ArticlePloS one2023
Ratio of extracellular water to intracellular water and simplified creatinine index as predictors of all-cause mortality for patients receiving hemodialysis.
Article in PloS one, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.
- Modified creatinine index for predicting prognosis in hemodialysis patients: a systematic review and meta-analysis.Renal failure · 2024Pooled it
- Associations of percentage body cell mass with insulin resistance and type 2 diabetes: mediation effect of body mass index.Asia Pacific journal of clinical nutrition · 2026Article
- Differential Associations of Lipopolysaccharide, Soluble NOX2-Derived Peptide, and Hydrogen Peroxide with Adiposity and Muscularity in Adults on Maintenance Hemodialysis.Antioxidants (Basel, Switzerland) · 2026Article
- Identification of Clinical Factors Associated With the Immunogenicity of Homologous ChAdOx1-nCoV-19 Vaccine in Hemodialysis Patients.The Kaohsiung journal of medical sciences · 2026Article
- Article
- Subclinical overhydration predicts lower time in range and greater glycemic variability in type 2 diabetes on hemodialysis.Scientific reports · 2026Article
- Effects of acute essential amino acid intake on post-prandial raw bioimpedance and fluid shifts between healthy young and older adults: An exploratory pilot study.Journal of electrical bioimpedance · 2025Article
- Body fluid volume calculated using the uric acid kinetic model relates to the vascular event.Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs · 2024Article
- Tirzepatide Reduces Fat Mass and Provides Good Glycaemic Control in Type 2 Diabetes Patients Undergoing Haemodialysis: A Single-Centre Retrospective Study.Endocrinology, diabetes & metabolism · 2024Article
- Association Between the Appendicular Extracellular-to-Intracellular Water Ratio and All-Cause Mortality: A 10-Year Longitudinal Study.The journals of gerontology. Series A, Biological sciences and medical sciences · 2024Article
- Body composition differences in patients with Metabolic Dysfunction-Associated Steatotic Liver Disease.Frontiers in nutrition · 2024Article
- Review
- Increased extracellular water/body mass is associated with functional impairment in hemodialysis patients.Renal failure · 2023Article
Corrections and comments
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Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The bioelectrical impedance analysis-measured ratio of extracellular water (ECW) to intracellular water (ICW) reflects fluid volume and malnutrition. It may be an indicator of protein-energy wasting and muscle wasting in hemodialysis patients. We examined the association between the ECW/ICW ratio and simplified creatinine index, which is a new surrogate marker of protein-energy wasting and muscle wasting, and whether their combination can accurately predict mortality. A total of 224 patients undergoing hemodialysis for more than 6 months and having undergone bioelectrical impedance analysis for the assessment of body composition were included. Patients were divided into two groups based on the cut-off values of the ECW/ICW ratio (0.57) and simplified creatinine index (20.4 mg/kg/day) for maximumly predicting mortality. Thereafter, they were cross-classified into four groups with each cut-off point. The ECW/ICW ratio was independently associated with the simplified creatinine index (β = -0.164; P = 0.042). During a follow-up of 3.5 years (2.0-6.0 years), 77 patients died. A higher ECW/ICW ratio (adjusted hazard ratio, 3.66, 95% confidence interval 1.99-6.72, P <0.0001) and lower simplified creatinine index (adjusted hazard ratio, 2.25, 95% confidence interval 1.34-3.79, P = 0.0021) were independently associated with an increased risk of all-cause mortality. The adjusted hazard ratio for the higher ECW/ICW ratio and lower simplified creatinine index group vs. the lower ECW/ICW ratio and higher simplified creatinine index group was 12.22 (95% confidence interval 3.68-40.57, p <0.0001). Furthermore, the addition of the ECW/ICW ratio and simplified creatinine index to the baseline risk model significantly improved the C-index from 0.831 to 0.864 (p = 0.045). In conclusion, the ECW/ICW ratio may be a surrogate marker of muscle wasting. Moreover, combining the ECW/ICW ratio and simplified creatinine index may improve the accuracy of predicting all-cause mortality and help stratify the mortality risk of hemodialysis patients.
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