Is fluid overload more important than diabetes in renal progression in late chronic kidney disease?

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

doi:10.1371/journal.pone.0082566

Abstract

Fluid overload is one of the major presentations in patients with late stage chronic kidney disease (CKD). Diabetes is the leading cause of renal failure, and progression of diabetic nephropathy has been associated with changes in extracellular fluid volume. The aim of the study was to assess the association of fluid overload and diabetes in commencing dialysis and rapid renal function decline (the slope of estimated glomerular filtration rate (eGFR) less than -3 ml/min per 1.73 m2/y) in 472 patients with stages 4-5 CKD. Fluid status was determined by bioimpedance spectroscopy method, Body Composition Monitor. The study population was further classified into four groups according to the median of relative hydration status (△HS =fluid overload/extracellular water) and the presence or absence of diabetes. The median level of relative hydration status was 7%. Among all patients, 207(43.9 %) were diabetic. 71 (15.0%) subjects had commencing dialysis, and 187 (39.6%) subjects presented rapid renal function decline during a median 17.3-month follow-up. Patients with fluid overload had a significantly increased risk for commencing dialysis and renal function decline independent of the presence or absence of diabetes. No significantly increased risk for renal progression was found between diabetes and non-diabetes in late CKD without fluid overload. In conclusion, fluid overload has a higher predictive value of an elevated risk for renal progression than diabetes in late CKD.

Highlights

Chronic kidney disease (CKD) has become a global public health problem
This study is the first to analyze the separate effect of fluid overload and diabetes on commencing dialysis or renal function decline in patients with stages 4-5 CKD
Fluid overload combined with diabetes together have an additive interaction of an increased risk for commencing dialysis

Summary

Introduction

Among many traditional risk factors of renal progression, diabetes is the leading cause of CKD in the developed world, and patients with diabetes and CKD have a greater increased risk of end-stage renal disease, and allcause and cardiovascular mortality than those without diabetes [1]. Accumulating evidence demonstrates the association between fluid overload and a significantly increased risk for all-cause or cardiovascular mortality in dialysis patients [5,6,7,8]. Our previous study demonstrated a significantly positive relationship between the severity of real fluid status and increased risk for commencing dialysis and rapid renal function decline in late CKD [10]. Fluid overload is the characteristic and an indicator of rapid renal progression in late CKD

Objectives

Methods

Results

Conclusion