Impact of Interdialytic Weight Gain (IDWG) on Nutritional Parameters, Cardiovascular Risk Factors and Quality of Life in Hemodialysis Patients

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Abstract

Introduction. The amount of interdialytic weight gain (IDWG) considering body weight is of great importance in hemodialysis patients. In general practice, patients are asked to get standard weight between two hemodialysis sessions. However, it should be individualized considering patient’s weight. We aimed to determine the association between the IDWG and the nutritional parameters, cardiovascular risk factors, and quality of life.

Methods. Thrity-two patients receiving hemodialysis at least for one year were enrolled into the study. Patients were monitored for 12 consecutive hemodialysis sessions; and the arithmetic mean of IDWG was calculated. IDWG% was calculated in accordance with patients’ dry weight. Data of patients with IDWG<3% (Group I) and IDWG≥3 (Group II) were compared. Sociodemographic variables, laboratory, anthropometric measurements, blood pressure, left ventricular mass index, Subjective Global Assessment Scale and SF-36 Quality of Life Scale were applied to evaluate the patients.

Results. 59.4% (n=19) and 40.6% (n=13) of patients were included in Group I and Group II, respectively. In Group II, albumin (p=0.02), potassium (p=0.02), phosphorus (p=0.04), nPCR (p=0.03), physical function (p=0.04), role limitations caused by physical problems (p=0.04), general health (p=0.03), physical quality of life (p=0.04) scores were significantly higher. A significant correlation was detected between IDWG and physical and mental quality of life, total score SF-36, albumin, total protein and the potassium values.

Conclusions. Patients with an IDWG ≥ 3% have better nutritional parameters and quality of life scales. The limiting of IDWG to 1-2 kg, ingoring patient weight may give rise to malnutrition and a reduced quality of life.

1. Lindberg M, Prutz K, Lindberg P, Wikstrom B. İnterdialytic weight gain and ultrafiltration rate in hemodialysis: lessons about fluid adherence from anational registry of clincal practise. Hemodial Int 2009; 13: 181-188.

2. Sarkar SR, Kotanko P, Levin NW. Interdialytic Weight Gain: Implications in Hemodialysis Patients. Semin Dial 2006; 19: 429-433.

3. Lopez-Gomez JM, Villaverde M, Jofre R, et al. İnterdialytic weight gain as a marker of blood pressure, nutrition, and survival in hemodilysis patients. Kidney Int Suppl 2005; 93: 63-68.

4. Kimmel PL, Varela MP, Peterson RA, et al. İnterdialytic weight gain and survival in hemodialysis patients: Effects of duration of ESRD and diabetes mellitus. Kidney Int 2000; 57: 1141-1451.

5. Ifudu O, Uribarri J, Rajwani I, et al. Relation between interdialytic weight gain, body weight and nutrition in hemodialysis patients. Am J Nephrol 2002; 22: 363-368.

6. Sherman RA, Cody RP, Rogers ME, Solanchick JC. Interdialytic weight gain and nutritional parameters in chronic hemodialysis patients. Am J Kidney Dis 1995; 25: 579-583.

7. Duranay M, Ozdemir O, Guler SC, Ecemis Z. Evaluation of nutritional parameters in hemodialysis patients. Turk Neph Dial Transpl 2004; 13: 16-20.

8. Sezer S, Arat Z, Ozdemir FN. Malnutrition in chronic renal failure. Turk Neph Dial Transpl 2000; 3: 125-129.

9. Sezer S, Ozdemir FN, Arat Z, et al. The Association of interdialytic weight gain with nutritional parameters and mortality risk in hemodialysis patients. Ren Fail 2002; 24: 37-48.

10. Demir M, Tonbul ZH. Malnutrition-Inflammation-Atherosclerosis (MIA Syndrome) in ESRD Patients. Turk Neph Dial Transpl 2005; 14: 160-165.

11. Kalantar-Zadeh K, Block G, Humphreys MH, Kopple JD. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int 2003; 63: 793-808.

12. Schiffrin EL, Lipman ML, Mann JF. Chronic kidney disease: effects on the cardiovascular system. Circulation 2007; 116: 85-97.

13. Heymsfield SB, McManus C, Smith J, et al. Anthropometric measurement of muscle mass: revised equations for calculating bone-free arm muscle area. Am J Clin Nutr 1982; 36: 680-690.

14. Yang SC, Chiang CK, Hsu SP, Hung KY. Relationship between interdialytic weight gain and nutritional markers in younger and older hemodialysis patients. J Ren Nutr 2008; 18: 210-222.

15. Steiber AL, Kalantar-Zadeh K, Secker D, et al. Subjective Global Assessment in chronic kidney disease: a review. J Ren Nutr 2004; 14: 191-200.

16. Ware JE Jr, Sherbourne CD. The MOS 36-item shortform health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30: 473-483.

17. Daugirdas JT. Second generation logarithmic estimates of single-pool variable volume KT/V: An analysis of error. J Am Soc Nephro 1993; l4: 1205-1213.

18. Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57: 450.

19. Savage DD, Garrison RJ, Kannel WB. The spectrum of left ventricular hypertrophy in a general population sample: the Framingham Study. Circulation 1987; 75: I26-33.

20. Chen YW, Chen HH, Pan CF, et al. İnterdialytic weight gain does not influence the nutrition of new hemodialysis patients. J Ren Nutr 2012; 22: 41-49.

21. Testa A, Beaud JM. The other side of the coin: Interdialytic weight gain as an index of good nutrition. Am J Kidney Dis 1998; 31: 830-834.

22. Chertow GM, Owen WF, Lazarus JM, et al. Exploring the reverse J-shaped curve between urea reduction ratio and mortality. Kidney Int 1999; 56: 1872-1878.

23. Salahudeen AK, Dykes P, May W. Risk factors for higher mortality at the highest levels of spkt/V in haemodialysis patients. Nephrol Dial Transplant 2003; 18: 1339-1344.

24. Agroyannis B, Fourtounas C, Tzanatos H, et al. Relationship between interdialytic weight gain and acid-base status in hemodialysis by bicarbonate. Artif Organs 2002; 26: 385-387.

25. Janardhan V, Soundararajan P, Rani NV, et al. Prediction of Malnutrition Using Modified Subjective Global Assessmentdialysis Malnutrition Score in Patients on Hemodialysis. Indian J Pharm Sci 2011; 73: 38-45.

26. Nerbass FB, Morais JG, Santos RG, et al. Factors related to interdialytic weight gain in hemodialysis patients. J Bras Nefrol 2011; 33: 300-305.

27. de Mutsert R, Snijder MB, van der Sman-de Beer F, et al. Association between body mass index and mortality is similar in the hemodialysis population and the general population at high age and equal duration of follow-up. J Am Soc Nephrol 2007; 18: 967-974.

28. Tutal E, Sezer S, Arat Z, Ozdemir FN. Comparison of Hemodialysis Patients With Continuous Ambulatory Peritoneal Dialysis Patients in Terms of Cardiovascular Disease Risk Factors: A Three-Year Follow-up. Turk Neph Dial Transpl 2005; 14: 5-13.

29. de Jager DJ, Grootendorst DC, Jager KJ, et al. Cardiovascular and Noncardiovascular Mortality Among Patients Starting Dialysis. JAMA 2009; 302: 1782-1789.

30. Luik AJ, Gladziva JP, Kooman JP, et al. Influence of interdialytic weight gain on blood pressure in hemodilaysis patients. Blood Purif 1994; 12: 259-266.

31. Ingrig JK, Patel UD, Gillesspie BS, et al. Relationship between interdialytic weight gain and blood pressure among prevalent hemodialysis patients. Am J Kidney Dis 2007; 50: 108-118.

32. Wu SC, Jeng FR. Relationship between increased interdialytic body weight and left ventricular hypertrophy in maintenance dialysis patients. Nephrology 2001; 6, 85-88.

33. Dwyer JT, Larive B, Leung J, et al. Hemodialysis Study Group.Nutritional status affects quality of life in Hemodialysis (HEMO) Study patients at baseline. J Ren Nutr 2002; 12: 213-223.

34. Rambod M, Bross R, Zitterkoph J, et al. Association of Malnutrition-Inflammation Score with quality of life and mortality in hemodialysis patients: a 5-year prospective cohort study. Am J Kidney Dis 2009; 53: 298-309.

35. Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis. J Am Soc Nephrol 2001; 12: 2797-2806.

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