Dialysis therapy
The extracellular fluid—to—intracellular fluid volume ratio is associated with large-artery structure and function in hemodialysis patients

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Abstract

Background: Large-artery derangement is a major risk factor for cardiovascular and all-cause mortality in patients with end-stage renal disease (ESRD). It is not clear how body fluid distribution affects large-artery structure and function in patients with ESRD. Methods: One hundred fifty-seven hemodialysis (HD) patients (mean age, 55.9 ± 15.1 years; 76 men, 81 women) were enrolled. Influence of the extracellular fluid (ECF)—to—intracellular fluid (ICF) ratio derived from bioimpedance spectroscopy on the structure and function of the common carotid artery (CCA) and aorta was analyzed. One hundred forty-four healthy subjects were examined to obtain normal reference values for body fluid compartments. Based on ECF-ICF ratio, 2 groups were identified: ECF-ICF ratio in the 95th percentile or less and ECF-ICF ratio greater than the 95th percentile of age- and sex-stratified normal reference values. Results: ECF-ICF ratio was significantly related to CCA diameter (r2 = 0.26; P < 0.001), CCA incremental modulus (Einc; r2 = 0.15; P < 0.001), carotid augmentation index (AGI; r2 = 0.10; P < 0.001), and aortic pulse wave velocity (aPWV; r2 = 0.21; P < 0.001). ECF-ICF ratio remained a significant independent determinant for CCA diameter (model r2 = 0.47; P < 0.001), Einc (r2 = 0.29; P < 0.001), aPWV (r2 = 0.51; P < 0.001), and AGI (r2 = 0.40; P < 0.001) when age, sex, mean blood pressure, anthropometrical parameters, HD duration, and status of diabetes mellitus were accounted for. HD patients with an ECF-ICF ratio greater than the 95th percentile had a greater CCA diameter, Einc, aPWV, and AGI than their counterparts. Conclusion: ECF-ICF ratio is associated with large-artery structure and function in HD patients. Patients with ESRD with a high ECF-ICF ratio are characterized by significant large-artery derangement.

Section snippets

Study population

Patients were considered eligible for inclusion when they (1) had been on HD therapy for at least 3 months and (2) had no clinical carotid artery stenosis. One hundred fifty-seven HD patients (76 men, 81 women) with a mean age of 55.9 ± 15.1 years were enrolled consecutively. Of these, 85 patients were administered a regular antihypertensive agent, including calcium channel blockers, diuretics, β-blockers, angiotensin-converting enzyme inhibitors, central-acting agents, angiotensin II

Body fluid compartments between healthy subjects and HD patients

HD patients were significantly lighter than healthy controls for both men and women (Table 1). In comparison to healthy men, HD men had smaller percentages of ECF and ICF and a greater ECF-ICF ratio (healthy versus HD men, P = 0.025 for percentage of ECF; P = 0.001 for percentage of ICF; and P< 0.001 for ECF-ICF ratio, respectively; Table 1). In comparison to healthy women, HD women also had smaller percentages of ECF and ICF and a greater ECF-ICF ratio (healthy versus HD women, P = 0.008 for

Discussion

The principal finding in this study is that ECF-ICF ratio, a simple body fluid distribution index derived from BIS, is associated strongly with structural and functional alterations in large arteries in long-term HD patients. Increased ECF-ICF ratio was associated with increased aPWV, CCA Einc, AGI, and CCA diameter, which have been associated with increased morbidity and mortality in HD patients.2, 3, 4, 5 These findings support our hypothesis that alterations in structure and function of the

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    Supported in part by grants no. NSC 88-2314-B-075-074 and NSC 89-2314-B-010-016 from the National Science Council; and intramural grants no. VGH 87-306, VGH 88-304, VGH 89-257, and VGH 90-66 from the Taipei Veterans General Hospital, Taiwan, ROC.

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