Kidney Week

Abstract: SA-PO420

Relationship between Fluid Overload and Anemia in the US Hemodialysis Population

Session Information

• Hemodialysis and Frequent Dialysis - 2
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Wang, Lin-Chun, Renal Research Institute, New York, New York, United States

Lin-Chun Wang, MS

• Rivera Fuentes, Lemuel, Renal Research Institute, New York, New York, United States

Lemuel Rivera Fuentes, MD

• Mermelstein, Ariella E., Renal Research Institute, New York, New York, United States

Ariella E. Mermelstein, MA

• Zhang, Hanjie, Renal Research Institute, New York, New York, United States

Hanjie Zhang, PhD

• Moissl, Ulrich, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany

Ulrich Moissl, PhD

• Raimann, Jochen G., Renal Research Institute, New York, New York, United States

Jochen G. Raimann, MD, PhD, MPH

• Thijssen, Stephan, Renal Research Institute, New York, New York, United States

Stephan Thijssen, DrMed

• van der Sande, Frank, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, Netherlands

Frank van der Sande, MD, PhD

• Kooman, Jeroen, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, Netherlands

Jeroen Kooman, MD, PhD

• Kotanko, Peter, Renal Research Institute, New York, New York, United States

Peter Kotanko, MD, FASN

Background

Current guidelines do not consider fluid overload (FO) when treating anemia in patients on hemodialysis (HD). Fluid status can be quantified using bioimpedance spectroscopy (BIS). We aimed to explore the association between FO and hemoglobin (Hgb) levels.

Methods

Pre-HD FO was assessed once per patient by BIS (Body Composition Monitor, Fresenius Medical Care, Germany). For each treatment within ±30 days from the BIS measurement, we calculated the pre-HD FO by assuming that differences in pre-HD body weight were equivalent to variations in FO. We built linear mixed effects models with Hgb as the dependent and FO as the independent variable. Inflammation was considered and adjusted with neutrophil-to-lymphocyte ratio (NLR). Patients were further divided into 3 groups according to fluid status (fluid depleted: <-1.1 l; normal hydrated: -1.1–1.1 l; fluid overloaded: >1.1 l).

Results

We studied 169 patients (61 years; 60% male), 78% were treated with erythropoietin stimulating agents (ESA). Hgb was inversely associated with increasing FO in the overall population [slope estimate -0.16 (95% CI: -0.20 to -0.12) g/dl per 1L of FO, P < 0.0001] (Fig. 1a). While significant in cohorts both with and without ESA, this effect was more pronounced in patients who did not receive ESA [slope estimate -0.20 (-0.30 to -0.095) g/dl per 1l of FO] (Fig. 1b and 1c). Adjustments for NLR did not alter the results. The comparison between the 3 sub-groups is shown in Fig. 2.

Conclusion

Hgb is inversely associated with FO in HD patients. While ESA administration mitigates the hemodilution effect, FO remains the main contributor to low Hgb. The present study showed that fluid status should be considered in the anemia management of patients on HD.