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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Effect of Strict Volume Control on Renal Progression and Mortality in Non-Dialysis-Dependent Chronic Kidney Disease
Kubra Esmeray1, Oguzhan Sıtkı Dizdar2, Selahattin Erdem1
1Division of Nephrology, Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey.
Insights
Maintaining normal fluid balance (normovolemia) in patients with chronic kidney disease (CKD) can slow disease progression. Volume overload in CKD patients increases mortality risk and worsens kidney function.
Area of Science:
- Nephrology
- Internal Medicine
- Cardiorenal Medicine
Background:
- Advanced chronic kidney disease (CKD) patients often have subtle fluid status abnormalities.
- Volume status significantly impacts renal disease progression and patient outcomes.
Purpose of the Study:
- To investigate the effect of volume status on renal disease progression in advanced CKD.
- To compare outcomes in normovolemic versus hypervolemic CKD patients.
Main Methods:
- Prospective interventional study of stage 3-5 CKD patients over 1 year.
- Fluid status assessed using bioimpedance spectroscopy.
- Diuretic therapy initiated/adjusted for blood pressure > 130/80 mm Hg in normovolemic patients.
Main Results:
- 48% of patients were hypervolemic at baseline.
- Hypervolemic patients showed decreased estimated glomerular filtration rate and increased systolic blood pressure.
- Hypervolemia was linked to higher mortality rates.
Conclusions:
- Normovolemia, achieved with diuretic therapy, can slow or improve renal disease progression.
- Volume overload in advanced CKD increases the risk of dialysis and mortality.
- Volume overload is a significant predictor of mortality in CKD.
Objective:
The aim of this study was to examine the effect of volume status on the progressions of renal disease in normovolemic and hypervolemic patients with advanced non-dialysis-dependent chronic kidney disease (CKD) who were apparently normovolemic in conventional physical exam-ination.
Materials And Methods:
This was a prospective interventional study performed in a group of stage 3-5 CKD patients followed up for 1 year. Three measurements were made for volume and renal status for every patient. The fluid status was assessed by a bioimpedance spectroscopy method. A blood pressure (BP) value > 130/80 mm Hg prompted the initiation or dose increment of diuretic treatment in normovolemic patients.
Result:
Forty-eight patients (48%) were hypervolemic. At the end of the 1-year follow-up, hypervolemic patients were found to have a significantly lower estimated glomerular filtration rate and higher systolic BP compared to baseline. Hypervolemia was associated with an increased incidence of death.
Conclusion:
We have shown that maintenance of normovolemia with diuretic therapy in normovolemic patients was able to slow down and even improve the progression of renal disease. Volume overload leads to an increased risk for dialysis initiation and a decrease in renal function in advanced CKD. Volume overload exhibits a stronger association with mortality in CKD patients.
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