Pérez-Morales R, Donate-Correa J, Martín-Núñez E, Pérez-Delgado N, Ferri C, López-Montes A, Jiménez-Sosa A, Navarro-González JF. Extracellular water/total body water ratio as predictor of mortality in hemodialysis patients.
Ren Fail 2021;
43:821-829. [PMID:
33966595 PMCID:
PMC8118427 DOI:
10.1080/0886022x.2021.1922442]
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Abstract
Background
Overhydration is a predictor of mortality in hemodialysis (HD) patients. Bioimpedance spectroscopy (BIS) is used to determine the body composition. Extracellular Water/Total Body Water (ECW/TBW) ratio has been proposed to predict mortality.
Methods
Multicenter, prospective, observational, proof-of-concept study to estimate the impact of ECW/TBW in global and cardiovascular mortality and the relationship with cardiovascular biomarkers. The study included 60 patients (mean age, 71.8 ± 11.4 years; mean time on HD, 52.3 ± 30.8 months) with a median follow-up of 30.5 months (IQ range, 17.2–34 months).
Results
Post-dialysis ECW/TBW was directly associated with NT-proBNP and cTnT. During the study 28 patients died, most of them (43%) due to cardiovascular events. Compared to the survivors, these subjects had a higher post-dialysis ECW/TBW ratio (p = 0.006), while for cardiovascular mortality the only significant difference was a higher pre-dialysis ECW/TBW. The ability of post-dialysis ECW/TBW ratio to predict all-cause mortality had an area under the ROC curve (AUC) of 0.71 (CI 95%, 0.57–0.81; p = 0.002), with a cutoff point of 0.5023. For cardiovascular mortality the AUC was 0.66 (CI 95%, 0.52–0.77; p = 0.045), with a cutoff point of 0.4713.
Conclusions
The post-dialysis ECW/TBW ratio measured by BIS can be a predictor of all-cause and cardiovascular mortality.
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