Abstract
We aimed to investigate whether annual change in the extracellular fluid to intracellular fluid (ΔECF/ICF) ratio can accurately predict mortality in hemodialysis patients. Totally, 247 hemodialysis patients were divided into two groups according to the median baseline ECF/ICF ratio of 0.563 and ΔECF/ICF ≥ 0% or < 0% during the first year, respectively. Thereafter, they were divided into four groups according to each cutoff point and were followed up for mortality assessment. The ECF/ICF ratio increased from 0.566 ± 0.177 to 0.595 ± 0.202 in the first year (P = 0.0016). During the 3.4-year median follow-up, 93 patients died (42 cardiovascular-specific causes). The baseline ECF/ICF ≥ 0.563 and ΔECF/ICF ≥ 0% were independently associated with all-cause mortality (adjusted hazard ratio [aHR] 4.55, 95% confidence interval [CI] 2.60–7.98 and aHR 8.11, 95% CI 3.47–18.96, respectively). The aHR for ECF/ICF ≥ 0.563 and ΔECF/ICF ≥ 0% vs. ECF/ICF < 0.563 and ΔECF/ICF < 0% was 73.49 (95% CI 9.45–571.69). For model discrimination, adding the ΔECF/ICF (0.859) alone and both the baseline ECF/ICF and ΔECF/ICF (0.903) to the established risk model (0.746) significantly improved the C-index. Similar results were obtained for cardiovascular mortality. In conclusion, the ΔECF/ICF ratio could not only predict all-cause and cardiovascular mortality but also improve predictability of mortality in hemodialysis patients.
Highlights
We aimed to investigate whether annual change in the extracellular fluid to intracellular fluid (ΔECF/ ICF) ratio can accurately predict mortality in hemodialysis patients
We have recently reported that the geriatric nutritional risk index (GNRI), a marker of Protein-energy wasting (PEW), significantly decreased during the first follow-up year, and its annual change improved the predictability of allcause and cardiovascular mortality in patients undergoing maintenance HD7
The present study demonstrated that the extracellular fluid to intracellular fluid (ECF/ICF) ratio increased in the first year and that an increased ∆ECF/ ICF ratio was independently associated with an increased risk of mortality in patients undergoing HD
Summary
We aimed to investigate whether annual change in the extracellular fluid to intracellular fluid (ΔECF/ ICF) ratio can accurately predict mortality in hemodialysis patients. 247 hemodialysis patients were divided into two groups according to the median baseline ECF/ICF ratio of 0.563 and ΔECF/ ICF ≥ 0% or < 0% during the first year, respectively Thereafter, they were divided into four groups according to each cutoff point and were followed up for mortality assessment. We have recently reported that the geriatric nutritional risk index (GNRI), a marker of PEW, significantly decreased during the first follow-up year, and its annual change improved the predictability of allcause and cardiovascular mortality in patients undergoing maintenance HD7. The present study aimed to examine the relationship between the annual change in the ECF/ICF ratio (ΔECF/ ICF ratio) with all-cause and cardiovascular mortality in patients undergoing HD. We investigated whether the ΔECF/ICF ratio could improve the predictive accuracy for mortality when it was added to the established risk factors
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