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Kidney Week

Abstract: SA-OR047

Increase of Extracellular Fluid Volume over Time Is Associated with ESKD and Mortality in Patients with CKD

Session Information

  • Biomarkers in CKD
    November 09, 2019 | Location: 152, Walter E. Washington Convention Center
    Abstract Time: 06:18 PM - 06:30 PM

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Faucon, Anne-Laure, CESP, INSERM U1018, Villejuif Cedex, France
  • Vidal-Petiot, Emmanuelle, Departement of Physiology, Hopital Bichat, Paris, France
  • Flamant, Martin, Departement of Physiology, Hopital Bichat, Paris, France
  • Metzger, Marie, CESP, INSERM U1018, Villejuif Cedex, France
  • Houillier, Pascal, Department of Physiology, Hopital Europeen Georges Pompidou, Paris, France
  • Haymann, Jean-Philippe, Department of Physiology, Hopital Tenon, Paris, France
  • Vrtovsnik, Francois, Department of Nephrology, Hopital Bichat, Paris, France
  • Boffa, Jean-Jacques, Department of Nephrology, Hopital Tenon, Paris, France
  • Thervet, Eric, Department of Nephrology, Hopital Europeen Georges Pompidou, Paris, France
  • Stengel, Benedicte, CESP, INSERM U1018, Villejuif Cedex, France
  • Leffondre, Karen, ISPED, INSERM U1219, University of Bordeaux, Bordeaux, France
  • Geri, Guillaume, Intensive Care Unit, Hopital Ambroise Pare, Boulogne-Billancourt, France

Group or Team Name

  • Renal and Cardiovascular Epidemiology
Background

Data on the association between longitudinal change in extracellular fluid volume (ECF) and end-stage kidney disease (ESKD) and mortality are lacking. The aim of the present study was to analyze whether ECF over time was associated with ESKD and mortality, in patients with chronic kidney disease (CKD).

Methods

1588 patients of the hospital-based tricentric NephroTest cohort with CKD stage 1-4 were included. ECF and glomerular filtration rate (GFR) were measured using the distribution volume and clearance of 51CrEDTA, respectively. ESKD was defined by initiation of chronic dialysis or pre-emptive transplantation. Joint models with shared random-effect were used to jointly analyze individual trajectories of ECF and the competing risks of ESKD and mortality. Time-to-event sub-model of the joint models was adjusted for age, gender, site, ethnicity, cardiovascular risk factors, underlying renal disease, measured GFR (mGFR), proteinuria, 24-h urinary sodium excretion, diuretics and renin-angiotensin system inhibitors.

Results

At baseline, patients (mean age 58.7±15.1 years, 67% men) had a mean mGFR of 44±19 mL/min/1.73m2, and ECF was 16.1±3.6 L. After a median follow-up of 5.3[IQR: 3.0;7.4] years with a median number of ECF measurement of 2 [IQR: 1;4] per patient, the mean rate of ECF increase was 117 mL/year 95%CI [90;144]. Between the first and the last visit, the percentage of patients treated by diuretic increased from 47.6 to 50.9% and mean 24-h urinary sodium excretion decreased from 155±73 to 150±73 mmol/d. ESKD occurred in 324 (20.4%) patients and 185 (11.6%) patients died before ESKD. In multivariable analysis, a higher current value of ECF was associated with an increased hazard of ESKD (adjusted hazard ratio [aHR] per 1L increase in ECF was 1.12 95%CI [1.06;1.18], p<0.001) and with mortality (aHR=1.08 [1.01;1.15], p=0.02).

Conclusion

In this large cohort of CKD patients, ECF over time was independently associated with ESKD and mortality. This highlights the need for a close monitoring and adjustment of treatments in these patients.