END-DIALYSIS OVERWEIGHT AND CHRONIC INFLAMMATION. A DANGEROUS CONNECTION

INTRODUCTION AND AIMS: Attaining dry body weight is paramount in dialysis practice, but this goal is not always reached. We hypothesized that the amount of enddialysis overweight (edOW), could be associated to increased chronic inflammation and mortality. Aim of the study: to evaluate the effect of edOW on serum C-reattive protein(hsCRP) concentrations and on survival in a cohort of 182 prevalent HD patients (pts) followed for 36 months.
METHODS: In 182 pts (117 men, age 65612 years, vintage 48 months; range 6-336), edOW was present in 98/182 (54%) pts. Mean value was 0.460.2 Kg (range: 0.1-1.4). In the 98 pts with edOW (Group 1) and in the other 84 (Group 2) we evaluated:
Ultrafiltration rate(UFR), hsCRPdry body weight (dBW), Kt/V, protein catabolic rate (PCRn), interdialytic weight gain (IDWG), mean arterial pressure (MAP). Unpaired Student’s t test was employed to compare groups, linear regression analysis to test
correlations, log-rank test and Kaplan-Meier curves to evaluate survival.
RESULTS: Mean UFR was 11.762.8 ml/Kg/hour, dBW 64612 Kg, hsCRP 6.6 (0.2-36) mg/L, Kt/V 1.2760.09, PCRn 1.0660.10 g/Kg/day, IDWG 2.860.4 Kg, MAP 9766.5 mmHg. edOW and hsCRP were directly and significantly correlated (r= 0.67; p<0.0001). Comparison between pts with (Group 1) and without (Group 2) edOW showed significant differences in: UFR (12.762.6 vs 10.962.6 ml/Kg/hour; p< 0.0001), hsCRP (13.068.1 vs 5.265.3 mg/L; p< 0.0001), and PCRn (1.0360.09 vs 1.0860.10 g/Kg/day; p<0.004). 98 pts (54%) died during follow-up for cardiovascular complications in 69% of cases. Survival curves showed significantly greater mortality in Group 1 vs Group 2 in relation to the amount of edOW, and hsCRP (p<0.0001).
CONCLUSIONS: : edOW and chronic inflammation are directly correlated in HD pts, and both are associated to a greater long-term risk of mortality.