Extracellular Fluid/Intracellular Fluid Volume Ratio as a Novel Risk Indicator for All-Cause Mortality and Cardiovascular Disease in Hemodialysis Patients
In hemodialysis patients, fluid overload and malnutrition are accompanied by extracellular fluid (ECF) expansion and intracellular fluid (ICF) depletion, respectively. We investigated the relationship between ECF/ICF ratio (as an integrated marker reflecting both fluid overload and malnutrition) and...
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| creator | Kim, Eun-Jung Choi, Myung-Jin Lee, Jeoung-Hwan Oh, Ji-Eun Seo, Jang-Won Lee, Young-Ki Yoon, Jong-Woo Kim, Hyung-Jik Noh, Jung-Woo Koo, Ja-Ryong |
| description | In hemodialysis patients, fluid overload and malnutrition are accompanied by extracellular fluid (ECF) expansion and intracellular fluid (ICF) depletion, respectively. We investigated the relationship between ECF/ICF ratio (as an integrated marker reflecting both fluid overload and malnutrition) and survival and cardiovascular disease (CVD) in the context of malnutrition-inflammation-arteriosclerosis (MIA) complex.
Seventy-seven patients from a single hemodialysis unit were prospectively enrolled. The ECF/ICF volume was measured by segmental multi-frequency bioimpedance analysis. MIA and volume status were measured by serum albumin, C-reactive protein (CRP), pulse wave velocity (PWV) and plasma B-type natriuretic peptide (BNP), respectively.
The mean ECF/ICF ratio was 0.56±0.06 and the cut-off value for maximum discrimination of survival was 0.57. Compared with the low ECF/ICF group, the high ECF/ICF group (ratio≥0.57, 42%) had higher all-cause mortality, CVD, CRP, PWV, and BNP, but lower serum albumin. During the 5-year follow-up, 24 all-cause mortality and 38 CVD occurred (18 and 24, respectively, in the high ECF/ICF group versus 6 and 14 respectively in the low ECF/ICF group, P |
| doi_str_mv | 10.1371/journal.pone.0170272 |
| format | Article |
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Seventy-seven patients from a single hemodialysis unit were prospectively enrolled. The ECF/ICF volume was measured by segmental multi-frequency bioimpedance analysis. MIA and volume status were measured by serum albumin, C-reactive protein (CRP), pulse wave velocity (PWV) and plasma B-type natriuretic peptide (BNP), respectively.
The mean ECF/ICF ratio was 0.56±0.06 and the cut-off value for maximum discrimination of survival was 0.57. Compared with the low ECF/ICF group, the high ECF/ICF group (ratio≥0.57, 42%) had higher all-cause mortality, CVD, CRP, PWV, and BNP, but lower serum albumin. During the 5-year follow-up, 24 all-cause mortality and 38 CVD occurred (18 and 24, respectively, in the high ECF/ICF group versus 6 and 14 respectively in the low ECF/ICF group, P<0.001). In the adjusted Cox analysis, the ECF/ICF ratio nullifies the effects of the MIA and volume status on survival and CVD and was an independent predictor of all-cause mortality and CVD: hazard ratio (95% confidence interval); 1.12 (1.01-1.25) and 1.09 (1.01-1.18) for a 0.01 increase in the ECF/ICF ratio. The degree of malnutrition (albumin), inflammation (CRP), arteriosclerosis (PWV), and fluid overload (BNP) were correlated well with the ECF/ICF ratio.
Hemodialysis patients with high ECF/ICF ratio are not only fluid overloaded, but malnourished and have stiff artery with more inflammation. The ECF/ICF ratio is highly related to the MIA complex, and is a major risk indicator for all-cause mortality and CVD.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0170272</identifier><identifier>PMID: 28099511</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Albumin ; Arteriosclerosis ; Arteriosclerosis - pathology ; Biology and Life Sciences ; Brain natriuretic peptide ; C-reactive protein ; C-Reactive Protein - analysis ; Cardiovascular disease ; Cardiovascular diseases ; Confidence intervals ; Dialysis ; Extracellular Fluid - metabolism ; Female ; Health risks ; Hemodialysis ; Hospitals ; Humans ; Inflammation ; Inflammation - pathology ; Internal medicine ; Intracellular ; Intracellular Fluid - metabolism ; Kidney diseases ; Longitudinal Studies ; Male ; Malnutrition ; Malnutrition - pathology ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Morbidity ; Mortality ; Natriuretic Peptide, Brain - blood ; Nephrology ; Patients ; Peritoneal dialysis ; Prospective Studies ; Pulse Wave Analysis ; Renal Dialysis - mortality ; Risk Factors ; Serum albumin ; Serum Albumin - analysis ; Survival ; Transplants & implants ; Wave velocity</subject><ispartof>PloS one, 2017-01, Vol.12 (1), p.e0170272-e0170272</ispartof><rights>2017 Kim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Kim et al 2017 Kim et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c559t-71a869243798b6d14be6f60fd20b07573b7b778cbf98e1767bb2fe22717d1b133</citedby><cites>FETCH-LOGICAL-c559t-71a869243798b6d14be6f60fd20b07573b7b778cbf98e1767bb2fe22717d1b133</cites><orcidid>0000-0003-4245-2569</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5242490/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5242490/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28099511$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kim, Eun-Jung</creatorcontrib><creatorcontrib>Choi, Myung-Jin</creatorcontrib><creatorcontrib>Lee, Jeoung-Hwan</creatorcontrib><creatorcontrib>Oh, Ji-Eun</creatorcontrib><creatorcontrib>Seo, Jang-Won</creatorcontrib><creatorcontrib>Lee, Young-Ki</creatorcontrib><creatorcontrib>Yoon, Jong-Woo</creatorcontrib><creatorcontrib>Kim, Hyung-Jik</creatorcontrib><creatorcontrib>Noh, Jung-Woo</creatorcontrib><creatorcontrib>Koo, Ja-Ryong</creatorcontrib><title>Extracellular Fluid/Intracellular Fluid Volume Ratio as a Novel Risk Indicator for All-Cause Mortality and Cardiovascular Disease in Hemodialysis Patients</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>In hemodialysis patients, fluid overload and malnutrition are accompanied by extracellular fluid (ECF) expansion and intracellular fluid (ICF) depletion, respectively. We investigated the relationship between ECF/ICF ratio (as an integrated marker reflecting both fluid overload and malnutrition) and survival and cardiovascular disease (CVD) in the context of malnutrition-inflammation-arteriosclerosis (MIA) complex.
Seventy-seven patients from a single hemodialysis unit were prospectively enrolled. The ECF/ICF volume was measured by segmental multi-frequency bioimpedance analysis. MIA and volume status were measured by serum albumin, C-reactive protein (CRP), pulse wave velocity (PWV) and plasma B-type natriuretic peptide (BNP), respectively.
The mean ECF/ICF ratio was 0.56±0.06 and the cut-off value for maximum discrimination of survival was 0.57. Compared with the low ECF/ICF group, the high ECF/ICF group (ratio≥0.57, 42%) had higher all-cause mortality, CVD, CRP, PWV, and BNP, but lower serum albumin. During the 5-year follow-up, 24 all-cause mortality and 38 CVD occurred (18 and 24, respectively, in the high ECF/ICF group versus 6 and 14 respectively in the low ECF/ICF group, P<0.001). In the adjusted Cox analysis, the ECF/ICF ratio nullifies the effects of the MIA and volume status on survival and CVD and was an independent predictor of all-cause mortality and CVD: hazard ratio (95% confidence interval); 1.12 (1.01-1.25) and 1.09 (1.01-1.18) for a 0.01 increase in the ECF/ICF ratio. The degree of malnutrition (albumin), inflammation (CRP), arteriosclerosis (PWV), and fluid overload (BNP) were correlated well with the ECF/ICF ratio.
Hemodialysis patients with high ECF/ICF ratio are not only fluid overloaded, but malnourished and have stiff artery with more inflammation. The ECF/ICF ratio is highly related to the MIA complex, and is a major risk indicator for all-cause mortality and CVD.</description><subject>Albumin</subject><subject>Arteriosclerosis</subject><subject>Arteriosclerosis - pathology</subject><subject>Biology and Life Sciences</subject><subject>Brain natriuretic peptide</subject><subject>C-reactive protein</subject><subject>C-Reactive Protein - analysis</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Confidence intervals</subject><subject>Dialysis</subject><subject>Extracellular Fluid - metabolism</subject><subject>Female</subject><subject>Health risks</subject><subject>Hemodialysis</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Inflammation</subject><subject>Inflammation - pathology</subject><subject>Internal medicine</subject><subject>Intracellular</subject><subject>Intracellular Fluid - metabolism</subject><subject>Kidney diseases</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Malnutrition</subject><subject>Malnutrition - pathology</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Natriuretic Peptide, Brain - blood</subject><subject>Nephrology</subject><subject>Patients</subject><subject>Peritoneal dialysis</subject><subject>Prospective Studies</subject><subject>Pulse Wave Analysis</subject><subject>Renal Dialysis - mortality</subject><subject>Risk Factors</subject><subject>Serum albumin</subject><subject>Serum Albumin - analysis</subject><subject>Survival</subject><subject>Transplants & implants</subject><subject>Wave velocity</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNUk1v1DAQjRCIlsI_QGCJC5ds_RHH8QWpWlq6UvlQBVytcewUL954sZMV-1f4tXi7adUCBw6WrfGbNzNvXlE8J3hGmCDHyzDGHvxsHXo7w0RgKuiD4pBIRsuaYvbwzvugeJLSEmPOmrp-XBzQBkvJCTksfp3-HCK01vvRQ0RnfnTmeNH_FUNfgx9XFl3C4AKChAB9CBvr0aVL39GiN66FIUTU5XPifTmHMVn0PsQBvBu2CHqD5hCNCxtI7TXvW5csZJDr0bldBePAb5NL6FMuYfshPS0edeCTfTbdR8WXs9PP8_Py4uO7xfzkomw5l0MpCDS1pBUTstG1IZW2dVfjzlCsseCCaaGFaFrdycYSUQutaWcpFUQYogljR8XLPe_ah6QmWZMiDZeiaSirMmKxR5gAS7WObgVxqwI4dR0I8UpBHFzrraKGWmihpdjySkoNWGqOq7yEShjBROZ6M1Ub9cqa1u609vdI7__07pu6ChvFaUUriTPB64kghh-jTYNaubRbFvQ2jLu-6yb3zGT1P1DCszacZOirP6D_FqLao9oYUoq2u-2bYLVz5U2W2rlSTa7MaS_uznybdGND9ht3GeGy</recordid><startdate>20170101</startdate><enddate>20170101</enddate><creator>Kim, Eun-Jung</creator><creator>Choi, Myung-Jin</creator><creator>Lee, Jeoung-Hwan</creator><creator>Oh, Ji-Eun</creator><creator>Seo, Jang-Won</creator><creator>Lee, Young-Ki</creator><creator>Yoon, Jong-Woo</creator><creator>Kim, Hyung-Jik</creator><creator>Noh, Jung-Woo</creator><creator>Koo, Ja-Ryong</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-4245-2569</orcidid></search><sort><creationdate>20170101</creationdate><title>Extracellular Fluid/Intracellular Fluid Volume Ratio as a Novel Risk Indicator for All-Cause Mortality and Cardiovascular Disease in Hemodialysis Patients</title><author>Kim, Eun-Jung ; Choi, Myung-Jin ; Lee, Jeoung-Hwan ; Oh, Ji-Eun ; Seo, Jang-Won ; Lee, Young-Ki ; Yoon, Jong-Woo ; Kim, Hyung-Jik ; Noh, Jung-Woo ; Koo, Ja-Ryong</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c559t-71a869243798b6d14be6f60fd20b07573b7b778cbf98e1767bb2fe22717d1b133</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Albumin</topic><topic>Arteriosclerosis</topic><topic>Arteriosclerosis - pathology</topic><topic>Biology and Life Sciences</topic><topic>Brain natriuretic peptide</topic><topic>C-reactive protein</topic><topic>C-Reactive Protein - analysis</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Confidence intervals</topic><topic>Dialysis</topic><topic>Extracellular Fluid - metabolism</topic><topic>Female</topic><topic>Health risks</topic><topic>Hemodialysis</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Inflammation</topic><topic>Inflammation - pathology</topic><topic>Internal medicine</topic><topic>Intracellular</topic><topic>Intracellular Fluid - metabolism</topic><topic>Kidney diseases</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Malnutrition</topic><topic>Malnutrition - pathology</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Natriuretic Peptide, Brain - blood</topic><topic>Nephrology</topic><topic>Patients</topic><topic>Peritoneal dialysis</topic><topic>Prospective Studies</topic><topic>Pulse Wave Analysis</topic><topic>Renal Dialysis - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kim, Eun-Jung</au><au>Choi, Myung-Jin</au><au>Lee, Jeoung-Hwan</au><au>Oh, Ji-Eun</au><au>Seo, Jang-Won</au><au>Lee, Young-Ki</au><au>Yoon, Jong-Woo</au><au>Kim, Hyung-Jik</au><au>Noh, Jung-Woo</au><au>Koo, Ja-Ryong</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Extracellular Fluid/Intracellular Fluid Volume Ratio as a Novel Risk Indicator for All-Cause Mortality and Cardiovascular Disease in Hemodialysis Patients</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-01-01</date><risdate>2017</risdate><volume>12</volume><issue>1</issue><spage>e0170272</spage><epage>e0170272</epage><pages>e0170272-e0170272</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>In hemodialysis patients, fluid overload and malnutrition are accompanied by extracellular fluid (ECF) expansion and intracellular fluid (ICF) depletion, respectively. We investigated the relationship between ECF/ICF ratio (as an integrated marker reflecting both fluid overload and malnutrition) and survival and cardiovascular disease (CVD) in the context of malnutrition-inflammation-arteriosclerosis (MIA) complex.
Seventy-seven patients from a single hemodialysis unit were prospectively enrolled. The ECF/ICF volume was measured by segmental multi-frequency bioimpedance analysis. MIA and volume status were measured by serum albumin, C-reactive protein (CRP), pulse wave velocity (PWV) and plasma B-type natriuretic peptide (BNP), respectively.
The mean ECF/ICF ratio was 0.56±0.06 and the cut-off value for maximum discrimination of survival was 0.57. Compared with the low ECF/ICF group, the high ECF/ICF group (ratio≥0.57, 42%) had higher all-cause mortality, CVD, CRP, PWV, and BNP, but lower serum albumin. During the 5-year follow-up, 24 all-cause mortality and 38 CVD occurred (18 and 24, respectively, in the high ECF/ICF group versus 6 and 14 respectively in the low ECF/ICF group, P<0.001). In the adjusted Cox analysis, the ECF/ICF ratio nullifies the effects of the MIA and volume status on survival and CVD and was an independent predictor of all-cause mortality and CVD: hazard ratio (95% confidence interval); 1.12 (1.01-1.25) and 1.09 (1.01-1.18) for a 0.01 increase in the ECF/ICF ratio. The degree of malnutrition (albumin), inflammation (CRP), arteriosclerosis (PWV), and fluid overload (BNP) were correlated well with the ECF/ICF ratio.
Hemodialysis patients with high ECF/ICF ratio are not only fluid overloaded, but malnourished and have stiff artery with more inflammation. The ECF/ICF ratio is highly related to the MIA complex, and is a major risk indicator for all-cause mortality and CVD.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28099511</pmid><doi>10.1371/journal.pone.0170272</doi><orcidid>https://orcid.org/0000-0003-4245-2569</orcidid><oa>free_for_read</oa></addata></record> |
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| language | eng |
| recordid | cdi_plos_journals_1859788234 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Albumin Arteriosclerosis Arteriosclerosis - pathology Biology and Life Sciences Brain natriuretic peptide C-reactive protein C-Reactive Protein - analysis Cardiovascular disease Cardiovascular diseases Confidence intervals Dialysis Extracellular Fluid - metabolism Female Health risks Hemodialysis Hospitals Humans Inflammation Inflammation - pathology Internal medicine Intracellular Intracellular Fluid - metabolism Kidney diseases Longitudinal Studies Male Malnutrition Malnutrition - pathology Medicine Medicine and Health Sciences Middle Aged Morbidity Mortality Natriuretic Peptide, Brain - blood Nephrology Patients Peritoneal dialysis Prospective Studies Pulse Wave Analysis Renal Dialysis - mortality Risk Factors Serum albumin Serum Albumin - analysis Survival Transplants & implants Wave velocity |
| title | Extracellular Fluid/Intracellular Fluid Volume Ratio as a Novel Risk Indicator for All-Cause Mortality and Cardiovascular Disease in Hemodialysis Patients |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T06%3A31%3A07IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Extracellular%20Fluid/Intracellular%20Fluid%20Volume%20Ratio%20as%20a%20Novel%20Risk%20Indicator%20for%20All-Cause%20Mortality%20and%20Cardiovascular%20Disease%20in%20Hemodialysis%20Patients&rft.jtitle=PloS%20one&rft.au=Kim,%20Eun-Jung&rft.date=2017-01-01&rft.volume=12&rft.issue=1&rft.spage=e0170272&rft.epage=e0170272&rft.pages=e0170272-e0170272&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0170272&rft_dat=%3Cproquest_plos_%3E1861577851%3C/proquest_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1859788234&rft_id=info:pmid/28099511&rft_doaj_id=oai_doaj_org_article_2d2eacac20e5499ba09b50462047d737&rfr_iscdi=true |