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The predictive value of bioimpedance-derived fluid parameters for cardiovascular events in patients undergoing hemodialysis

BACKGROUND: It is becoming increasingly evident that the accurate assessment of fluid status is critical to ensure optimal care in patients undergoing hemodialysis (HD). Various fluid parameters, including overhydration (OH) and overhydration/extracellular water (OH/ECW%), which can be obtained usin...

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Autores principales: Cheng, Linghong, Chang, Liyang, Tian, Rongrong, Zhou, Jianfang, Luo, Fenxia, Zhang, Hongmei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9318232/
https://www.ncbi.nlm.nih.gov/pubmed/35856161
http://dx.doi.org/10.1080/0886022X.2022.2095287
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author Cheng, Linghong
Chang, Liyang
Tian, Rongrong
Zhou, Jianfang
Luo, Fenxia
Zhang, Hongmei
author_facet Cheng, Linghong
Chang, Liyang
Tian, Rongrong
Zhou, Jianfang
Luo, Fenxia
Zhang, Hongmei
author_sort Cheng, Linghong
collection PubMed
description BACKGROUND: It is becoming increasingly evident that the accurate assessment of fluid status is critical to ensure optimal care in patients undergoing hemodialysis (HD). Various fluid parameters, including overhydration (OH) and overhydration/extracellular water (OH/ECW%), which can be obtained using a bioimpedance spectroscopy device have been used to indicate the hydration status in such patients. This study aimed to explore the effect of these fluid parameters on cardiovascular events and determine which parameter was a better predictor of cardiovascular events (CVEs). METHODS: A total of 227 patients who underwent HD at the Hangzhou Hospital of Traditional Chinese Medicine were enrolled in this prospective study between December 2017 and August 2018. Clinical data were collected, and the fluid status of patients was assessed using a body composition monitor. The patients were followed up until December 2020. The primary outcomes were CVEs. The association between fluid parameters and CVEs was analyzed using Cox proportional hazards models. The areas under the curve (AUCs) of receiver operating characteristic analysis and improvement in the global chi-squared value were used to compare the predictive values of fluid parameters for CVEs. RESULTS: During a median follow-up of 31 months, 66 CVEs were recorded. The patients with a higher absolute hydration index (OH) and a relative hydration index (OH/ECW%) exhibited an increased risk of developing CVEs. After adjusting for confounding factors, both OH [hazard ratio (HR) 1.279 per L, 95% confidence interval (CI) 1.047–1.562; p = 0.016] and OH/ECW% (HR 1.061 per %, 95% CI 1.017–1.108; p = 0.006) were independently associated with CVEs. The predictive ability of the absolute hydration index was superior to the relative hydration index based on AUC calculations for CVEs. Furthermore, a greater change in χ(2) in predicting CVEs was noted for the absolute hydration index. CONCLUSIONS: Both absolute hydration index and relative hydration index were found to be independent predictors of CVEs in univariate and multivariate analyses. Furthermore, the absolute hydration index had a better additive predictive value than the relative hydration index in predicting CVEs.
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spelling pubmed-93182322022-07-27 The predictive value of bioimpedance-derived fluid parameters for cardiovascular events in patients undergoing hemodialysis Cheng, Linghong Chang, Liyang Tian, Rongrong Zhou, Jianfang Luo, Fenxia Zhang, Hongmei Ren Fail Clinical Study BACKGROUND: It is becoming increasingly evident that the accurate assessment of fluid status is critical to ensure optimal care in patients undergoing hemodialysis (HD). Various fluid parameters, including overhydration (OH) and overhydration/extracellular water (OH/ECW%), which can be obtained using a bioimpedance spectroscopy device have been used to indicate the hydration status in such patients. This study aimed to explore the effect of these fluid parameters on cardiovascular events and determine which parameter was a better predictor of cardiovascular events (CVEs). METHODS: A total of 227 patients who underwent HD at the Hangzhou Hospital of Traditional Chinese Medicine were enrolled in this prospective study between December 2017 and August 2018. Clinical data were collected, and the fluid status of patients was assessed using a body composition monitor. The patients were followed up until December 2020. The primary outcomes were CVEs. The association between fluid parameters and CVEs was analyzed using Cox proportional hazards models. The areas under the curve (AUCs) of receiver operating characteristic analysis and improvement in the global chi-squared value were used to compare the predictive values of fluid parameters for CVEs. RESULTS: During a median follow-up of 31 months, 66 CVEs were recorded. The patients with a higher absolute hydration index (OH) and a relative hydration index (OH/ECW%) exhibited an increased risk of developing CVEs. After adjusting for confounding factors, both OH [hazard ratio (HR) 1.279 per L, 95% confidence interval (CI) 1.047–1.562; p = 0.016] and OH/ECW% (HR 1.061 per %, 95% CI 1.017–1.108; p = 0.006) were independently associated with CVEs. The predictive ability of the absolute hydration index was superior to the relative hydration index based on AUC calculations for CVEs. Furthermore, a greater change in χ(2) in predicting CVEs was noted for the absolute hydration index. CONCLUSIONS: Both absolute hydration index and relative hydration index were found to be independent predictors of CVEs in univariate and multivariate analyses. Furthermore, the absolute hydration index had a better additive predictive value than the relative hydration index in predicting CVEs. Taylor & Francis 2022-07-20 /pmc/articles/PMC9318232/ /pubmed/35856161 http://dx.doi.org/10.1080/0886022X.2022.2095287 Text en © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Study
Cheng, Linghong
Chang, Liyang
Tian, Rongrong
Zhou, Jianfang
Luo, Fenxia
Zhang, Hongmei
The predictive value of bioimpedance-derived fluid parameters for cardiovascular events in patients undergoing hemodialysis
title The predictive value of bioimpedance-derived fluid parameters for cardiovascular events in patients undergoing hemodialysis
title_full The predictive value of bioimpedance-derived fluid parameters for cardiovascular events in patients undergoing hemodialysis
title_fullStr The predictive value of bioimpedance-derived fluid parameters for cardiovascular events in patients undergoing hemodialysis
title_full_unstemmed The predictive value of bioimpedance-derived fluid parameters for cardiovascular events in patients undergoing hemodialysis
title_short The predictive value of bioimpedance-derived fluid parameters for cardiovascular events in patients undergoing hemodialysis
title_sort predictive value of bioimpedance-derived fluid parameters for cardiovascular events in patients undergoing hemodialysis
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9318232/
https://www.ncbi.nlm.nih.gov/pubmed/35856161
http://dx.doi.org/10.1080/0886022X.2022.2095287
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