![]() ![]() Īnthropometric formulas combined with tracer dilution techniques have been extensively used to calculate TBW in patients with CKD. recently reported an association between fluid overload and adverse kidney outcomes in the short term in patients with advanced stage 4 to 5 CKD. Using the Body Composition Monitor, which assesses the extracellular volume status by comparing the measured ECW to the expected ECW, Tsai et al. Therefore, an increased ECW/TBW ratio may be also observed in lean, elderly patients without edema. The ECW/TBW ratio is affected not only by changes in the ECW, but also by changes in the intracellular water (ICW) component of TBW. However, the ECW/TBW ratio may not be an ideal measurement of volume overload. ![]() In bioimpedance analysis (BIA), the ratio of extracellular water (ECW) to total body water (TBW) has been used as an indicator of the fluid volume status. However, whether excess extracellular volume is associated with kidney disease progression is unclear, and such studies are hampered by the lack of suitable markers of hypervolemia. Elderly patients with CKD may thus be susceptible to volume overload.Įxcess extracellular volume is a major clinical problem in patients with chronic kidney disease (CKD) and causes lower extremity edema, hypertension, pulmonary vascular congestion or edema, and heart failure. The balance between ICW and ECW changes with age in that the percentage of ECW content in the body fluid composition increases. Proteinuria was independently associated with the extracellular volume status. The ECW BIA/TBW Watson ratio was independently associated with adverse renal outcomes. After adjustment for covariates, the %ECW BIA/TBW Watson ratio was significantly associated with adverse renal outcomes (hazard ratio, 1.21 95 % confidence interval, 1.10–1.34 P < 0.001). During a median follow-up of 4.9 years, patients in the highest tertile of the %ECW BIA/TBW Watson ratio were at greater risk of adverse renal outcomes (16.6 per 100.0 patient years) than were those in the lowest tertile (8.1 per 100.0 patient years) or second tertile (5.6 per 100.0 patient years) (log-rank P = 0.005). Consequently, the %ECW BIA in the body fluid composition increased with age. Both the intracellular and extracellular water volumes decreased with age (correlation between ICW and age, r = -0.30, P < 0.001 correlation between ECW and age, r = -0.17, P = 0.03). In the multivariate analysis, proteinuria remained independently associated with the %ECW BIA/TBW Watson ratio. ResultsĪ higher %ECW BIA/TBW Watson ratio tended to be associated with older age, male sex, diabetes mellitus, resistant hypertension, lower renal function, lower serum albumin levels, higher proteinuria levels, and a higher frequency of furosemide use. The main outcomes were adverse renal outcomes as defined by a decline of ≥50% from the baseline glomerular filtration rate or initiation of renal replacement therapy. ![]() The extracellular volume status was assessed by examining the ratio of extracellular water measured by BIA (ECW BIA) to the total body water calculated using the Watson formula (TBW Watson). Patients were categorized according to tertiles of extracellular volume status. ![]() We performed a retrospective cohort study of 149 patients with CKD who underwent bioelectrical impedance analysis (BIA) from 2005 to 2009. We investigated the association between the extracellular volume status and renal outcomes. However, whether the extracellular volume status is associated with disease progression is unclear. Excess extracellular volume is a major clinical problem in patients with chronic kidney disease (CKD). ![]()
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