The Associations of Malnutrition and Aging with Fluid Volume Imbalance Between Intra- and Extracellular Water in Patients with Chronic Kidney Disease

Overview

Journal J Nutr Health Aging

Specialties Geriatrics
Nutritional Sciences

Date 2015 Dec 2

PMID 26624209

Citations 13

Authors

Y Ohashi

R Tai

T Aoki

S Mizuiri

T Ogura

Y Tanaka

T Okada

A Aikawa

K Sakai

Affiliations

Soon will be listed here.

Abstract

Objectives: Fluid imbalance due to sodium retention and malnutrition can be characterized by the ratio of extracellular water (ECW) to intracellular water (ICW). We investigated whether the ECW/ICW ratio is a risk factor for adverse outcomes.

Design: Retrospective cohort study.

Setting And Participants: 149 patients with chronic kidney disease from 2005 to 2009, who were followed until August 2013.

Measurements: Body fluid composition was measured by bioelectrical impedance analysis. Patients were categorized according to the ECW/ICW ratio tertile. Daily nutrient intake was estimated from 24-h dietary recall and analyzed using standard food composition tables. The main outcomes were adverse renal outcomes, as defined by a decline of 50% or more from the baseline glomerular filtration rate or initiation of renal replacement therapy, cardiovascular events, and all-cause mortality.

Results: The ECW/ICW ratio increased with downward ICW slope with age and renal dysfunction besides ECW excess with massive proteinuria. Sodium intake, protein intake, and calorie intake were negatively correlated with the ECW/ICW ratios due to the steeper decreasing ICW content with the decreased dietary intake than the decreasing ECW content. During a median 4.9-year follow up, patients in the highest tertile had the worst adverse renal outcomes (15.9 vs. 5.1 per 100 patient-years, P < 0.001), cardiovascular events (4.1 vs. 0.3 per 100 patient-years, P = 0.002), and mortality (11.2 vs. 1.3 per 100 patient-years, P < 0.001). The adjusted hazard ratio (95% confidence intervals) for adverse renal outcomes, cardiovascular events, and mortality were 1.15 (1.03 - 1.26), 1.12 (0.93 - 1.31), and 1.29 (1.11 - 1.50), respectively.

Conclusions: Fluid imbalance between ICW and ECW occurring in malnourished and elderly patients with chronic kidney disease may explain the reserve capacity for volume overload and is associated with adverse renal outcomes and all-cause mortality.

Citing Articles

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The Feasibility of Semi-Continuous and Multi-Frequency Thoracic Bioimpedance Measurements by a Wearable Device during Fluid Changes in Hemodialysis Patients.

Schoutteten M, Lindeboom L, De Canniere H, Pieters Z, Bruckers L, Brys A Sensors (Basel). 2024; 24(6).

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Liu Y, Liu X, Duan L, Zhao Y, He Y, Li W Sci Rep. 2023; 13(1):17570.

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Association Between the Appendicular Extracellular-to-Intracellular Water Ratio and All-Cause Mortality: A 10-Year Longitudinal Study.

Iwasaka C, Yamada Y, Nishida Y, Hara M, Yasukata J, Miyoshi N J Gerontol A Biol Sci Med Sci. 2023; 79(2).

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References

Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K . Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009; 53(6):982-92. DOI: 10.1053/j.ajkd.2008.12.034. View

Calhoun D, Jones D, Textor S, Goff D, Murphy T, Toto R . Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008; 51(6):1403-19. DOI: 10.1161/HYPERTENSIONAHA.108.189141. View

Ledingham J . Sodium retention and volume expansion as mechanisms. Am J Hypertens. 1991; 4(10 Pt 2):534S-540S. DOI: 10.1093/ajh/4.10.534s. View

Ekinci E, Clarke S, Thomas M, Moran J, Cheong K, MacIsaac R . Dietary salt intake and mortality in patients with type 2 diabetes. Diabetes Care. 2011; 34(3):703-9. PMC: 3041211. DOI: 10.2337/dc10-1723. View

Cha K, Brown E, Wilmore D . A new bioelectrical impedance method for measurement of the erythrocyte sedimentation rate. Physiol Meas. 1994; 15(4):499-508. DOI: 10.1088/0967-3334/15/4/011. View

Wehner F, Olsen H, Tinel H, Kinne-Saffran E, Kinne R . Cell volume regulation: osmolytes, osmolyte transport, and signal transduction. Rev Physiol Biochem Pharmacol. 2003; 148:1-80. DOI: 10.1007/s10254-003-0009-x. View

Franco R, Bortner C, Cidlowski J . Potential roles of electrogenic ion transport and plasma membrane depolarization in apoptosis. J Membr Biol. 2006; 209(1):43-58. DOI: 10.1007/s00232-005-0837-5. View

Kovesdy C, Kalantar-Zadeh K . Why is protein-energy wasting associated with mortality in chronic kidney disease?. Semin Nephrol. 2009; 29(1):3-14. PMC: 5500837. DOI: 10.1016/j.semnephrol.2008.10.002. View

Hung S, Lin Y, Huang H, Pu H, Tarng D . Aldosterone and mortality in hemodialysis patients: role of volume overload. PLoS One. 2013; 8(2):e57511. PMC: 3585342. DOI: 10.1371/journal.pone.0057511. View

10.

Thomas M, Moran J, Forsblom C, Harjutsalo V, Thorn L, Ahola A . The association between dietary sodium intake, ESRD, and all-cause mortality in patients with type 1 diabetes. Diabetes Care. 2011; 34(4):861-6. PMC: 3064042. DOI: 10.2337/dc10-1722. View

11.

Ahmed M, Abed M, Voelkl J, Lang F . Triggering of suicidal erythrocyte death by uremic toxin indoxyl sulfate. BMC Nephrol. 2013; 14:244. PMC: 4228285. DOI: 10.1186/1471-2369-14-244. View

12.

Amraoui F, Bos S, Vogt L, van den Born B . Long-term renal outcome in patients with malignant hypertension: a retrospective cohort study. BMC Nephrol. 2012; 13:71. PMC: 3470982. DOI: 10.1186/1471-2369-13-71. View

13.

Susantitaphong P, Laowaloet S, Tiranathanagul K, Chulakadabba A, Katavetin P, Praditpornsilpa K . Reliability of blood pressure parameters for dry weight estimation in hemodialysis patients. Ther Apher Dial. 2013; 17(1):9-15. DOI: 10.1111/j.1744-9987.2012.01136.x. View

14.

Weir M . Body mass index-mortality paradox in hemodialysis patients: blood pressure, blood volume, and nutritional status. Hypertension. 2011; 58(6):989-90. DOI: 10.1161/HYPERTENSIONAHA.111.181818. View

15.

Furstenberg A, Davenport A . Comparison of multifrequency bioelectrical impedance analysis and dual-energy X-ray absorptiometry assessments in outpatient hemodialysis patients. Am J Kidney Dis. 2010; 57(1):123-9. DOI: 10.1053/j.ajkd.2010.05.022. View

16.

Lang F, Gulbins E, Szabo I, Lepple-Wienhues A, M Huber S, Duranton C . Cell volume and the regulation of apoptotic cell death. J Mol Recognit. 2004; 17(5):473-80. DOI: 10.1002/jmr.705. View

17.

Agarwal R . Body mass index-mortality paradox in hemodialysis: can it be explained by blood pressure?. Hypertension. 2011; 58(6):1014-20. PMC: 3241970. DOI: 10.1161/HYPERTENSIONAHA.111.180091. View

18.

HUMPHREYS M . Mechanisms and management of nephrotic edema. Kidney Int. 1994; 45(1):266-81. DOI: 10.1038/ki.1994.33. View

19.

Kumar S, Khosravi M, Massart A, Davenport A . Is there a role for N-terminal probrain-type natriuretic peptide in determining volume status in haemodialysis patients?. Nephron Clin Pract. 2013; 122(1-2):33-7. DOI: 10.1159/000348510. View

20.

Bortner C, Cidlowski J . Cell shrinkage and monovalent cation fluxes: role in apoptosis. Arch Biochem Biophys. 2007; 462(2):176-88. PMC: 1941616. DOI: 10.1016/j.abb.2007.01.020. View