Objective To observe the influence of interdialytic weight gain (IDWG) variation on prognosis in maintenance hemodialysis (MHD) patients. Methods The general information, laboratory indicators and patient outcomes of 229 MHD patients during October 2018 to October 2021 were recruited from the Department of Nephrology, Minhang Hospital, Fudan University. According to the interdialytic weight gain coefficient of variation (IDWG-CV), patients were divided into three groups: high IDWG variation group (IDWG-CV average of 0.617), moderate IDWG variation group (IDWG-CV average of 0.345) and low IDWG variation group (IDWG-CV average of 0.231). The relationship between IDWG-CV and all-cause mortality and cardiovascular disease mortality was analyzed. Results In the 229 MHD patients, the mean age was 61.79±14.47 years, the mean age of dialysis was 58.93±21.10 months (95% CI: 56.187～61.682), and 55 patients (24%) died, among which 24 patients (10.5%) died of cardiovascular diseases. The all-cause mortality
in the high IDWG variation group was higher than that in the moderate and low IDWG variation groups but without statistical significance (31.6% vs. 24.7% vs. 15.8%, χ2=5.219, P=0.074). The cardiovascular disease mortality in the high IDWG variation group was also higher than that in the moderate and low IDWG variation groups (18.4% vs. 9.1% vs. 3.9%, χ2=8.724, P=0.013). Subgroup of the patients based on whether IDWG variation of the patient was in the target range showed that all-cause mortality and cardiovascular disease mortality were higher in the patients with higher IDWG variation out of the target range than in the patients in other 5 groups (For all- cause mortality: 51.4% vs. 14.6%, 40.0%, 17.3%, 33.3% and 6.1%; χ2=22.351, 2.030,
11.379, 0.765 and 11.831; P＜0.001, 0.154, 0.001, 0.382 and 0.001. For cardiovascular disease mortality: 31.4% vs. 7.3%, 16.0%, 5.8%, 3.7% and 4.1%; χ2=11.672, 7.506, 10.201, 1.851 and 7.305; P=0.001, 0.006, 0.001, 0.174 and 0.007). COX regression showed that advanced age (HR=2.365, 95% CI: 1.160～4.822, P=0.018), oliguria (HR=0.525, 95% CI: 0.284～0.972, P=0.040), hypoproteinemia (HR=0.291, 95% CI: 0.162～0.522, P＜0.001) and higher IDWG (HR=3.385, 95% CI: 1.909～6.002, P＜0.001) were the independent risk factors for all- cause mortality in MHD patients; hypoproteinemia (HR=0.223, 95% CI: 0.087～ 0.575, P=0.002) and higher IDWG (HR=3.318, 95% CI: 1.387～7.940, P=0.007) were the independent risk
factors for cardiovascular disease mortality in MHD patients. Kaplan-Meier survival analysis showed that the patients with IDWG variation not in the target range had higher all-cause mortality and cardiovascular disease mortality than those with IDWG variation in the target range (χ2=26.570 and 10.423, P＜0.001 and 0.001). The patients with higher IDWG variation had higher all-cause mortality and cardiovascular disease mortality than those with moderate and low IDWG variation (χ2=7.116 and 10.097, P=0.028 and 0.006). Conclusions MHD patients with higher IDWG variation have higher all-cause mortality and cardiovascular disease mortality. Patients with higher IDWG variation out of the target range have a higher mortality. Control of the IDWG variation within the target range and with low IDWG variation may be beneficial in improving survival rate in MHD patients.
［1］National Kidney Foundation KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates：Hemodialysis Adequacy,Peritoneal Dialysis Adequacy and Vascular Access. Am J Kidney Dis, 2006, 48:s1-S322．
［2］日本透析医学会.日本透析医学会年度报, 2009[EB/OL]．
［3］Fouque D, Vennegoor M. Ter Wee P. EBPG guideline on nutrition. Nephrol Dial Transplant. 2007; 22:ii45-ii87.
［4］中国血液透析充分性临床实践指南.中华医学杂志, 2015; 95:2748-2753.
［5］Ipema KJ, Kuipers J, Westerhuis R,et al. Causes and Consequences of Interdialytic weight gain. Kidney Blood Press Res. 2016; 41:710-720.
［6］Bossola M, Calvani R, Marzetti E,et al. Thirst in patients on chronic hemodialysis: What do we know so far? Int Urol Nephrol. 2020;52:697-711.
［7］Thomson BK, Huang SH, Leitch RE,et al. Pre to post-dialysis plasma sodium change better predicts clinical outcomes than dialysate to plasma sodium gradient in quotidian hemodialysis. Hemodial Int. 2013; 17:548-556.
［8］Ferraz SF, Freitas AT, Vaz IM,et al. Nutritional status and interdialytic weight gain of chronic hemodialysis patients. J Bras Nefrol. 2015; 37:306-314.
［9］Ramaswamy K,Brahmbhatt Y,Xia J,et al. Individualized dialysate sodium prescriptions using sodium gradients for high-risk hemodialysis patients lowered interdialytic weight gain and achieved target weights. Hemodial Int. 2020; 24:406-413.
［10］Wong MM, McCullough KP, Bieber BA et al. Interdialytic weight gain:trends, predictors, and associated outcomes in the international Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2017; 69:367-379
［11］Saran R, Bragg-Gresham JL, Levin NW, et al. Longer treatment time and slower ultrafiltration in hemodialysis: associations with reduced mortality in the DOPPS. Kidney Int 2006; 69:1222-1228.
［12］Movilli E, Gaggia P, Zubani R, et al. Association between high ultrafiltration rates and mortality in uraemic patients on regular haemodialysis. A 5-year prospective observational multicentre study. Nephrol Dial Transplant 2007;22:3547-3552.
［13］Flythe JE, Kimmel SE, Brunelli SM. Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney Int 2011;79:250-257.
［14］Saran R, Bragg-Gresham JL, Rayner HC, et al. Nonadherence in hemodialysis:associations with mortality, hospitalization,and practice patterns in the DOPPS. Kidney Int 2003; 64:254-262.
［15］Foley RN, Herzog CA, Collins AJ. Blood pressure and longterm mortality in United States hemodialysis patients: USRDS waves 3 and 4 study. Kidney Int 2002; 62:1784-1790.
［16］Kalantar-Zadeh K, Regidor DL, Kovesdy CP, et al. Fluid retention is associated with cardiovascular mortality in patients undergoing long-term hemodialysis. Circulation 2009; 119:671-679.
［17］Hecking M, Moissl U, Genser B,et al. Greater fluid overload and lower interdialytic weight gain are independently associated with mortality in a large international hemodialysis population. Nephrol Dial Transplant 2018; 33:1832-1842.
［18］Usvyat LA, Barth C, Bayh I et al. Interdialytic weight gain, systolic blood pressure, serum albumin, and C-reactive protein levels change in chronic dialysis patients prior to death. Kidney Int 2013; 84:149-157.
［19］Hecking M, Karaboyas A, Antlanger M,et al. Significance of Interdialytic Weight Gain versus Chronic Volume Overload:Consensus OpinionAm J Nephrol. 2013;38:78-90.
［20］Chamney PW, Wabel P, Moissl UM, et al. A whole-body model to distinguish excess fluid from the hydration of major body tissues. Am J Clin Nutr 2007; 85: 80-89.
［21］Wabel P, Chamney P, Moissl U, Jirka T: Importance of whole-body bioimpedance spectroscopy for the management of fluid balance. Blood Purif 2009; 27: 75-80.
［22］Zoccali C, Moissl U, Chazot C, et al. Chronic fluid overload and mortality in ESRD. J Am Soc Nephrol. 2017;28:2491‐2497.
［23］Cabrera C, Brunelli SM, Rosenbaum D, et al. A retrospective, longitudinal study estimating the association between interdialytic weight gain and cardiovascular events and death in hemodialysis patients. BMC Nephrol. 2015;16:113.
［24］Di Lullo L, Gorini A, Russo D, Santoboni A, Ronco C. Left ventricular hypertrophy in chronic kidney disease atients: from pathophysiology to treatment. Cardiorenal Med. 2015;5:254-66.
［25］Elsayed ME, Stack AG. What are the consequences of volume expansion in chronic dialysis patients?: pulmonary manifestations of volume expansion. Semin Dial. 2015;28:235-9.
［26］Bakirci T, Sasak G, Ozturk S, Akcay S, Sezer S, HaberalM. Pleural effusion in long-term hemodialysis patients. Transplant Proc. 2007;39:889-91.
［27］Havlucu Y, Kursat S, Ekmekci C, Celik P, Serter S, Bayturan O,et al. Pulmonary hypertension in patients with chronic renal failure. Respiration. 2007;74:503-10.
［28］Zoccali, C, Moissl, U, Chazot, C, Mallamaci, F, Tripepi, G, Arkossy, O, Wabel, P, Stuard, S. Chronic fluid overload and mortality in ESRD. J Am Soc Nephrol. 2017;28:2491-7.
［29］Sakai A, Hamada H, Hara K, et al. Nutritional counseling regulates interdialytic weight gain and blood pressure in outpatients receiving maintenance hemodialysis. J Med Invest. 2017;64:129-135.
［30］Colson A, Brinkley A, Braconnier P, et al. Impact of salt reduction in meals consumed during hemodialysis sessions on interdialytic weight gain and hemodynamic stability. Hemodial Int. 2018; 22:501-506.
［31］Flythe JE, Mangione TW, Brunelli SM,et al. Patient-stated preferences regarding volume-related risk mitigation strategies for hemodialysis. Clin J Am Soc Nephrol. 2014; 9:1418-1425.
［32］Bellomo G, Coccetta P, Pasticci F, et al. The effect of psychological intervention on thirst and interdialytic weight gain in patients on chronic hemodialysis:a randomized controlled trial. J Ren Nutr. 2015; 25:426-432.
