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Abstract: PO0859

Relationship Between Fluid Overload and Hemoglobin Concentration in Hemodialysis Patients: A Longitudinal Analysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Rivera Fuentes, Lemuel, Renal Research Institute, New York, New York, United States
  • Mermelstein, Ariella E., Renal Research Institute, New York, New York, United States
  • Kaysen, George A., University of California Davis, Davis, California, United States
  • Raimann, Jochen G., Renal Research Institute, New York, New York, United States
  • Moissl, Ulrich, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany
  • Thijssen, Stephan, Renal Research Institute, New York, New York, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States

Group or Team Name

  • Renal Research Institute
Background

Quantification of fluid status by bioimpedance spectroscopy (BIS) has become routine outside United States (US). We performed the first assessment of fluid status in US hemodialysis (HD) clinics using a BIS device. We studied the longitudinal association between fluid overload (FO) and hemoglobin (Hgb) concentration adjusting for inflammation and erythropoiesis-stimulating agents (ESA).

Methods

Measurement of FO [Body Composition Monitor (BCM); Fresenius Medical Care] was conducted cross-sectionally in chronic HD patients in 4 HD clinics in New York. We built linear mixed effects models with Hgb as the dependent variable and calculated FO longitudinally to include as a fixed effect. We tested the robustness of the association to account for the influence of inflammation by including the neutrophil-lymphocyte ratio (NLR) as an additional fixed effect. As a subset analysis 2 separate models were built in subjects with or without ESAs. To corroborate the dilutional effect of FO we exchanged Hgb for albumin as a fixed effect.

Results

We studied 169 patients (Figure1). FO was inversely associated with Hgb [Estimate -0.16 (-0.20 to -0.12) g/dl per 1L of FO], a significant fixed effect that remained unchanged in magnitude even after inclusion of NLR [Estimate 0.04 (-0.05 to 0.06) g/dl per 1 unit of NLR]. The effect was larger in patients without ESA prescription [Estimate -0.22 (-0.32 to -0.12) g/dl per 1L of FO]. FO was a significant determinant of albumin [Estimate -0.02 (-0.03 to -0.01) g/dl per 1L of FO] with NLR being a significant fixed effect [Estimate -0.03 (-0.04 to -0.01) g/dl per 1 unit of NLR].

Conclusion

Hgb is inversely affected by FO, a significant effect independent of inflammation (NLR). The impact of FO on Hgb concentration is larger in those with no ESA treatment emphasizing that fluid status has to be considered in anemia management. The effect of FO on albumin supports hemodilution as the principal cause for the changes seen on Hgb.

Demographics.

Funding

  • Commercial Support –