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Chronic Fluid Overload and Mortality in ESRD.

Carmine Zoccali¹, Ulrich Moissl², Charles Chazot³

¹Center of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy; carmine.zoccali@tin.it.

Journal of the American Society of Nephrology : JASN

|May 6, 2017

Summary

Fluid overload (FO) in end-stage renal disease (ESRD) patients on hemodialysis significantly increases mortality risk. Chronic FO exposure is a major predictor of death across all systolic blood pressure categories, highlighting the need for fluid status monitoring.

Keywords:

ESRD Epidemiology and outcomes VOLUME EXPANSION blood pressure hemodialysis mortality risk

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Published on: July 28, 2018

Area of Science:

Nephrology
Cardiovascular Medicine
Clinical Epidemiology

Background:

Sustained fluid overload (FO) is a known contributor to hypertension, heart failure, and mortality in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis.
Previous research has not established a clear link between chronic FO exposure and mortality in this vulnerable patient group.

Purpose of the Study:

To investigate the relationship between baseline and cumulative fluid overload (FO) exposure over one year and mortality risk in incident ESRD patients.
To analyze this relationship across different systolic blood pressure (syst-BP) categories.

Main Methods:

A cohort study involving 39,566 incident ESRD patients from a large international dialysis network.
Whole-body bioimpedance spectroscopy was used to assess fluid status, with over 200,000 FO measurements recorded.
Statistical analyses examined mortality risk associated with baseline and cumulative FO across three syst-BP categories (<130, 130-160, >160 mmHg).

Main Results:

Both baseline and cumulative 1-year FO exposure were significant predictors of excess mortality across all studied systolic blood pressure categories (P<0.001).
Cumulative FO exposure demonstrated a stronger association with increased death risk compared to baseline FO.
Hazard ratios for mortality increased with higher levels of FO, irrespective of blood pressure control.

Conclusions:

Chronic fluid overload in ESRD patients is a substantial risk factor for mortality, independent of blood pressure levels.
The findings suggest that fluid status monitoring may be more beneficial than relying solely on predialysis blood pressure measurements for managing ESRD patients.
Further clinical trials are warranted to compare the efficacy of fluid status-guided versus blood pressure-guided treatment policies in ESRD.