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Overall mortality in ESRD patients on MHD is approximately 20-30%, primarily due to
cardiovascular disease and infections. Overhydration (OH) is a risk factor for cardiac dysfunction – leading to
left ventricular hypertrophy (LVH), myocardial infarction (MI), congestive cardiac failure (CCF), increased
incidence of intradialytic morbid events and sudden death. Excessive removal of fluid during dialysis leads to
hypotension, and inadequate removal often leads to hypertension with LVH and heart failure. Clinical
assessment of fluid status is often inaccurate. BIA analysed by the body composition monitor (BCM) gives a
measure of total body water (TBW), ECW, ICW and Fat free mass (FFM). A meta-analysis of BIA-based
predicted survival in ESRD published in 2018 revealed that overhydration >15% predicted mortality. A
systematic review published in 2021 demonstrated that ECW/TBW>0.4, ECW/ICW >10% increment and
OH/ECW>15% were independent risk factors for cardiovascular events (CVE) mortality in patients receiving
dialysis.
The aim of our study was to estimate the prevalence of overhydration and malnutrition in ESRD on
MHD and to study the factors associated with poor nutritional status and poor quality of life in these patients. It
was a single-centre prospective study - subjects above 18y, on MHD for atleast 3 months underwent pre-HD
BIA using a body composition monitor and answered Subjective Global Assessment and SF-36 proformas.
Overhydration (OH) was defined as excess fluid of 1.1L as detected by BCM.
A total of 150 patients were
recruited, 41 were female (27.3%). 50% were under the age of 40y. Out of 150 patients, 101 had overhydration
(67.3%) with a mean excess fluid of 3.77±2.68L. Patients in the OH group had significantly more dyspnea (69%
vs 26.5%), lower leg and sacral edema (74% vs 40%) and increased lung water due to pulmonary edema and
effusion (74% vs 44%). There was an inverse correlation between the dialysis vintage and OH status, patients
with longer dialysis vintage had lesser OH, potentially due to increased dietary, medication and MHD
compliance with time. Patients in the OH group had more intradialytic hypotension due to excess water removal
compared to the No-OH group( 83.9% vs 16%,p=0.005). The population of patients studied had overall poor
nutritional status, with the OH group having lesser muscle mass and more excess water. Females and patients in
the OH group reported lower SF-36 scores but was non-significant.
The demographics portends to a serious
demographic shift and a long burden of disease among the younger population. Early education and counselling
regarding compliance to fluid and salt restriction is imperative and invaluable. Limitations of our study - single
center study, the adaptability, cost of procuring the BCM would have to be factored in a smaller institute or a
hospital. Other non-invasive measures of identifying overhydration such as venous excess ultrasound (VEXUS),
lung ultrasound would have added an additional layer of importance to this study.