Korean J Med.  2018 Dec;93(6):548-555. 10.3904/kjm.2018.93.6.548.

Relative Association of Overhydration and Muscle Wasting with Mortality in Hemodialysis Patients: Assessment by Bioelectrical Impedance Analysis

• Kim E
• Seo SO
• Choi YB
• Lee MJ
• Lee JE
• Kim HJ

• KMID: 2438046
• DOI: http://doi.org/10.3904/kjm.2018.93.6.548

Abstract

BACKGROUND/AIMS
Assessment of fluid status in hemodialysis patents is very important. Overhydration in hemodialysis is associated with generalized edema, cardiovascular complications, and hypertension. The aim of this study was to determine the factors correlated with mortality of hemodialysis patients, assessing body muscle mass and fluid status using bioelectrical impedance analysis (BIA).
METHODS
This study enrolled 93 patients who underwent hemodialysis between January 2010 and May 2015 at CHA Bundang Medical Center. Medical records of enrollees up to June 2017 were reviewed retrospectively. These included laboratory results (serum albumin, C-reactive protein [CRP], lipid profile, etc.) and BIA data (extracellular water, intracellular water, total body water, soft lean mass, fat free mass, skeletal muscle mass, etc.).
RESULTS
Eleven of 93 patients had expired by May 2017. Among the surviving subjects, mean age was younger, CRP levels were lower, albumin levels were higher, and extracellular water/total body water (ECW/TBW) ratios were lower than in the expired patient group. Kaplan-Meier survival analysis revealed that overhydration (ECW/TBW > 0.4) was associated with higher mortality.
CONCLUSIONS
In hemodialysis patients, overhydration is an important factor in mortality, and BIA could be a reliable modality in its assessment. We suggest that, for hemodialysis patients, overhydration is more of a risk factor for mortality than is muscle wasting.

Keyword

Hemodialysis; Mortality; Overhydration

MeSH Terms

Body Water
C-Reactive Protein
Edema
Electric Impedance*
Humans
Hypertension
Medical Records
Mortality*
Muscle, Skeletal
Renal Dialysis*
Retrospective Studies
Risk Factors
Water
C-Reactive Protein
Water