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Extracellular Fluid Volume and Mortality in Hemodialysis.

Demirci C|Özkahya M|Demirci M|Hür E|Momin Adam S|Ok E|Başçi A|Töz H
BANTAO Journal 2009; Volume 7: Supplement 1, OP-06
OBJECTIVE: We investigated whether the amount of extracellular water (ECW) assessed by bioimpedance analysis (BIA) predicts mortality in hemodialysis (HD) patients.
SUBJECTS/METHODS: In June 2006, ECW was measured by multifrequency BIA (Bodystat Quadscan 4000, British Isles) on a midweek interdialytic day and was corrected for body surface area (BSA) in 502 maintenance HD patients (mean age 55.9 ±13.5 yrs, HD duration 54 ±42 mo, female 41%, diabetes 35.8%). Demographical, clinical and laboratory data were recorded at the time of analysis. Overall and cardiovascular (CV) mortality were assessed during a mean follow-up of 22 ±17 months (1 to 36 ).
RESULTS: Ninety-three deaths were observed during follow-up, 53 from CV diseases. ECW-BSA was significantly lower in survivors compared to non-survivors (9.63± 0.73 vs 9.90± 0.83 L/m, respectively; p=0.004). In multivariate Cox regression analysis, after adjusting for all variables, ECW-BSA was an independent predictor of both overall and CV mortality (RR: 1.48, p=0.007 and RR: 1.80, p=0.002; respectively) (table). Patients with ECW-BSA below 9.62 L/m2 (median value) had a significantly better 3-year cumulative survival than patients with a ECW-BSA equal or higher than 9.62 L/m2 (p=0.01) (figure).
CONCLUSION: High extracellular fluid volume is an independent predictor of both cardiovascular and overall mortality in HD patients.
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