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Bioimpedance-defined overhydration predicts survival in end stage kidney failure (ESKF): systematic review and subgroup meta-analysis.

Tabinor, Matthew; Elphick, Emma; Dudson, Michael; Shing Kwok, Chun; Lambie, Mark; Davies, Simon J.

Bioimpedance-defined overhydration predicts survival in end stage kidney failure (ESKF): systematic review and subgroup meta-analysis. Thumbnail


Authors

Matthew Tabinor

Emma Elphick

Michael Dudson

Chun Shing Kwok



Abstract

Both overhydration and comorbidity predict mortality in end-stage kidney failure (ESKF) but it is not clear whether these are independent of one another. We undertook a systematic review of studies reporting outcomes in adult dialysis patients in which comorbidity and overhydration, quantified by whole body bioimpedance (BI), were reported. PubMed, EMBASE, PsychInfo and the Cochrane trial database were searched (1990-2017). Independent reviewers appraised studies including methodological quality (assessed using QUIPS). Primary outcome was mortality, with secondary outcomes including hospitalisation and cardiovascular events. Of 4028 citations identified, 46 matched inclusion criteria (42 cohorts; 60790 patients; 8187 deaths; 95% haemodialysis/5% peritoneal dialysis). BI measures included phase angle/BI vector (41%), overhydration index (39%) and extra:intracellular water ratio (20%). 38 of 42 cohorts had multivariable survival analyses (MVSA) adjusting for age (92%), gender (66%), diabetes (63%), albumin (58%), inflammation (CRP/IL6-37%), non-BI nutritional markers (24%) and echocardiographic data (8%). BI-defined overhydration (BI-OH) independently predicted mortality in 32 observational cohorts. Meta-analysis revealed overhydration >15% (HR 2.28, 95% CI 1.56-3.34, P?<?0.001) and a 1-degree decrease in phase angle (HR 1.74, 95% CI 1.37-2.21, P?<?0.001) predicted mortality. BI-OH predicts mortality in dialysis patients independent of the influence of comorbidity.

Journal Article Type Article
Acceptance Date Jan 25, 2018
Online Publication Date Mar 13, 2018
Publication Date Mar 13, 2018
Publicly Available Date Mar 29, 2024
Journal Scientific Reports
Print ISSN 2045-2322
Publisher Nature Publishing Group
Peer Reviewed Peer Reviewed
Volume 8
Article Number 4441
DOI https://doi.org/10.1038/s41598-018-21226-y
Keywords cardiology; haemodialysis; peritoneal dialysis
Publisher URL https://www.nature.com/articles/s41598-018-21226-y

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