Fluid overload, pulse wave velocity, and ratio of brachial pre-ejection period to ejection time in diabetic and non-diabetic chronic kidney disease.

Yi-Chun Tsai,Szu-Chia Chen,Hung-Tien Kuo,Yi-Wen Chiu,Hung-Chun Chen,Tzu-Hui Chen,Mei-Chuan Kuo,Shang-Jyh Hwang,Giuseppe Remuzzi

doi:10.1371/journal.pone.0111000

Abstract

Fluid overload is one of the characteristics in chronic kidney disease (CKD). Changes in extracellular fluid volume are associated with progression of diabetic nephropathy. Not only diabetes but also fluid overload is associated with cardiovascular risk factors The aim of the study was to assess the interaction between fluid overload, diabetes, and cardiovascular risk factors, including arterial stiffness and left ventricular function in 480 patients with stages 4–5 CKD. Fluid status was determined by bioimpedance spectroscopy method, Body Composition Monitor. Brachial-ankle pulse wave velocity (baPWV), as a good parameter of arterial stiffness, and brachial pre-ejection period (bPEP)/brachial ejection time (bET), correlated with impaired left ventricular function were measured by ankle-brachial index (ABI)-form device. Of all patients, 207 (43.9%) were diabetic and 240 (50%) had fluid overload. For non-diabetic CKD, fluid overload was associated with being female (β = –2.87, P = 0.003), heart disease (β = 2.69, P = 0.04), high baPWV (β = 0.27, P = 0.04), low hemoglobin (β = –1.10, P<0.001), and low serum albumin (β = –5.21, P<0.001) in multivariate analysis. For diabetic CKD, fluid overload was associated with diuretics use (β = 3.69, P = 0.003), high mean arterial pressure (β = 0.14, P = 0.01), low bPEP/ET (β = –0.19, P = 0.03), low hemoglobin (β = –1.55, P = 0.001), and low serum albumin (β = –9.46, P<0.001). In conclusion, baPWV is associated with fluid overload in non-diabetic CKD and bPEP/bET is associated with fluid overload in diabetic CKD. Early and accurate assessment of these associated cardiovascular risk factors may improve the effects of entire care in late CKD.

Highlights

Cardiovascular disease (CVD) is the major cause of morbidity and mortality in patients with chronic kidney disease (CKD)
The aim of this study was to evaluate the relationship between fluid overload, diabetes and Brachial-ankle pulse wave velocity (baPWV) or brachial pre-ejection period (bPEP)/brachial ejection time (bET) in patients with stages 4–5 CKD
Fluid overload was associated with baPWV, a clinical indicator of arterial stiffness, in non-diabetic CKD

Summary

Introduction

Cardiovascular disease (CVD) is the major cause of morbidity and mortality in patients with chronic kidney disease (CKD). Hung et al indicated a significant association of fluid overload with cardiovascular risk factors, such as diabetes, systolic blood pressure, and arterial stiffness in CKD patients not on dialysis [3]. Previous studies reported that fluid overload was a predictor of cardiovascular mortality in patients on dialysis [4,5,6,7]. Diabetic CKD patients have a greater risk of commencing dialysis, and higher all-cause and cardiovascular mortality than non-diabetic CKD patients [8]. This is probably the result that more advanced atherosclerotic change of vascular or cardiac level in diabetic CKD or vascular disease in nondiabetic CKD is not necessarily atherosclerotic. The aim of this study is to evaluate the relationship between fluid overload, diabetes, and baPWV or bPEP/bET and whether baPWV or bPEP/bET could be used as simple clinically available measures for risk stratification in late CKD

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Conclusion