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.

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.

Citation

Tabinor, M., Elphick, E., Dudson, M., Shing Kwok, C., Lambie, M., & Davies, S. J. (2018). Bioimpedance-defined overhydration predicts survival in end stage kidney failure (ESKF): systematic review and subgroup meta-analysis. Scientific reports, 8, Article 4441. https://doi.org/10.1038/s41598-018-21226-y

• Journal Article Type: Article
• Acceptance Date: Jan 25, 2018
• Online Publication Date: Mar 13, 2018
• Publication Date: Mar 13, 2018
• 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