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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Overhydration in hemodialysis (HD) patients has been linked to higher mortality and morbidity due to its association with chronic inflammation, left ventricular hypertrophy, and malnutrition–inflammation–atherosclerosis (MIA). Skeletal muscle mass (SMM) and phase angle (PA) are predictors of survival, while inflammatory indices derived from complete blood count—such as neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (NLR and PLR)—are consolidating as prognostic markers in chronic kidney disease (CKD). This study evaluated the relationship between overhydration, inflammatory status, and body composition in HD patients using whole-body electrical bioimpedance with the BWA device (Body Water Analysis).
Thirty prevalent HD patients were recruited from October to December 2024. A consecutive monthly assessment protocol was established: baseline measurement (October), first follow-up at 30 days (November), and second follow-up at 90 days (December). Only 14 of the 30 patients completed all three measurements required by the protocol. The following parameters were recorded at each assessment: skeletal muscle mass (SMM), skeletal muscle index (SMI), extracellular water/total body water (AEC/ACT), phase angle (PA), and the NLR and PLR indices.
Table 1. Correlations of SMM, SMI, NLR, and PLR with AEC/ACT across the three measurements.
Measurement
SMM vs AEC/ACT
SMI vs AEC/ACT
NLR vs AEC/ACT
PLR vs AEC/ACT
First
0.62
0.71
0.08
0.18
Second
-0.05
-0.08
0.31
0.60
Third
0.06
-0.02
0.51
0.58
At the first measurement, there was a positive correlation between SMI and AEC/ACT (r = 0.71) and between SMM and AEC/ACT (r = 0.62). At the second measurement, no significant relationship was observed between SMM/SMI and AEC/ACT, although the PLR index showed a strong correlation with AEC/ACT (r = 0.60). At the third measurement, inflammatory indices showed consistent correlations with overhydration: NLR (r = 0.51) and PLR (r = 0.58).
The initial association between muscle mass and overhydration could be explained by the intracellular compartment and its relationship with lean mass. However, over time, the correlation shifts toward inflammatory markers (NLR, PLR), supporting the role of chronic inflammation induced by volume overload in the loss of muscle mass and in the progressive deterioration that impacts prognosis. These findings are consistent with the literature, which highlights the interrelationship among hydration, inflammation, and nutritional status in HD patients.
In HD patients, overhydration showed dynamic behavior: initially associated with muscle mass and progressively linked to systemic inflammation. This relationship should be taken into account since the overhydration status may mask the patient’s inflammatory condition. Longitudinal evaluation using bioimpedance, together with simple inflammatory biomarkers (NLR, PLR), could optimize risk stratification and medical and nutritional interventions.
