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Faucon AL, Leffondré K, Flamant M, Metzger M, Boffa JJ, Haymann JP, Houillier P, Thervet E, Vrtovsnik F, Proust-Lima C, Stengel B, Vidal-Petiot E, Geri G. Trajectory of extracellular fluid volume over time and subsequent risks of end-stage kidney disease and mortality in chronic kidney disease: a prospective cohort study. J Intern Med 2021; 289:193-205. [PMID: 32654192 DOI: 10.1111/joim.13151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Extracellular fluid volume (ECF) is independently associated with chronic kidney disease (CKD) progression and mortality in patients with CKD, but the prognostic value of the trajectory of ECF over time beyond that of baseline value is unknown. OBJECTIVES To characterize ECF trajectory and evaluate its association with the risks of end-stage kidney disease (ESKD) and mortality. METHODS From the prospective tricentric NephroTest cohort, we included 1588 patients with baseline measured glomerular filtration rate (mGFR) ≥15 mL min-1 /1.73 m2 and ECF measurement. ECF and GFR were measured repeatedly using the distribution volume and clearance of 51 Cr-EDTA, respectively. ESKD and mortality were traced through record linkage with the national registries. Adjusted shared random-effect joint models were used to analyse the association between the trajectory of ECF over time and the two competing outcomes. RESULTS Patients were mean age 58.7 years, 66.7% men, mean mGFR of 43.6 ± 18.6 mL min-1 /1.73 m2 and mean ECF of 16.1 ± 3.6 L. Over a median follow-up of 5.3 [IQR: 3.0;7.4] years, ECF increased by 136 [95%CI 106;167] mL per year on average, whilst diuretic prescription and 24-hour urinary sodium excretion remained stable. ESKD occurred in 324 (20.4%) patients, and 185 (11.6%) patients died before ESKD. A higher current value of ECF was associated with increased hazards of ESKD (adjusted hazard ratio [aHR]: 1.12 [95%CI 1.06;1.18]; P < 0.001 per 1 L increase in ECF), and death before ESKD (aHR: 1.10 [95%CI 1.04;1.17]; P = 0.002). CONCLUSIONS The current value of ECF was associated with the risks of ESKD and mortality, independent of multiple potential confounders, including kidney function decline. This highlights the need for a close monitoring and adjustment of treatment to avoid fluid overload in CKD patients.
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Affiliation(s)
- A-L Faucon
- From the, Centre de recherche en Epidémiologie et Santé des Populations, INSERM UMR 1018, Renal and Cardiovascular Epidemiology, Université Paris-Saclay, Paris, France
| | - K Leffondré
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, ISPED, Bordeaux, France
| | - M Flamant
- Department of Physiology, AP-HP, Hôpital Bichat and INSERM U1149, Paris, France.,Université de Paris, Paris, France
| | - M Metzger
- From the, Centre de recherche en Epidémiologie et Santé des Populations, INSERM UMR 1018, Renal and Cardiovascular Epidemiology, Université Paris-Saclay, Paris, France
| | - J-J Boffa
- Department of Nephrology, AP-HP, Hôpital Tenon, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - J-P Haymann
- Université Pierre et Marie Curie, Paris, France.,Department of Physiology, AP-HP, Hôpital Tenon, Paris, France
| | - P Houillier
- Université de Paris, Paris, France.,Department of Physiology, AP-HP, INSERM U1138, Centre de Recherche des Cordeliers, Hôpital Européen Georges Pompidou and Centre de Recherche des Cordeliers, Paris, France
| | - E Thervet
- Université de Paris, Paris, France.,Department of Nephrology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - F Vrtovsnik
- Université de Paris, Paris, France.,Department of Nephrology, AP-HP, Hôpital Bichat, Paris, France
| | - C Proust-Lima
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, ISPED, Bordeaux, France
| | - B Stengel
- From the, Centre de recherche en Epidémiologie et Santé des Populations, INSERM UMR 1018, Renal and Cardiovascular Epidemiology, Université Paris-Saclay, Paris, France
| | - E Vidal-Petiot
- Department of Physiology, AP-HP, Hôpital Bichat and INSERM U1149, Paris, France.,Université de Paris, Paris, France
| | - G Geri
- From the, Centre de recherche en Epidémiologie et Santé des Populations, INSERM UMR 1018, Renal and Cardiovascular Epidemiology, Université Paris-Saclay, Paris, France.,Medical Intensive Care Unit, AP-HP, Hôpital Ambroise Paré, Boulogne-Billancourt, France.,Université Paris-Saclay, Université Versailles Saint-Quentin-en-Yvelines, Versailles, France
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