Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Sep;49(9):3000605211031063.
doi: 10.1177/03000605211031063.

Effect of bioimpedance-defined overhydration parameters on mortality and cardiovascular events in patients undergoing dialysis: a systematic review and meta-analysis

Yajie Wang  1 , Zejuan Gu  2
Affiliations
Meta-Analysis

Effect of bioimpedance-defined overhydration parameters on mortality and cardiovascular events in patients undergoing dialysis: a systematic review and meta-analysis

Yajie Wang et al. J Int Med Res. 2021 Sep.

Abstract

Objective: To evaluate the role of bioimpedance-defined overhydration (BI-OH) parameters in predicting the risk of mortality and cardiovascular (CV) events in patients undergoing dialysis.

Methods: We searched multiple electronic databases for studies investigating BI-OH indicators in the prediction of mortality and CV events through 23 May 2020. We assessed the effect of BI-OH indexes using unadjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Sensitivity analysis was used for each outcome.

Results: We included 55 studies with 104,758 patients in the meta-analysis. Extracellular water/total body water (ECW/TBW) >0.4 (HR 5.912, 95% CI: 2.016-17.342), ECW/intracellular water (ICW) for every 0.01 increase (HR 1.041, 95% CI: 1.031-1.051), and OH/ECW >15% (HR 2.722, 95% CI: 2.005-3.439) increased the risk of mortality in patients receiving dialysis. ECW/TBW >0.4 (HR 2.679, 95% CI: 1.345-5.339) and ECW/ICW per increment of 10% (HR 1.032, 95% CI: 1.017-1.047) were associated with an increased risk of CV events in patients undergoing dialysis. A 1-degree increase in phase angle was a protective factor for both mortality (HR 0.676, 95% CI: 0.474-0.879) and CV events (HR 0.736, 95% CI: 0.589-0.920).

Conclusions: BI-OH parameters might be independent predictors for mortality and CV events in patients undergoing dialysis.

Keywords: Bioimpedance-defined overhydration; cardiovascular event; dialysis; meta-analysis; mortality; outcome.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow chart of the literature search.
Figure 2.
Figure 2.
Forest plots of mortality among patients receiving dialysis with a 1-degree increase in phase angle. (a) Overall analysis; (b) subgroup analysis for dialysis method; (c) subgroup analysis for quality assessment. TE, hazard ratio; seTE, standard error; HR, hazard ratio; CI, confidence interval; RRT, dialysis method; PD, peritoneal dialysis; HD, hemodialysis; HQ, high quality; LQ, low quality.
Figure 3.
Figure 3.
Forest plots of mortality among patients receiving dialysis with overhydration/extracellular water ratio >15% (a) overall analysis; (b) subgroup analysis for dialysis method; (c) subgroup analysis for quality assessment. TE, hazard ratio; seTE, standard error; HR, hazard ratio; CI, confidence interval; RRT, dialysis method; PD, peritoneal dialysis; HD, hemodialysis; HQ, high quality; LQ, low quality.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Himmelfarb J, Vanholder R, Mehrotra R, et al.. The current and future landscape of dialysis. Nat Rev Nephrol 2020; 16: 573–585. - PMC - PubMed
    1. Sanderson KR, Harshman LA.Renal replacement therapies for infants and children in the ICU. Curr Opin Pediatr 2020; 32: 360–366. - PMC - PubMed
    1. US Renal Data System 2019 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis 2019: S0272-6386(19)31008-X. doi: 10.1053/j.ajkd.2019.09.002. - PubMed
    1. Ronco C, Verger C, Crepaldi C, et al.. Baseline hydration status in incident peritoneal dialysis patients: the initiative of patient outcomes in dialysis (IPOD-PD study)†. Nephrol Dial Transplant 2015; 30: 849–858. - PMC - PubMed
    1. Guo Q, Lin J, Li J, et al.. The Effect of Fluid Overload on Clinical Outcome in Southern Chinese Patients Undergoing Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2015; 35: 691–702. - PMC - PubMed