ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-OR088

Prognostic Value of Extracellular Fluid Volume in CKD: A Prospective Cohort Study

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Faucon, Anne-Laure, CESP, INSERM U1018, Villejuif, France
  • Flamant, Martin, Hôpital Bichat, Paris, France
  • Metzger, Marie, CESP U1018, INSERM, Villejuif, France
  • Boffa, Jean-Jacques, Hôpital Tenon, Paris, France
  • Haymann, Jean-philippe, Hôpital Tenon, Paris, France
  • Houillier, Pascal, Hôpital Européen Georges Pompidou, Paris, France
  • Thervet, Eric, Hôpital Européen Georges Pompidou, Paris, France
  • Stengel, Benedicte, CESP, INSERM U1018, Villejuif, France
  • Geri, Guillaume, Hôpital Ambroise Paré, Paris, France
  • Vidal-Petiot, Emmanuelle, Hôpital Bichat, Paris, France
Background

Volume overload has been shown to be an independent risk factor for mortality in chronic dialysis patients. However, few studies have analyzed the prognostic value of extracellular fluid (ECF) volume in patients with chronic kidney disease (CKD), not on dialysis. The aim of this study was to analyze the association between ECF volume and end-stage renal disease (ESRD) and mortality in patients with non-dialysis CKD.

Methods

The NephroTest study is a prospective hospital-based tricentric cohort which included 2,084 patients with CKD stage 1-5 of various aetiologies, between 2000 and 2012. ECF volume was measured as the distribution volume of 51CrEDTA, and expressed as a ratio of measured over theoretical ECF (rECF) - the latter being calculated using Moore formula. Measured glomerular filtration rate (mGFR) was assessed from the renal clearance of 51Cr-EDTA. Cause-specific Cox regression models were used to estimate hazard ratios (HR, 95% confidence intervals) of ESRD and death before ESRD associated with rECF tertiles in 1,610 patients with mGFR > 15 ml/min/1.73 m2.

Results

Mean age of patients was 58.7±15.1years, and 66.8% were men. Baseline mean mGFR was 43.7±18.7mL/min/1.73m2, mean ECF volume and rECF were 16.1±3.8L and 0.96±0.14, respectively. After a median follow-up of 6.1 [IQR: 3.64;8.37] years, ESRD occurred in 329 (20.4%) patients and 187 (11.6%) patients died before ESRD. After adjustment for age, sex, site, ethnicity, cardiovascular risk factors, underlying renal disease, mGFR, proteinuria, 24-hour sodium excretion, diuretics and diuresis, a higher baseline rECF was significantly associated with ESRD (HR for second vs. first tertile = 1.28 [0.94;1.74], HR for third vs. first tertile = 1.51 [1.08;2.10]), and with mortality (HR for second vs. first tertile = 0.99 [0.63;1.56], HR for third vs. first tertile = 1.81 [1.17;2.80]).

Conclusion

Our data suggest that rECF volume is an independent risk factor of ESRD and mortality. Monitoring and avoiding excessive fluid overload is important for the clinical management of patients with CKD.