2017, Cilt 26, Sayı 2, Sayfa(lar) 183-189
The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients
Ender HÜR1, Şennur BUDAK KÖSE2, Kemal MAĞDEN1, Gürsel YILDIZ3, Utku SOYALTIN1, Bilal TOKA1, Naki TURAN4, Saadet ÇELİKÖRS5, Bünyamin ALTUNDAL4, Ali TUNÇ4, Adil YILMAZ4, Ahmet SİVRİ4, Siren SEZER5, Soner DUMAN6
1Bülent Ecevit University Faculty of Medicine, Department of Nephrology, Zonguldak, Turkey
2İstanbul Education and Research Hospital, Department of Nephrology, İstanbul, Turkey
3Zonguldak Atatürk State Hospital, Department of Nephrology, Zonguldak, Turkey
4Zonguldak Can, Hemodialysis Centers, Zonguldak, Turkey
5Başkent University Faculty of Medicine, Zonguldak Hemodialysis Centers, Zonguldak, Turkey
6Ege University Faculty of Medicine, Department of Nephrology, İzmir, Turkey
Keywords: Overhydration, Bioimpedance, Malnutrition, Fat tissue index, Mortality
OBJECTIVE: Hypervolemia and malnutrition are often undiagnosed risk factors for hemodialysis (HD). Our aim was to investigate the long-term effects of hypervolemia and malnutrition evaluated by bioimpedance spectroscopy (BIS) on survival. (Clinical Trials. Gov Identifier: NCT01468363).

MATERIAL and METHODS: A total of 431 Prevalent HD patients were followed for 32.2±14.4 months. The patients underwent BIS measurement, a medical history was obtained, and routine tests were analyzed at the baseline and at the end of the study. Hospitalizations and complications of HD were recorded.

RESULTS: The mean age was 59.4±14.6 (10-92) years with a total of 431 (53.6% males) patients of which 125 died. The percentage of diabetics was 47%, erythropoietin use 67%, and diuretic use 40%. Predialysis systolic blood pressure (BP) was 133.4±25.8 and diastolic BP 79.2±12.4 mm Hg. The rate of diabetes, and the number of hospitalizations and blood transfusions were higher in the patients who died. Diastolic BP as a clinical hypervolemia finding, BIS hypervolemia indicator of over hydration (OH), and extracellular water (ECW) were all increased, and fat tissue index as a malnutrition finding was decreased in patients who died. There were significant rates of anemia and hypoalbuminemia in this group as well. The cumulative survival was lower in hypervolemic patients as assessed by relative hydration status OH/ECW.

CONCLUSION: Hypervolemia and malnutrition are the long-term mortality indicators in hemodialysis. Early diagnosis and treatment is important. Clinical findings may not be sufficient and laboratory and BIS methods can be used for diagnosis.

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