Format

Send to

Choose Destination
See comment in PubMed Commons below
PLoS One. 2013 Dec 9;8(12):e82566. doi: 10.1371/journal.pone.0082566. eCollection 2013.

Is fluid overload more important than diabetes in renal progression in late chronic kidney disease?

Author information

  • 1Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
  • 2Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan ; Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan.
  • 3Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.
  • 4Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

Abstract

Fluid overload is one of the major presentations in patients with late stage chronic kidney disease (CKD). Diabetes is the leading cause of renal failure, and progression of diabetic nephropathy has been associated with changes in extracellular fluid volume. The aim of the study was to assess the association of fluid overload and diabetes in commencing dialysis and rapid renal function decline (the slope of estimated glomerular filtration rate (eGFR) less than -3 ml/min per 1.73 m(2)/y) in 472 patients with stages 4-5 CKD. Fluid status was determined by bioimpedance spectroscopy method, Body Composition Monitor. The study population was further classified into four groups according to the median of relative hydration status (△HS =fluid overload/extracellular water) and the presence or absence of diabetes. The median level of relative hydration status was 7%. Among all patients, 207(43.9 %) were diabetic. 71 (15.0%) subjects had commencing dialysis, and 187 (39.6%) subjects presented rapid renal function decline during a median 17.3-month follow-up. Patients with fluid overload had a significantly increased risk for commencing dialysis and renal function decline independent of the presence or absence of diabetes. No significantly increased risk for renal progression was found between diabetes and non-diabetes in late CKD without fluid overload. In conclusion, fluid overload has a higher predictive value of an elevated risk for renal progression than diabetes in late CKD.

PMID:
24349311
PMCID:
PMC3857275
DOI:
10.1371/journal.pone.0082566
[PubMed - indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Public Library of Science Icon for PubMed Central
    Loading ...
    Support Center