Volume overload correlates with cardiovascular risk factors in patients with chronic kidney disease

Area of Science:

• Nephrology
• Cardiology
• Biomedical Engineering

Background:

• Volume overload predicts mortality in dialysis patients.
• Fluid status in non-dialysis chronic kidney disease (CKD) patients is poorly understood.
• Cardiovascular disease (CVD) risk factors are prevalent in CKD.

Purpose of the Study:

• To accurately characterize fluid status in CKD patients stages 3-5.
• To investigate the association between overhydration and CVD risk factors in this population.
• To evaluate the utility of bioimpedance devices for identifying high-risk CKD patients.

Main Methods:

• Utilized a multifrequency bioimpedance device (Body Composition Monitor) to measure extracellular water.
• Defined overhydration as excess extracellular water compared to predicted healthy levels.
• Assessed volume overload using the 90th percentile of overhydration in a normal population.
• Analyzed associations between overhydration and clinical/biochemical parameters in 338 CKD patients stages 3-5.

Main Results:

• Only 48% of CKD patients stages 3-5 were euvolemic; 52% experienced volume overload.
• Patients with volume overload had higher systolic blood pressure, increased arterial stiffness, and used more antihypertensive medications and diuretics.
• Independent predictors of overhydration included male sex, diabetes, pre-existing CVD, systolic blood pressure, serum albumin, TNF-α, and proteinuria.

Conclusions:

• Volume overload is common and significantly associated with traditional and novel CVD risk factors in non-dialysis CKD patients.
• Bioimpedance monitoring can help identify high-risk CKD patients with volume overload.
• Early identification and management of fluid status are crucial for mitigating CVD risk in CKD.