Relative Interdialytic Weight Gain Research Articles

Role of health literacy profiles in fluid management of individuals receiving haemodialysis: A cross-sectional study.

To identify health literacy profiles in individuals receiving haemodialysis and to explore how these profiles interact with individuals' self-efficacy, engagement with traditional dietary habits, self-reported fluid restriction and relative-interdialytic weight gain. A cross-sectional study engaging nephrology departments from four hospitals in Guangdong Province, China. A sample of 433 individuals receiving haemodialysis participated between December 2018 and July 2019. We assessed health literacy, self-efficacy and self-reported fluid restriction using the Health Literacy Questionnaire, the Fluid Self-efficacy Scale and the Fluid Adherence Subscale, respectively. Traditional dietary habits, including daily tea drinking, soup drinking and preserved food consumption, were measured using three yes/no questions. Relative-interdialytic weight gain was calculated by dividing the mean interdialytic weight gain (from three recent intervals) by dry weight. Latent profile analysis and structural equation modelling were performed. Three health literacy profiles were identified: low, moderate and high. Compared to those in the low health literacy profile, individuals in high and moderate health literacy profiles demonstrated an indirect association with reduced relative-interdialytic weight gain. This reduction can be attributed to their higher self-efficacy levels, decreased reliance on dietary habits and higher self-reported fluid restrictions. Most participants exhibited either low or moderate levels of health literacy. Improving health literacy has the potential to promote self-efficacy and foster effective fluid restriction, ultimately leading to a reduction in relative-interdialytic weight gain in individuals receiving haemodialysis. This study reveals heterogeneity in health literacy levels among individuals receiving haemodialysis and illuminates the connections between an individual's entire spectrum of health literacy and fluid management. These findings provide valuable insights for developing person-centred fluid management interventions, especially for individuals with diverse cultural dietary backgrounds within the haemodialysis population. We adhered to the STROBE guideline. Patients were included only for collecting their data.

Factors Associated with Long-Term Survival in Maintenance Hemodialysis Patients: A 5-Year Prospective Follow-Up Study.

ObjectivesIn addition to an increase in the prevalence of dialysis treatments for end-stage renal disease worldwide, the mortality rates among patients on maintenance hemodialysis remain higher than that of the general population. This study aims to evaluate factors associated with long-term survival in stable maintenance hemodialysis patients.MethodsA total of 100 patients initiating hemodialysis by February 2013 were included in this prospective cross-sectional 5-year follow-up study. Data on patient demographics, anthropometric-nutritional parameters, systolic and diastolic blood pressure levels, and hemodialysis parameters, including etiology of kidney failure, hemodialysis duration, peritoneal dialysis history, relative interdialytic weight gain (RIDWG), and Kt/V, were recorded.ResultsOverall 5-year survival rate was 56.6%. The 5-year survival rate was higher in patients with younger age (71.4% below median vs. 42.0% above median, p=0.023), lower systolic (63.3 vs. 50%, respectively, p=0.005) and diastolic (62.5 vs. 51.0%, respectively, p=0.02) blood pressure levels, higher Kt/V (46.9 vs. 66.0%, respectively, p=0.044), lower RIDWG (54.0 vs. 32.7%, respectively, p=0.026), and lower serum leptin levels (63.3 vs. 50.0%, respectively, p=0.047). Cox-regression analysis revealed that only systolic blood pressure (B = 1.081, 95% CI, 0.152 to 0.756, p=0.08) was a significant risk factor for poor survival.ConclusionOur findings revealed pre-dialysis systolic blood pressure as the sole risk factor for poor long-term survival in stable maintenance hemodialysis patients. Malnutrition-inflammation, measures of nutrition, inflammation, and anemia had no significant impact on long-term survival.

Association between pill burden and interdialytic weight gain in patients with hemodialysis: A multi-center cross-sectional study.

High daily pill burden affects quality of life and mortality. High interdialytic weight gain (IDWG) is associated with increased mortality. We examined the association between pill burden and IDWG in hemodialysis patients. This cross-sectional study was conducted in six dialysis centers in Japan in June 2017. The exposure was the number of daily tablets, and outcome was defined as 1 day of relative IDWG divided by post-dialysis weight from the previous session. Among 188 outpatients (mean age, 68.7 [SD, 10.3] years; men, 67.0%; median dialysis vintage, 76.0 [interquartile range, 36.5, 131.5] months), the mean number of daily tablets was 19.7 ± 9.9, and mean relative weight gain was 3.5 ± 1.2%. Multiple linear regression analysis showed a regression coefficient of 0.021 (95% confidence interval: 0.004-0.039), indicating that one additional tablet prescription increased the IDWG by 0.021%. In hemodialysis patients, the daily pill burden was a significant, independent risk for increased relative IDWG.

The impact of the Christmas holiday effect on interdialytic weight gain in hemodialysis patients: A multicenter observational retrospective cohort study.

The 3-day interdialytic interval (IDI) is associated with high interdialytic weight gain (IDWG), but little is known about the effect of public or religious holidays on IDWG. Consequently, we evaluated the impact of the "Christmas holiday effect" on IDWG of hemodialysis patients. A retrospective cohort study of adult hemodialysis patients (over 18 years) was conducted across five dialysis units in Australia. Demographic and clinical data were collected from electronic medical records. IDWG was established for three time points; regular 3-day IDI, 2-day IDI preceding the Christmas holiday and a 3-day IDI that included the Christmas holiday. Paired t-tests and logistic regression were used to compare differences in mean IDWG before and after the Christmas holiday and to examine factors associated with high IDWG, respectively. Two hundred and fifty-two patients, 69% of whom were male, with mean (SD) age of 65.4 ± 15.3 years, were studied. Most had end-stage kidney disease due to diabetes (44%), and they had been on hemodialysis for a median of 25.5 (IQR, 60-10) months. There was a significant increase in absolute IDWG (MD 0.21 kg, 95% CI -0.07 to 0.36; P = 0.004) and relative IDWG (MD 0.3%, 95% CI 0.10-0.40; P = 0.01) after the holiday 3-day IDI compared with the regular 3-day IDI. Older age (OR 0.12; 95% CI 0.02-0.55) and a unit increase in hemoglobin (OR 0.94; 95% CI 0.89-0.99) were associated with lower odds of high relative IDWG while speaking a language other than English increased the odds for high relative IDWG (OR 5.03; 95% CI 1.12-22.65). Absolute and relative IDWG increased significantly after the Christmas holiday. Individualizing dialysis needs may improve outcomes for these patients.

Health literacy as predictors of fluid management in people receiving hemodialysis in China: A structural equation modeling analysis

ObjectivesTo explore the impact of health literacy (HL) on perceived benefits of fluid restriction (PBFR), self-reported fluid restriction (SRFR) and relative-interdialytic weight gain (R-IDWG) in people receiving hemodialysis (HD). MethodsWe conducted a cross-sectional study in two nephrology departments from two hospitals in Guangzhou, China (n = 226). The HL questionnaire, PBFR Subscale of Health Belief Model Constructs and Fluid Adherence Subscale of the HD Patients Therapy Adherence Scale were used. R-IDWG was calculated by the mean IDWG (from 3 consecutive HD), divided by the dry weight. ResultsIn structural equation modeling, three domains of the HL questionnaire, namely Actively Managing My Health, Social Support and Actively Engaging with Healthcare Providers (HCPs), were directly and positively associated with PBFR. Higher Actively Managing My Health predicted higher SRFR both directly and indirectly. Sufficient Social Support and adequate Actively Engaging with HCPs predicted higher SRFR indirectly. All three HL domains predicted R-IDWG indirectly. ConclusionImproving patients’ HL could increase their understanding of PBFR and be more apt to follow fluid restrictions and reduce R-IDWG. Practice implicationsA better understanding of the relationships among HL, PBFR, SRFR and R-IDWG will allow for tailored interventions to decrease R-IDWG in people receiving HD.

Interdialytic Weight Gain and Its Relation to Outcome among Patients on Maintenance Hemodialysis

Abstract Introduction The most common cause of mortality among chronic hemodialysis (HD) patients is cardiovascular disease. Hypervolemia is an important risk factor for hypertension and cardiovascular mortality in HD patients that include chronic volume overload and interdialytic weight gain (IDWG).IDWG affects cardiovascular morbidity and mortality Daily fluctuations in extracellular fluid volume might promote cardiac remodeling resulting in left ventricular hypertrophy (LVH) and cardiac fibrosis. Aim of the study to assess interdialytic weight gain and (its relation to morbidity and mortality) among patients on maintenance hemodialysis. Patient and methods 100 ESRD patients on regular hemodialysis included in study in Ain Shams University hospitals in march 2016 and followed up after one year in march 2017. Type of study cohort study Patients were divided into two groups according to interdialytic weight gain (IDWG): Group I (high IDWG) 50 patients with Absolute weight gain 4kg or more. Or relative IDWG more than 3.5% of total body weight. Group II (low IDWG) 50 patients with absolute weight gain less than 3kg Or relative IDWG less than 3.5% of total body weight. Echocardiography (TTE) for all patients at the start of the study and followed up after one year for detecting outcomes included all-cause mortality, cardiovascular mortality, hospitalization for heart failure/volume overload, hospitalization for myocardial infarction, stroke. Results we found that patient with high (IDWG) group II has significantly higher increase in left ventricular mass index (LVMI),inferior vena cava (IVC) diameter and significantly higher decrease in ejection fraction more than low IDWG group I. Conclusions Patients with high IDWG group II at higher risk of increase LVMI, decrease ejection fraction, increase in interventricular septum (IVS), increase in inferior vena cava diameter more than patients of low IDWG group I and has more cardiovascular morbidity and mortality.

Association of all-cause mortality with pre-dialysis systolic blood pressure and its peridialytic change in chronic hemodialysis patients.

BackgroundPre-dialysis systolic blood pressure (pre-HD SBP) and peridialytic SBP change have been associated with morbidity and mortality among hemodialysis (HD) patients in previous studies, but the nature of their interaction is not well understood.MethodsWe analyzed pre-HD SBP and peridialytic SBP change (calculated as post-HD SBP minus pre-HD SBP) between January 2001 and December 2012 in HD patients treated in US Fresenius Medical Care facilities. The baseline period was defined as Months 4–6 after HD initiation, and all-cause mortality was noted during follow-up. Only patients who survived baseline and had no missing covariates were included. Censoring events were renal transplantation, modality change or study end. We fitted a Cox proportional hazard model with a bivariate spline functions for the primary predictors (pre-HD SBP and peridialytic SBP change) with adjustment for age, gender, race, diabetes, access-type, relative interdialytic weight gain, body mass index, albumin, equilibrated normalized protein catabolic rate and ultrafiltration rate.ResultsA total of 172 199 patients were included. Mean age was 62.1 years, 61.6% were white and 55% were male. During a median follow-up of 25.0 months, 73 529 patients (42.7%) died. We found that a peridialytic SBP rise combined with high pre-HD SBP was associated with higher mortality. In contrast, when concurrent with low pre-HD SBP, a peridialytic SBP rise was associated with better survival.ConclusionThe association of pre-HD and peridialytic SBP change with mortality is complex. Our findings call for a joint, not isolated, interpretation of pre-HD SBP and peridialytic SBP change.

Non-adherence to hemodialysis, perception of the illness, and severity of advanced nephropathy

Introduction:Hemodialysis (HD) is a complex therapy that imposes several changes in the patient's life. Failure to follow therapy recommendations is called non-adherence (NA). The patient's illness perception, severity of chronic kidney disease, and individual strategies for coping with HD can have an impact on NA to the demands of therapy.Methods:This was a cross-sectional study with end-stage renal disease patients on conventional HD in Salvador, Bahia. We evaluated attendance to treatment and interdialytic weight gain (IDWG) as parameters of NA to HD, and investigated its association with clinical aspects and measures of disease perception (illness effects questionnaire - IEQ) and severity of nephropathy (end stage renal disease severity index - ESRD-SI), by analyzing Pearson or Spearman correlation.Results:79 patients were evaluated, 57% male, aged 53.1 ± 12.3 years, with length of HD of 108 (89 - 131.5) months. Age correlated with ESRD-SI (r = 0.43) and NA parameters: negative correlation with relative IDWG (r = -0.41) and reduction in sessions (r = -0.31) and positive correlation with %HD performed (r = 0.25). The scores on the IEQ and ESRD-SI showed a positive correlation (r = 0.44; p <0.001), but did not show any correlation with the analyzed NA parameters.Conclusions:We did not find a correlation between illness perception and severity index of advanced nephropathy with the behaviors of NA to chronic HD. In this study, age correlated both with the perception of severity of advanced nephropathy and the parameters of NA to chronic HD.

Association Between Interdialytic Weight Gain, Perception About Dry Weight, and Dietary and Fluid Behaviors Based on Body Mass Index Among Patients on Hemodialysis

This study aimed to identify dietary and fluid behaviors associated with relative interdialytic weight gain (RIDWG) (divided by the respective dry weight [DW]) by stratifying the patients according to body mass index (BMI). This was a cross-sectional, multicenter investigation. Between July 2016 and March 2017, data were collected from 4 Japanese dialysis centers in 3 cities. The patients (n=577) were asked to reply to a self-completed questionnaire, including questions on perception about DW and dietary and fluid behaviors. The differences in perception about DW and dietary and fluid behaviors were compared between RIDWG nonadherence (average RIDWG ≥5％ a month) and adherence subgroups. The 360 participants were stratified into thin (<20; 28.6%), normal low (≥20 and<22; 22.5%), normal high (≥22 and<25; 31.7%), and overweight (≥25; 17.2%) groups on the basis of BMI. In the thin and normal low BMI groups, the RIDWG nonadherent patients were more likely to identify their DW as "looking to increase." Although the difference was less prominent between the adherence subgroups in the thin BMI group, the RIDWG nonadherent patients in normal low BMI group seemed to generally take less care to intentionally regulate their behaviors as a representative of sodium-intake/fluid management. Although patients with a larger body size (overweight and normal high BMI groups) were not associated with this perception about DW, they were associated with some demographic characteristics; regarding the normal high BMI group, a higher proportion of RIDWG nonadherent patients worked full-time, and they more frequently reported an irregular eating pattern. Dietary and fluid behaviors associated with RIDWG differed according to the BMI group. Assessing more specific types of patient behaviors, focusing on the underlying factors associated with dietary and fluid behaviors, and taking BMI into consideration are required.

Interdialytic Weight Gain: Trends, Predictors, and Associated Outcomes in the International Dialysis Outcomes and Practice Patterns Study (DOPPS)

High interdialytic weight gain (IDWG) is associated with adverse outcomes in hemodialysis (HD) patients. We identified temporal and regional trends in IDWG, predictors of IDWG, and associations of IDWG with clinical outcomes. Analysis 1: sequential cross-sections to identify facility- and patient-level predictors of IDWG and their temporal trends. Analysis 2: prospective cohort study to assess associations between IDWG and mortality and hospitalization risk. 21,919 participants on HD therapy for 1 year or longer in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 2 to 5 (2002-2014). Analysis 1: study phase, patient demographics and comorbid conditions, HD facility practices. Analysis 2: relative IDWG, expressed as percentage of post-HD weight (<0%, 0%-0.99%, 1%-2.49%, 2.5%-3.99% [reference], 4%-5.69%, and≥5.7%). Analysis 1: relative IDWG as a continuous variable using linear mixed models; analysis 2:mortality; all-cause and cause-specific hospitalization using Cox regression, adjusting for potential confounders. From phase 2 to 5, IDWG declined in the United States (-0.29kg;-0.5% of post-HD weight), Canada (-0.25kg;-0.8%), and Europe (-0.22kg;-0.5%), with more modest declines in Japan and Australia/New Zealand. Among modifiable factors associated with IDWG, the most notable was facility mean dialysate sodium concentration: every 1-mEq/L greater dialysate sodium concentration was associated with 0.13 (95% CI, 0.11-0.16) greater relative IDWG. Compared to relative IDWG of 2.5% to 3.99%, there was elevated risk for mortality with relative IDWG≥5.7% (adjusted HR, 1.23; 95% CI, 1.08-1.40) and elevated risk for fluid-overload hospitalization with relative IDWG≥4% (HRs of 1.28 [95% CI, 1.09-1.49] and 1.64 [95% CI, 1.27-2.13] for relative IDWGs of 4%-5.69% and≥5.7%, respectively). Possible residual confounding. No dietary salt intake data. Reductions in IDWG during the past decade were partially explained by reductions in dialysate sodium concentration. Focusing quality improvement strategies on reducing occurrences of high IDWG may improve outcomes in HD patients.

A retrospective, longitudinal study estimating the association between interdialytic weight gain and cardiovascular events and death in hemodialysis patients.

BackgroundGreater interdialytic weight gain (IDWG) is associated with risk of all-cause mortality and hospitalization. Dialysis patients are also at greater risk of cardiovascular (CV) events than patients without kidney disease. This retrospective study examined the potential association between IDWG and specific types of CV events.MethodsData were obtained from United States Renal Data System claims and the electronic health records of Medicare patients who initiated hemodialysis between 01 January 2007 and 31 December 2008 at a large dialysis organization. Absolute IDWG was defined as predialysis weight minus postdialysis weight from the prior treatment, and relative IDWG was calculated as percentage of postdialysis weight with mean values for each, calculated over dialysis days 91 to 180. Patient outcomes were considered beginning on day 181, continuing until death, discontinuation of care, censoring, or study end (31 December 2009). Outcomes included all-cause mortality, CV mortality, hospitalization for nonfatal heart failure/volume overload, hospitalization for nonfatal myocardial infarction, MACE (a composite measure of nonfatal myocardial infarction, nonfatal ischemic stroke, or CV death), and MACE+ (events comprising MACE as well as arrhythmia, nonfatal hemorrhagic stroke, or hospitalization for heart failure). Associations between IDWG and outcomes over the exposure period were estimated using proportional hazards regression and adjusted for baseline characteristics.Results39,256 patients qualified for analysis. In general, associations of relative IDWG with outcomes were more potent, consistent, and monotonic than those for absolute IDWG. Relative IDWG > 3.5 % body weight was independently associated with all outcomes studied: point estimates ranged from 1.18 (myocardial infarction) to 1.26 (CV mortality) and were consistent among patients with and without diabetes, and with and without baseline heart failure. Absolute IDWG > 3 kg was associated with outcomes other than myocardial infarction: point estimates ranged from 1.11 (MACE) to 1.20 (heart failure).ConclusionsGreater IDWG is associated with an increased risk of CV morbid events. Strategies that mitigate IDWG may improve CV health and survival among hemodialysis patients.

Relationship between relative interdialytic weight gain and serum leptin levels, nutrition, and inflammation in chronic hemodialysis patients.

Excessive relative interdialytic weight gain (RIDWG, %) is an important risk factor for long-term adverse cardiovascular outcomes in chronic hemodialysis (HD) patients. On the other hand, it may also be an index of good appetite and nutritional status. We aimed to assess the relationship between RIDWG and appetite, nutrition, inflammation parameters of chronic HD patients. 100 chronic anuric HD patients were enrolled in this prospective study between January 2013 and January 2014. Patients with hospitalization, major surgery, obvious infectious/inflammatory disease, end-stage liver disease, malignancies, and malabsorption syndromes were excluded. Patients were divided into 3 groups according to their RIDWG levels; group 1 = RIDWG < 3%, group 2 = RIDWG: 3 - 5%, and group 3 = RIDWG > 5%. Group 3 patients were younger (p = 0.011) and had a lower body mass index (BMI) (p = 0.014). Nutrition and inflammation parameters including malnutrition inflammation score (MIS), serum albumin, prealbumin, triceps skinfold thickness, hs-CRP, and TNF-α ere not significantly different between the groups. Leptin and leptin/BMI ratio were significantly lower in group 3 (p = 0.001). RIDWG was negatively correlated with age (p = 0.001, r = -0.371), BMI (p = 0.001, r = -0.372), leptin (p = 0.001, r = -0.369), leptin/BMI (p = 0.001, r = -0.369). After adjustment for BMI in linear regression analyis, leptin/BMI remained significantly correlated with RIDWG (p = 0.024). This study revealed that RIDWG was associated with younger age, lower BMI and dry weight, and lower serum leptin levels. More detailed studies are needed to validate and dissect the mechanisms of these findings.

Prediction of Mortality in the First Two Years of Hemodialysis: Results from a Validation Study

Background: Chronic hemodialysis (HD) patients experience high rates of mortality. Alerting medical staff of patients at increased risk of death may support clinical decision making. Methods: A large cohort of incident HD patients was used to develop logistic regression models to predict death in the subsequent 6 months (‘derivation cohort’). Predictors were age, gender, race, ethnicity, vascular access type, diabetic status, pre-HD systolic and diastolic blood pressure, pre-HD weight, pre-HD temperature, relative interdialytic weight gain, serum albumin, hemoglobin, phosphorus, serum creatinine, serum sodium, urea reduction ratio, equilibrated normalized protein catabolic rate, and equilibrated dialytic and renal Kt/V. These logistic regression models were then applied to validation cohorts. Predictive performance of the models was described in terms of sensitivity, specificity, and area under receiver-operating characteristic curves (AUC-ROC). Results: A total of 6,838 incident HD patients were followed over 2 years. The derivation cohort initially comprised 4,512 patients. In the validation cohort of initially 2,326 patients, the logistic regression models were able to predict mortality in subsequent 6-month periods with a sensitivity between 58 and 69%, and a specificity of 74–77%; the respective AUC-ROC were 0.67–0.72 (all p < 0.0001). Pre-HD weight and serum albumin levels were consistently significant predictors of mortality in all models. Conclusion: The results indicate that logistic regression models are useful tools in estimating incident HD patients’ probability of death in 6-month intervals for at least up to 2 years after beginning dialysis. Model predictions may be used to alert medical staff to patients at increased risk of death and facilitate timely diagnostic and therapeutic interventions to improve outcomes.

Sodium Setpoint and Sodium Gradient: Influence on Plasma Sodium Change and Weight Gain

Background/Aims: In hemodialysis and hemodiafiltration patients, the plasma sodium (PNa) measured before dialysis can be regarded as the sodium setpoint. By the end of dialysis, the PNa typically approximates the prescribed dialysate sodium (DNa), the difference between DNa and PNa being considered the sodium gradient. We determined the relationship between setpoint, gradient and pre- to postdialysis PNa change (delta PNa), and studied associations with dialysis-related variables. Methods: Cohort study. Measurements from 132 patients during 12 consecutive treatments included PNa and DNa concentrations, pre- to postdialysis body weight and predialysis systolic blood pressure. Results: Sodium setpoints were normally distributed (137.9 ± 2.4 mmol/l), DNa prescriptions were non-normally distributed (138.9 ± 1.8 mmol/l). The sodium gradient correlated strongly with delta PNa (r = 0.76, p < 0.001). Both sodium gradient and delta PNa correlated with relative interdialytic weight gain (IDWG; r = 0.25, p = 0.004, and r = 0.44, p < 0.001, respectively), but not with predialysis systolic blood pressure. These correlations were consistent after exclusion of patients with urine volume >500 ml/day and patients undergoing sodium profiling, and increased after exclusion of patients with hemodiafiltration protocols. Predictors for having higher relative IDWG (≧2.8%) were delta PNa concentrations ≧0 mmol/l and younger age. Predictors for having a delta PNa concentration ≧0 mmol/l were lower sodium setpoints, higher DNa prescriptions, use of Nikkiso machines, sodium profiling and younger age. Patients with positive delta PNa despite negative gradients were significantly younger, used more Nikkiso machines and presented with higher IDWG. Conclusion: IDWG correlated with the sodium gradient and more strongly with delta PNa, suggesting the need for studying other outcomes, such as morbidity and mortality.

Relationship Between Interdialytic Weight Gain and Nutritional Markers in Younger and Older Hemodialysis Patients

Our objective was to investigate the correlations of interdialytic weight gain (IDWG) with the Malnutrition Inflammation Score (MIS) and other nutritional markers, especially when age difference is considered. This was a cross-sectional study. The setting was an outpatient hemodialysis (HD) center in a community hospital. Excluding those with obvious inflammatory diseases, hospitalizations, and major surgery within the preceding 3 months, we enrolled all anuric patients who had undergone maintenance hemodialysis three times a week for >1 year. In total, 84 women and 80 men were enrolled. Their age (mean +/- SD) was 57.9 +/- 13.0 years. The conditions of food intake and nutritional status were evaluated with MIS items. Concerning IDWG, the average of 12 sessions within 4 weeks was used. The relative IDWG (RIDWG) was calculated as IDWG divided by the respective dry weight. Other laboratory data were obtained from routine monthly sampling. Whereas IDWG and RIDWG had no significant correlation with any of the MIS items in younger patients (<65 years old; n = 106), RIDWG had a positive correlation with the severity of insufficient food intake, gastrointestinal upset, functional incapacity, and wasting of muscle and subcutaneous fat in older patients (>/=65 years old; n = 58). On the other hand, IDWG and RIDWG had no significant correlation with serum albumin level in younger and older HD patients, respectively. Our findings suggest that in older HD patients, the greater that the RIDWG is, the poorer the nutritional status will be. However, there is still controversy regarding IDWG and RIDWG as nutritional markers in HD patients.

Low birthweight dwarfism with asymmetry (Silver's syndrome): treatment with human growth hormone.

<h3>Background and objectives</h3> Interdialytic weight gain in patients on hemodialysis is associated with adverse cardiovascular outcomes and increased mortality. The degree of interdialytic weight gain is influenced by sodium intake. We evaluated the effects of tenapanor (AZD1722 and RDX5791), a minimally systemically available inhibitor of the sodium/hydrogen exchanger isoform 3, on interdialytic weight gain in patients with CKD stage 5D treated with hemodialysis. <h3>Design, setting, participants, &amp; measurements</h3> This phase 2, randomized, double–blind study (NCT01764854; conducted January to September of 2013) enrolled adults on maintenance hemodialysis with interdialytic weight gain ≥3.0% of postdialysis weight and ≥2 kg. Patients were randomly assigned (1:1) to receive tenapanor or placebo. The primary end point was change in mean interdialytic weight gain (percentage of baseline postdialysis weight) from baseline (mean across a 2-week run-in period) to week 4. In a subgroup of inpatients, 24-hour stool sodium and stool weight were assessed for 1 week. <h3>Results</h3> Sixteen patients received 1 week of inpatient treatment (tenapanor, eight; placebo, eight), and 72 patients received 4 weeks of treatment in an outpatient setting (tenapanor, 37; placebo, 35; completers: tenapanor, 31; placebo, 33). In the outpatient cohort, no significant effect on interdialytic weight gain was detected; least squares mean changes in relative interdialytic weight gain from baseline to week 4 were tenapanor, −0.26% (95% confidence interval, −0.57% to 0.06%) and placebo, −0.23% (95% confidence interval, −0.54% to 0.07%; <i>P=</i>0.46). During week 1 (inpatient cohort only), compared with placebo, tenapanor treatment resulted in higher stool sodium content (mean [±SD]: tenapanor, 36.6 [±21.8] mmol/d; placebo, 2.8 [±2.7] mmol/d; <i>P</i>&lt;0.001) and higher stool weight (tenapanor, 172.5 [±68.1] g/d; placebo, 86.3 [±30.0] g/d; <i>P</i>&lt;0.01). A similar safety profile was observed across treatment groups with the exception of diarrhea, which occurred more frequently with tenapanor treatment. <h3>Conclusions</h3> Tenapanor treatment increased stool sodium and weight over placebo in patients undergoing hemodialysis. However, over 4 weeks of treatment, there was no difference in interdialytic weight gain between patients treated with tenapanor and those receiving placebo.