TY - JOUR
T1 - Interdialytic weight gain and survival in hemodialysis patients
T2 - Effects of duration of ESRD and diabetes mellitus
AU - Kimmel, Paul L.
AU - Varela, Maria P.
AU - Peterson, Rolf A.
AU - Weihs, Karen L.
AU - Simmens, Samuel J.
AU - Alleyne, Sylvan
AU - Amarashinge, Amali
AU - Mishkin, Gary J.
AU - Cruz, Illuminado
AU - Veis, Judith H.
N1 - Funding Information:
Dr. Kimmel was supported during these studies by a grant from the National Institutes of Diabetes, Digestive, and Kidney Diseases (1-RO1-DK 45578). We thank the nursing, social work, and dietary staff of the outpatient hemodialysis units of the George Washington University Medical Center, the Howard University Medical Center, and the Washington Veterans Affairs Medical Center for cooperating in this study. We are indebted to the hard-working research staff and volunteers (Nicole Shidler, Julie Kovac, Maria Whittington, Deatrice Williams, Ilse Wendorf, Kaidi Fullerton, Kirti Sharma, Deneane Boyle, Ghada Swadek, Mark Collier, Beth Lorell, Drew Gechman, and Karen Arndt), who collected and entered these data. We are also indebted to Ms. Nancy Armistead and the staff of ESRD Network 5, who provided data on vital statistics of patients enrolled in the study. Most of all, we thank our patients who continue to teach us about chronic renal disease for volunteering to participate in this study. These findings were presented in part at the 31st Annual Meeting of the American Society of Nephrology, October 1998, Philadelphia, PA, USA. Dr. M.P. Varela was a fellow of the International Society of Nephrology from Hospital de Clinicas, Montevideo, Uruguay, during the analysis of these data.
PY - 2000
Y1 - 2000
N2 - Background. Medical mortality determinants in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) are well known. More recently, associations have been established between the dose of dialysis administered and patient survival. We showed in a prospective study that both dialyzer type and patient compliance with the dialysis prescription were independently associated with survival. Although several parameters of dialytic technique and patient compliance are associated with differential survival in patients with ESRD treated with HD, the association of interdialytic weight gain (IWG) with survival is unclear. No study has assessed the relationship between IWG and mortality in HD patients, controlled for multiple medical risk factors. The aim of our study was to determine whether IWG was associated with survival in patients with ESRD treated with HD, controlling for multiple medical and dialytic risk factors. Methods. We prospectively conducted an observational, longitudinal, multicenter study of 283 urban HD patients to determine the relationship of IWG with several dialytic parameters and patient survival. Medical risk factors such as demographic indices and comorbid conditions were assessed. We studied Kt/V, the protein catabolic rate (PCR), serum albumin and anthropometric measurements, behavioral compliance indices, dialyzer characteristics, and serum electrolyte concentrations, and correlated these with IWG. In addition, the duration of dialysis was assessed in HD patients with and without diabetes mellitus. Cox proportional hazards models assessed the relative mortality risk of increased IWG, controlling for variations in medical comorbidity and other mortality determinants. Results. The mean (±SD) age of our population was 54.6 ± 14.1 years, and the mean time they were treated with HD was 30.4 ± 46.9 months. The mean IWG was 1.54 ± 0.71% dry wt/day. Correlations were found between increased IWG and younger age, and lower midarm circumference, and increased Kt/V, PCR, and serum potassium concentration. The mean follow-up period was 48.9 ± 10.6 months. An increase in IWG was associated with a significantly increased relative mortality risk in diabetic ESRD patients treated with HD when variations in age, comorbidity, serum albumin concentration, and dialyzer type and site were controlled. There was, however, no association of increased mortality risk with increased IWG in the larger population of patients without diabetes. In further analyses, the increased mortality risk associated with increased IWG was found to be present only in patients with diabetes mellitus who had recently started HD therapy for ESRD. Conclusion. IWG is correlated with several nutritional and dialytic variables and with parameters that predict survival in HD patients. Increased IWG is independently associated with decreased survival of diabetic ESRD patients treated with HD, after adjusting for variation in other medical risk factors. The population of incident diabetic HD patients is particularly susceptible to increased risk associated with increased IWG. The mechanisms underlying these results are obscure, but IWG might be associated with poorer survival in this population if it were linked to worsened hypertension, cardiovascular stress, or poorer glycemic control. Interventions to improve compliance with IWG in incident diabetic HD patients are warranted.
AB - Background. Medical mortality determinants in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) are well known. More recently, associations have been established between the dose of dialysis administered and patient survival. We showed in a prospective study that both dialyzer type and patient compliance with the dialysis prescription were independently associated with survival. Although several parameters of dialytic technique and patient compliance are associated with differential survival in patients with ESRD treated with HD, the association of interdialytic weight gain (IWG) with survival is unclear. No study has assessed the relationship between IWG and mortality in HD patients, controlled for multiple medical risk factors. The aim of our study was to determine whether IWG was associated with survival in patients with ESRD treated with HD, controlling for multiple medical and dialytic risk factors. Methods. We prospectively conducted an observational, longitudinal, multicenter study of 283 urban HD patients to determine the relationship of IWG with several dialytic parameters and patient survival. Medical risk factors such as demographic indices and comorbid conditions were assessed. We studied Kt/V, the protein catabolic rate (PCR), serum albumin and anthropometric measurements, behavioral compliance indices, dialyzer characteristics, and serum electrolyte concentrations, and correlated these with IWG. In addition, the duration of dialysis was assessed in HD patients with and without diabetes mellitus. Cox proportional hazards models assessed the relative mortality risk of increased IWG, controlling for variations in medical comorbidity and other mortality determinants. Results. The mean (±SD) age of our population was 54.6 ± 14.1 years, and the mean time they were treated with HD was 30.4 ± 46.9 months. The mean IWG was 1.54 ± 0.71% dry wt/day. Correlations were found between increased IWG and younger age, and lower midarm circumference, and increased Kt/V, PCR, and serum potassium concentration. The mean follow-up period was 48.9 ± 10.6 months. An increase in IWG was associated with a significantly increased relative mortality risk in diabetic ESRD patients treated with HD when variations in age, comorbidity, serum albumin concentration, and dialyzer type and site were controlled. There was, however, no association of increased mortality risk with increased IWG in the larger population of patients without diabetes. In further analyses, the increased mortality risk associated with increased IWG was found to be present only in patients with diabetes mellitus who had recently started HD therapy for ESRD. Conclusion. IWG is correlated with several nutritional and dialytic variables and with parameters that predict survival in HD patients. Increased IWG is independently associated with decreased survival of diabetic ESRD patients treated with HD, after adjusting for variation in other medical risk factors. The population of incident diabetic HD patients is particularly susceptible to increased risk associated with increased IWG. The mechanisms underlying these results are obscure, but IWG might be associated with poorer survival in this population if it were linked to worsened hypertension, cardiovascular stress, or poorer glycemic control. Interventions to improve compliance with IWG in incident diabetic HD patients are warranted.
KW - Anthropometry
KW - Chronic renal disease
KW - ESRD
KW - Survival on hemodialysis
KW - Weight gain
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U2 - 10.1046/j.1523-1755.2000.00941.x
DO - 10.1046/j.1523-1755.2000.00941.x
M3 - Article
C2 - 10720966
AN - SCOPUS:0033933970
SN - 0085-2538
VL - 57
SP - 1141
EP - 1151
JO - Kidney International
JF - Kidney International
IS - 3
ER -