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Interdialytic weight gain (IDWG) in hemodialysis patients has conflicting clinical implications since it has been perceived as a combination of volume and nutritional characteristics. This study aimed to examine the prognostic value of IDWG in terms of mortality in relation to albumin and its association with nutritional parameters, including body composition data, in hemodialysis patients.
This one-year prospective observational cohort study was done at the outpatient renal unit of Chong Hua Hospital in Cebu City from November 2022 to October 2023. The study comprised 74 chronic kidney disease patients who had been on thrice weekly dialysis for at least three months. Patients were categorized into two groups according to the IDWG%: <3% (Group I) and >/=3% (Group II). Bioimpedance analysis (BIA) was used to calculate the estimated dry weight and other body composition data, which was reviewed once every six months for a year. The averaged mean IDWG and IDWG% of 12 hemodialysis sessions were studied in the first, sixth, and twelfth months. Albumin levels were dichotomized into >/=3.8 mg/dL and <3.8 mg/dL segments. After a year, the link between IDWG% and mortality risk in relation to albumin was determined.
Conclusions
The mortality risk was significantly increased in the low IDWG% group (46.7% mortality), all of whom had albumin levels less than 3.8 g/dL. In contrast, there were no deaths among high-IDWG patients with high albumin levels. Furthermore, those with high IDWG died primarily from cardiovascular disease (87%), while those with low IDWG mainly died from sepsis (43%). Although albumin levels varied significantly amongst IDWG groups, none of the bioimpedance metrics were linked with both albumin and IDWG%. Our findings support the concept that IDWG goals should be tailored to individual patients.