ArticleClinical journal of the American Society of Nephrology : CJASN2024
Associations of Abnormal Fluid Status, Plasma Sodium Disorders, and Low Dialysate Sodium with Mortality in Patients on Hemodialysis.
Article in Clinical journal of the American Society of Nephrology : CJASN, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Article
- Point-of-Care Ultrasound in Post-Kidney Transplant Patients: Venous Excess Ultrasound Score and Lung Ultrasound for Fluid Assessment.Blood purification · 2026Article
- Integrated Ultrasound Approach to Fluid Assessment and Nutritional Status in Hemodialysis.Cardiorenal medicine · 2026Observational
- Osmolarity trajectories and outcomes in patients with acute pancreatitis in the intensive care unit: group-based trajectory modeling.BMC medical informatics and decision making · 2025Article
- Increased risk of cardiac death with cumulative exposure to fluid overload and dialysate sodium ≤138 mmol/l in hemodialysis patients.Clinical kidney journal · 2025Article
- Prognostic implications of systemic immune-inflammation index and systemic inflammation response index in hemodialysis patients.BMC nephrology · 2025Article
- Association between inflammatory markers and mortality in hemodialysis patients.Jornal brasileiro de nefrologiaArticle
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
Background: Abnormal fluid and plasma sodium concentrations are established prognostic factors for patients on hemodialysis. However, the cumulative effects of abnormal salt and water and potential effect modifications and the effect of dialysate sodium remain incompletely understood. Methods: The study followed 68,196 patients on incident hemodialysis from 875 dialysis clinics in 25 countries over 10 years (2010–2020) investigating dose-response patterns between cumulative exposure time of fluid overload/depletion (measured by bioimpedance spectroscopy using the Fresenius Body Composition Monitor), abnormal plasma sodium levels, low dialysate sodium, and all-cause mortality. We calculated time-varying cumulative exposure (in months) of relative fluid overload (any degree; >7% or severe; >13 or >15% in women or men, respectively) and fluid depletion (<−7%), hypo- or hypernatremia (sodium <135 or >145 mmol/L, respectively), low dialysate sodium (≤138 mmol/L), and estimated hazard ratios for all-cause mortality using a multivariable Cox model. Results: Of 2,123,957 patient-months, 61% were spent in any degree of fluid overload, 4% in fluid depletion, 11% in hyponatremia, and 1% in hypernatremia. Any degree of fluid overload was associated with higher all-cause mortality (hazard ratio peak at 3.42 [95% confidence intervals, 3.12 to 3.75] relative to no exposure), and this association with all-cause mortality seemed to be stronger with severe fluid overload. The risk pattern associated with hyponatremia was approximately linear in the first four patient-months and then plateaued after the fourth patient-month. We did not observe effect modification between fluid overload and hyponatremia. Conclusions: Even mild fluid overload was associated with higher mortality in patients on hemodialysis. Whether more stringent fluid management results in clinical improvement requires further investigation.
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