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Titolo The mortality risk of overhydration in haemodialysis patients
Autore Volker Wizemann1, Peter Wabel2, Paul Chamney2, Wojciech Zaluska3, Ulrich Moissl2, Christiane Rode1, Teresa Malecka-Masalska3 and Daniele Marcelli2 - 1Georg-Haas Dialysezentrum Giessen, 2Fresenius Medical Care, Germany and 3University of Lublin, Poland
Referenza Nephrol Dial Transplant (2009); 24: 1574-1579
Contenuto Background. While cardiovascular events remain the primary form of mortality in haemodialysis (HD) patients, few centres are aware of the impact of the hydration status (HS). The aim of this study was to investigate how the magnitude of the prevailing overhydration influences long-term survival. Methods. We measured the hydration status in 269 prevalent HD patients (28% diabetics, dialysis vintage = 41.2 ± 70 months) in three European centres with a body composition monitor (BCM) that enables quantitative assessment of hydration status and body composition. The survival of these patients was ascertained after a follow-up period of 3.5 years. The cut off threshold for the definition of hyperhydration was set to 15% relative to the extracellular water (ECW), which represents an excess of ECW of ∼2.5 l. Cox-proportional hazard models were used to compare survival according to the baseline hydration status for a set of demographic data, comorbid conditions and other predictors. Results. The median hydration state (HS) before the HD treatment (_HSpre) for all patients was 8.6 ± 8.9%. The unadjusted gross annual mortality of all patients was 8.5%. The hyperhydrated subgroup (n = 58) presented _HSpre = 19.9 ± 5.3% and a gross mortality of 14.7%. The Cox adjusted hazard ratios (HRs) revealed that age (HRage = 1.05, 1/year; P < 0.001), systolic blood pressure (BPsys) (HRBPsys = 0.986 1/mmHg; P = 0.014), diabetes (HRDia = 2.766; P < 0.001), peripheral vascular disease (PVD) (HRPVD = 1.68; P = 0.045) and relative hydration status (_HSpre) (HR_HSpre = 2.102 P = 0.003) were the only significant predictors ofmortality in our patient population. Conclusion. The results of our study indicate that the hydration state is an important and independent predictor of mortality in chronicHDpatients secondary only to the presence of diabetes. We believe that it is essential to measure the hydration status objectively and quantitatively in order to obtain a more clearly defined assessment of the prognosis of haemodialysis patients.
Data 19.05.2009
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