• Yi-Chun Tsai, Jer-Chia Tsai, Szu-Chia Chen, Yi-Wen Chiu, Shang-Jyh Hwang, Chi-Chih Hung, Tzu-Hui Chen, Mei-Chuan Kuo, and Hung-Chun Chen.
• Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
• Am. J. Kidney Dis. 2014 Jan 1;63(1):68-75.

BackgroundFluid overload is a common phenomenon in patients in a late stage of chronic kidney disease (CKD). However, little is known about whether fluid overload is related to kidney disease progression in patients with CKD. Accordingly, the aim of the study was to assess the association of the severity of fluid status and kidney disease progression in an advanced CKD cohort.Study DesignProspective observational cohort study.Setting & ParticipantsThis cohort study enrolled 472 non-dialysis-dependent patients with CKD stages 4-5 who were in an integrated CKD care program from January 2011 to December 2011 and followed up until December 2012 or initiation of renal replacement therapy (RRT).PredictorsTertile of fluid overload, with cutoff values at 0.6 and 1.6 L.OutcomesRRT, rapid estimated glomerular filtration rate (eGFR) decline (faster than 3 mL/min/1.73 m(2) per year), and change in eGFR.MeasurementsThe severity of fluid overload was measured by a bioimpedance spectroscopy method. eGFR was computed using the 4-variable MDRD (Modification of Diet in Renal Disease) Study equation.ResultsDuring a median 17.3-month follow-up, 71 (15.0%) patients initiated RRT and 187 (39.6%) experienced rapid eGFR decline. The severity of fluid overload was associated with increased risk of RRT (tertile 3 vs tertile 1: adjusted HR, 3.16 [95% CI, 1.33-7.50]). Fluid overload value was associated with increased risk of rapid eGFR decline (tertile 3 vs tertile 1: adjusted OR, 4.68 [95% CI, 2.30-9.52]). Furthermore, the linear mixed-effects model showed that the reduction in eGFR over time was faster in tertile 3 than in tertile 1 (P=0.02).LimitationsThe effect of fluid volume variation over time must be considered.ConclusionsFluid overload is an independent risk factor associated with initiation of RRT and rapid eGFR decline in patients with advanced CKD.Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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