ORIGINAL ARTICLE

The association of overhydration with chronic inflammation in chronic maintenance hemodiafiltration patients

Corresponding Author

Lajos Zsom

[email protected]

Fresenius Medical Care, Cegléd, Hungary

Correspondence to: L. Zsom, Fresenius Medical Care Dialysis Center, Törteli u. 1-3, 2700 Cegléd, Hungary. E-mail: [email protected]Search for more papers by this author

Mária Faludi,

Mária Faludi

Department of Internal Medicine, Semmelweis University, Budapest, Hungary

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Tibor Fülöp,

Tibor Fülöp

orcid.org/0000-0002-3346-7040

Medical Services, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, United States of America

Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America

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Neville R. Dossabhoy,

Neville R. Dossabhoy

Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America

Overton Brooks VA Medical Center, Shreveport, Louisiana, United States of America

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László Rosivall,

László Rosivall

Institute of Pathophysiology, Semmelweis University, Budapest, Hungary

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Mihály B. Tapolyai,

Mihály B. Tapolyai

Fresenius Medical Care, Hatvan, Hungary

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Lajos Zsom,

Corresponding Author

Lajos Zsom

[email protected]

Fresenius Medical Care, Cegléd, Hungary

Correspondence to: L. Zsom, Fresenius Medical Care Dialysis Center, Törteli u. 1-3, 2700 Cegléd, Hungary. E-mail: [email protected]Search for more papers by this author

Mária Faludi,

Mária Faludi

Department of Internal Medicine, Semmelweis University, Budapest, Hungary

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Tibor Fülöp,

Tibor Fülöp

orcid.org/0000-0002-3346-7040

Medical Services, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, United States of America

Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America

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Neville R. Dossabhoy,

Neville R. Dossabhoy

Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America

Overton Brooks VA Medical Center, Shreveport, Louisiana, United States of America

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László Rosivall,

László Rosivall

Institute of Pathophysiology, Semmelweis University, Budapest, Hungary

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Mihály B. Tapolyai,

Mihály B. Tapolyai

Fresenius Medical Care, Hatvan, Hungary

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First published: 05 March 2019

https://doi.org/10.1111/hdi.12742

Citations: 11

Conflict of Interest: The authors alone are responsible for the content and writing of the paper. Dr Zsom and Dr Tapolyai are current employee of Fresenius Medical Care (FMC) Hungary and Dr Fülöp is a former employee of FMC Hungary. Dr Fülöp and Dr Dossabhoy are current employees of the United States Veterans Health Administration. However, the views and opinions expressed herewith do not reflect the official views or opinion or endorsed by the FMC Hungary or the United States Veteran Health Administrations.

Disclosure of grants or other funding: None received.

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Abstract

Introduction: Achieving euvolemia is one of the major challenges when treating end-stage renal disease (ESRD) patients receiving maintenance renal replacement therapy. Fluid overload is recognized as an independent predictor of mortality in ESRD, but its association with chronic inflammation is less well explored especially in chronic maintenance hemodiafiltration.

Methods: We performed a cross-sectional study of 87 prevalent ESRD patients receiving chronic maintenance hemodiafiltration (vintage 66.5 ± 57.1 months) with bioimpedance analysis to characterize the degree of percent overhydration (OH%). We also compared the levels of inflammatory markers, including C-reactive protein (CRP), serum albumin, neutrophil/lymphocyte ratio (NLR), and hemoglobin red cell distribution width (RDW) for the overhydrated (OH% ≥ 15%) versus euvolemic (OH% < 15%) groups. Linear regression analysis was performed to explore relationships between the degree of OH and inflammatory indicators.

Findings: The cohort represented an all-European population with a mean age of 60.9 ± 14.7 years and prevalence of diabetes mellitus of 27%. The entire cohort's OH% was 14.9% ± 5.1% (range −11.1% to 39.0%); further, the <15% group of patients’ OH% was 8.0% ± 8.5% versus 20.9% ± 5.1% in the OH% ≥ 15% group (P < 0.0001). Forty-seven patients (53%) were overhydrated by traditional criteria (OH% ≥15%) and 20 patients (23%) were severely overhydrated (OH% > 20%). The euvolemic (OH% <15%) versus severely overhydrated (OH% > 20%) groups had significant differences in markers of inflammation: CRP (9.8 ± 10.6 vs. 21.5 ± 21.6 mg/L, P < 0.006), serum albumin (37.6 ± 02.9 vs. 34.5 ± 5.3 g/L, P < 0.004), and NLR (3.06 ± 1.25 vs. 3.92 ± 2.04; P < 0.004). On linear regression, significant correlations were found between OH% and CRP (r = 0.2899, P < 0.006), serum albumin (r = −0.3670; P < 0.0005), RDW (r = 0.2992; P < 0.005), and NLR (r = 0.2900; P < 0.006).

Discussion: In a prevalent hemodiafiltration cohort, OH was common and correlated with several inflammatory markers.

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Volume23, Issue3

July 2019

Pages 384-391

The association of overhydration with chronic inflammation in chronic maintenance hemodiafiltration patients

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The association of overhydration with chronic inflammation in chronic maintenance hemodiafiltration patients

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