Kidney Week

Abstract: TH-OR088

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

Session Information

• Novel Risk Factors for CKD
  October 25, 2018 | Location: 6E, San Diego Convention Center
  Abstract Time: 05:54 PM - 06:06 PM

Category: CKD (Non-Dialysis)

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

Authors

• Faucon, Anne-Laure, CESP, INSERM U1018, Villejuif, France

Anne-Laure Faucon, MD

• Flamant, Martin, Hôpital Bichat, Paris, France

Martin Flamant,

• Metzger, Marie, CESP U1018, INSERM, Villejuif, France

Marie Metzger,

• Boffa, Jean-Jacques, Hôpital Tenon, Paris, France

Jean-Jacques Boffa,

• Haymann, Jean-philippe, Hôpital Tenon, Paris, France

Jean-philippe Haymann,

• Houillier, Pascal, Hôpital Européen Georges Pompidou, Paris, France

Pascal Houillier,

• Thervet, Eric, Hôpital Européen Georges Pompidou, Paris, France

Eric Thervet,

• Stengel, Benedicte, CESP, INSERM U1018, Villejuif, France

Benedicte Stengel,

• Geri, Guillaume, Hôpital Ambroise Paré, Paris, France

Guillaume Geri,

• Vidal-Petiot, Emmanuelle, Hôpital Bichat, Paris, France

Emmanuelle Vidal-Petiot,

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.