ree of fluid overload, 28% in severe fluid overload, and 4% in fluid depletion; 11% were spent in hyponatremia and 1% in hypernatremia; and 64% were spent on low dialysate sodium.Cumulative exposure to even mild fluid overload was associated with higher risk of death, and this association was independent of abnormal plasma sodium and low dialysate sodium. 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....

中文翻译：

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血液透析患者液体状态异常、血浆钠紊乱和低透析液钠与死亡率的相关性


液体超负荷的 REE，严重液体超负荷时为 28%，液体耗竭时为 4%;11% 用于低钠血症，1% 用于高钠血症;64% 用于低透析液钠。即使是轻度液体超负荷的累积暴露也与较高的死亡风险相关，并且这种关联与异常血浆钠和低透析液钠无关。背景 异常的体液和血浆钠浓度是血液透析患者确定的预后因素。然而，异常盐和水的累积影响以及潜在影响改变和透析液钠的影响仍不完全清楚。方法 该研究在 10 年（2010-2020 年）跟踪了来自 25 个国家/地区的 875 家透析诊所的 68,196 名新事件血液透析患者，调查了液体超负荷/耗竭的累积暴露时间之间的剂量反应模式（使用费森尤斯身体成分监测仪通过生物阻抗光谱测量）、血浆钠水平异常、低透析液钠和全因死亡率。我们计算了相对液体超负荷（任何程度;>7% 或严重;女性或男性分别为 >13 或 >15%）和液体耗竭 （<-7%）、低钠或高钠血症（分别为 <135 或 >145 mmol/L）、低透析液钠 （≤138 mmol/L） 的时间变化累积暴露（以月为单位），并使用多变量 Cox 模型估计全因死亡率的风险比。结果 在 2,123,957 个患者月中，61% 用于任何程度的液体超负荷，4% 用于液体耗竭，11% 用于低钠血症，1% 用于高钠血症。任何程度的液体超负荷都与较高的全因死亡率相关（风险比峰值为 3.42 [95% 置信区间，3.12 至 3。75] 相对于无暴露），并且这种与全因死亡率的相关性似乎在严重液体超负荷时更强。与低钠血症相关的风险模式在患者前 4 个月大致呈线性，然后在第 4 个患者月后趋于稳定。我们没有观察到液体超负荷和低钠血症之间的效果改变。结论 即使是轻度液体超负荷也与血液透析患者的较高死亡率相关。更严格的液体管理是否会导致临床改善需要进一步研究。