg, alb 3.8±0.5 (g/dl), hgb 10.8±1.9 g/dl, Ca 8.8±0.9 mg/dl, P 4.7±1.4 mg/dl, 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 years and 2,978 death events were observed. After controlling, RR of death for each group as compared to NV (ref) was a) for predialysis FS: FD 1.19 [NS], MFO 1.18 [1.08-1.30], SFO 1.61 [1.45-1.79], EFO 2.50 [2.09-2.98]; b) for postdialysis FS: FD 1.06 [NS], MFO 1.1 [NS], SFO 1.18 [NS], EFO 1.94 [1.36-2.76]
Conclusion
In our cohort and after multivariate adjustments predialysis MFO, SFO and EFO increased risk of death while there was no impact of FD. Postdialysis FS had no independent impact on survival except for EFO patients.