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

Lajos Zsom, Mária Faludi, Tibor Fülöp, Neville R. Dossabhoy, L. Rosivall, Mihály B. Tapolyai

Research output: Contribution to journalArticle

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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.

Original languageEnglish
JournalHemodialysis International
DOIs
Publication statusPublished - Jan 1 2019

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Hemodiafiltration
Serum Albumin
C-Reactive Protein
Chronic Kidney Failure
Neutrophils
Erythrocyte Indices
Maintenance
Lymphocytes
Inflammation
Renal Replacement Therapy
Linear Models
Hemoglobins
Cross-Sectional Studies
Mortality

Keywords

  • Albumin
  • bioimpedance analysis
  • C-reactive protein
  • hemodialysis
  • inflammatory markers
  • overhydration

ASJC Scopus subject areas

  • Hematology
  • Nephrology

Cite this

The association of overhydration with chronic inflammation in chronic maintenance hemodiafiltration patients. / Zsom, Lajos; Faludi, Mária; Fülöp, Tibor; Dossabhoy, Neville R.; Rosivall, L.; Tapolyai, Mihály B.

In: Hemodialysis International, 01.01.2019.

Research output: Contribution to journalArticle

Zsom, Lajos ; Faludi, Mária ; Fülöp, Tibor ; Dossabhoy, Neville R. ; Rosivall, L. ; Tapolyai, Mihály B. / The association of overhydration with chronic inflammation in chronic maintenance hemodiafiltration patients. In: Hemodialysis International. 2019.
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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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author = "Lajos Zsom and M{\'a}ria Faludi and Tibor F{\"u}l{\"o}p and Dossabhoy, {Neville R.} and L. Rosivall and Tapolyai, {Mih{\'a}ly B.}",
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language = "English",
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T1 - The association of overhydration with chronic inflammation in chronic maintenance hemodiafiltration patients

AU - Zsom, Lajos

AU - Faludi, Mária

AU - Fülöp, Tibor

AU - Dossabhoy, Neville R.

AU - Rosivall, L.

AU - Tapolyai, Mihály B.

PY - 2019/1/1

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N2 - 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.

AB - 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.

KW - Albumin

KW - bioimpedance analysis

KW - C-reactive protein

KW - hemodialysis

KW - inflammatory markers

KW - overhydration

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DO - 10.1111/hdi.12742

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