Introduction: Interdialytic weight-gain (IDWG) has been linked to various complications in hemodialysis (HD) patients. Method: Prospective clinical-observational study to evaluate the effect of IDWG in HD patients on the rate of hospital admissions over a 12-month period, and the impact of high IDWG on the frequency of IDH. Results: Of the 240 patients, those who had IDWG ≥ 4%, 81% had at least one hospital admission due to volume-overload or the need for extra HD-session(s). On the other hand, only 19% of those having IDWG < 4% had been admitted or got extra HD sessions (p < 0.001). Of those who were admitted (over 12 months) due to volume overload; 74.1% had IDWG ≥ 4%, while 25.9% had IDWG < 4% (p < 0.001). Regarding IDH, 87% of patients having IDWG ≥ 4% had at least one episode of IDH/week. On the other hand, only 22.5% of those with IDWG < 4% had one episode of IDH/week (p < 0.001). When analyzing those who had at least one IDH episode/week; 72.9% of them had IDWG ≥ 4%, while only 27.1% had IDWG < 4% (p < 0.001). Conclusion: In HD patients, the frequency of hospital admission due to volume-overload and the need for extra HD-sessions is strongly related to the amount of IDWG (>4% in our patients), the same stands for the frequency of IDH. Thus, control of IDWG in HD patients is of great importance, keeping in mind the importance of the nutrition status of HD patients that may also impact IDWG.
AlSahow, A., AlRukhaimi, M., Al Wakeel, J., Al-Ghamdi, S.M., AlGhareeb, S., AlAli, F., Al Salmi, I., AlHelal, B., AlGhonaim, M., Bieber, B.A., Pisoni, R.L. and GCC-DOPPS 5 Study Group (2016) Demographics and Key Clinical Characteristics of Hemodialysis Patients from the Gulf Cooperation Council Countries Enrolled in the Dialysis Outcomes and Practice Patterns Study Phase 5 (2012-2015). Saudi Journal of Kidney Disease and Transplantation, 27, 12-23. https://doi.org/10.4103/1319-2442.194885
Shaheen, F.A., Al Wakeel, J., Al-Ghamdi, S.M., Alhelal, B., AlGhareeb, S., Al Obaidli, A.A., AlSalmi, I., Abdulaziz, H.E., Bieber, B.A., Pisoni, R.L. and GCC-DOPPS 5 Study Group (2016) Cardiovascular and Cerebrovascular Comorbidities in Hemodialysis Patients from the Gulf Cooperation Council Countries Enrolled in the Dialysis Outcome and Practice Pattern Study Phase 5 (2012-2015). Saudi Journal of Kidney Disease and Transplantation, 27, S24-S30. https://doi.org/10.4103/1319-2442.194886
Abouchacra, S., Obaidli, A., Al-Ghamdi, S.M., Al Wakeel, J., Al Salmi, I., Al Ghareeb, S., Al Azmi, M., Elsayed, M., Bieber, B.A., Pisoni, R.L. and GCC-DOPPS 5 Study Group (2016) Gulf Cooperation Council-Dialysis Outcomes and Practice Patterns Study: An Overview of Anemia Management Trends at the Regional and Country Specific Levels in the Gulf Cooperation Council Countries. Saudi Journal of Kidney Disease and Transplantation, 27, 51-61. https://doi.org/10.4103/1319-2442.194895
Flythe, J.E., Kimmel, S.E. and Brunelli, S.M. (2011) Rapid Fluid Removal during Dialysis Is Associated with Cardiovascular Morbidity and Mortality. Kidney International, 79, 250-257. https://doi.org/10.1038/ki.2010.383
Kalantar-Zadeh, K., Regidor, D.L., Kovesdy, C.P., et al. (2009) Fluid Retention Is Associated with Cardiovascular Mortality in Patients Undergoing Long-Term Hemodialysis. Circulation, 119, 671-679. https://doi.org/10.1161/CIRCULATIONAHA.108.807362
Saran, R., Bragg-Gresham, J.L., Levin, N.W., et al. (2006) Longer Treatment Time and Slower Ultrafiltration in Hemodialysis: Associations with Reduced Mortality in the DOPPS. Kidney International, 69, 1222-1228. https://doi.org/10.1038/sj.ki.5000186
Kimmel, P.L., Varela, M.P., Peterson, R.A., et al. (2000) Interdialytic Weight Gain and Survival in Hemodialysis Patients: Effects of Duration of ESRD and Diabetes Mellitus. Kidney International, 57, 1141-1151. https://doi.org/10.1046/j.1523-1755.2000.00941.x
Al Majarfi, A., Al Salmi, A., Metry, A.M., Al Ismaili, F., Hola, A. and Hannawi, S. (2018) Epidemiology of Patients at Initial Treatment with Hemodialysis. ARC Journal of Nephrology, 3, 6-12.
Al Ismaili, F., Al Salmi, I., Al Maimani, Y., et al. (2017) Epidemiological Transition of End-Stage Kidney Disease in Oman. Kidney International Reports, 2, 27-35. https://doi.org/10.1016/j.ekir.2016.09.001
Al Alawi, I., Al Salmi, I., Al Mawali, A., Al Maimani, Y. and Sayer, J.A. (2017) End-Stage Kidney Failure in Oman: An Analysis of Registry Data with an Emphasis on Congenital and Inherited Renal Diseases. International Journal of Nephrology, 2017, Article ID: 6403985. https://doi.org/10.1155/2017/6403985
Al Alawi, I.H., Al Salmi, I., Al Mawali, A. and Sayer, J.A. (2017) Kidney Disease in Oman: A View of the Current and Future Landscapes. Iranian Journal of Kidney Diseases, 11, 263-270. https://doi.org/10.1155/2017/6403985
Liang, X., Wang, W. and Li, H. (2013) Water and Sodium Restriction on Cardiovascular Disease in Young Chronic Hemodialysis Patients. Chinese Medical Journal, 126, 1667-1672.
Fouque, D., Vennegoor, M. and Ter Wee, P. (2007) EBPG Guideline on Nutrition. Nephrology Dialysis Transplantation, 22, ii45-ii87. https://doi.org/10.1093/ndt/gfm020
Kim, D.Y., Kim, B., Moon, K.H., Lee, S. and Lee, D.Y. (2014) Effect of Gradually Lowering Dialysate Sodium Concentration on the Interdialytic Weight Gain, Blood Pressure, and Extracellular Water in Anuric Hemodialysis Patients. Renal Failure, 36, 23-27. https://doi.org/10.3109/0886022X.2013.830360
Lee, M.J., Doh, F.M., Kim, C.H., Koo, H.M., Oh, H.J., Park, J.T., et al. (2014) Interdialytic Weight Gain and Cardiovascular Outcome in Incident Hemodialysis Patients. American Journal of Nephrology, 39, 427-435. https://doi.org/10.1159/000362743
Movilli, E., Camerini, C., Gaggia, P., Zubani, R., Feller, P., Poiatti, P., et al. (2013) Magnitude of End-Dialysis Overweight Is Associated with All-Cause and Cardiovascular Mortality: A 3-Year Prospective Study. American Journal of Nephrology, 37, 370-377. https://doi.org/10.1159/000349931
Nie, Y., Zhang, Z., Zou, J., Liang, Y., Cao, X., Liu, Z., et al. (2016) Hemodialysis-Induced Regional Left Ventricular Systolic Dysfunction. Hemodialysis International, 20, 564-572. https://doi.org/10.1111/hdi.12434
Al Salmi, I., Larkina, M., Wang, M., Subramanian, L., Morgenstern, H., Jacobson, S., Hakim, R., Tentori, F., Saran, R., Akiba, T., Tomilina, N.A., Port, F.K., Robinson, B.M. and Pisoni, R.L. (2018) Missed Hemodialysis Treatments: International Variation, Predictors, and Outcomes in the Dialysis Outcomes and Practice Patterns Study. American Journal of Kidney Diseases, 72, 634-643. https://doi.org/10.1053/j.ajkd.2018.04.019
Fischbach, M., Zaloszyc, A. and Shroff, R. (2015) The Interdialytic Weight Gain: A Simple Marker of Left Ventricular Hypertrophy in Children on Chronic Haemodialysis. Pediatric Nephrology, 30, 859-863. https://doi.org/10.1007/s00467-015-3086-6
Garagarza, C.A., Valente, A.T., Oliveira, T.S. and Caetano, C.G. (2015) Effect of Personalized Nutritional Counseling in Maintenance Hemodialysis Patients. Hemodialysis International, 19, 412-418. https://doi.org/10.1111/hdi.12260
Sakai, A., Hamada, H., Hara, K., Mori, K., Uchida, T., Mizuguchi, T., et al. (2017) Nutritional Counseling Regulates Interdialytic Weight Gain and Blood Pressure in Outpatients Receiving Maintenance Hemodialysis. The Journal of Medical Investigation, 64, 129-135. https://doi.org/10.2152/jmi.64.129
Sezer, S., Kulah, E., Ozdemir, F.N., Tutal, E., Arat, Z. and Haberal, M. (2004) Clinical Consequences of Intermittent Elevation of C-Reactive Protein Levels in Hemodialysis Patients. Transplantation Proceedings, 36, 38-40. https://doi.org/10.1016/j.transproceed.2003.11.022
Sezer, S., Ozdemir, F.N., Arat, Z., Perim, O., Turan, M. and Haberal, M. (2002) The Association of Interdialytic Weight Gain with Nutritional Parameters and Mortality Risk in Hemodialysis Patients. Renal Failure, 24, 37-48. https://doi.org/10.1081/JDI-120002659
Kramer, H., Yee, J., Weiner, D.E., Bansal, V., Choi, M.J., Brereton, L., et al. (2016) Ultrafiltration Rate Thresholds in Maintenance Hemodialysis: An NKF-KDOQI Controversies Report. American Journal of Kidney Diseases, 68, 522-532. https://doi.org/10.1053/j.ajkd.2016.06.010
Al Salmi, I. and Hannawi, S. (2016) The World Health Report—Health Systems Empowering Citizens and Improving Performance. Research on Humanities and Social Sciences, 6, 6.
Al Salmi, I. and Hannawi, S. (2018) Health Workforce in the Sultanate of Oman: Improving Performance and the Health System. Journal of Internal Medicine and Patient Care Health, 1, 6.
Osman, W., Al Dohani, H., Al Hinai, A.S., et al. (2020) Aldosterone Renin Ratio and Chronic Kidney Disease. Saudi Journal of Kidney Disease and Transplantation, 31, 70-78. https://doi.org/10.4103/1319-2442.279963
Bomback, A.S., Kshirsagar, A.V., Ferris, M.E. and Klemmer, P.J. (2009) Disordered Aldosterone-Volume Relationship in End-Stage Kidney Disease. Journal of the Renin-Angiotensin-Aldosterone System: JRAAS, 10, 230-236. https://doi.org/10.1177/1470320309352353
Raimann, J.G., Chan, C.T., Daugirdas, J.T., Depner, T., Gotch, F.A., Greene, T., et al. (2016) The Effect of Increased Frequency of Hemodialysis on Volume-Related Outcomes: A Secondary Analysis of the Frequent Hemodialysis Network Trials. Blood Purification, 41, 277-286. https://doi.org/10.1159/000441966
Kim, J.C., Kalantar-Zadeh, K. and Kopple, J.D. (2013) Frailty and Protein-Energy Wasting in Elderly Patients with End Stage Kidney Disease. Journal of the American Society of Nephrology, 24, 337-351. https://doi.org/10.1681/ASN.2012010047
Wong, M.M., McCullough, K.P., Bieber, B.A., Bommer, J., Hecking, M., Levin, N.W., et al. (2017) Interdialytic Weight Gain: Trends, Predictors, and Associated Outcomes in the International Dialysis Outcomes and Practice Patterns Study (DOPPS). American Journal of Kidney Diseases, 69, 367-379. https://doi.org/10.1053/j.ajkd.2016.08.030
Hecking, M., Moissl, U., Genser, B., Rayner, H., Dasgupta, I., Stuard, S., et al. (2018) Greater Fluid Overload and Lower Interdialytic Weight Gain Are Independently Associated with Mortality in a Large International Hemodialysis Population. Nephrology Dialysis Transplantation, 33, 1832-1842. https://doi.org/10.1093/ndt/gfy083
Sherman, R.A., Cody, R.P., Rogers, M.E. and Solanchick, J.C. (1995) Interdialytic Weight Gain and Nutritional Parameters in Chronic Hemodialysis Patients. American Journal of Kidney Diseases, 25, 579-583. https://doi.org/10.1016/0272-6386(95)90126-4
Lindley, E.J. (2009) Reducing Sodium Intake in Hemodialysis Patients. Seminars in Dialysis, 22, 260-263. https://doi.org/10.1111/j.1525-139X.2009.00570.x
Kooman, J.P., van der Sande, F., Leunissen, K. and Locatelli, F. (2003) Sodium Balance in Hemodialysis Therapy. Seminars in Dialysis, 16, 351-355. https://doi.org/10.1046/j.1525-139X.2003.16070.x
Hecking, M., Karaboyas, A., Saran, R., Sen, A., Inaba, M., Rayner, H., Horl, W.H., Pisoni, R.L., Robinson, B.M., Sunder-Plassmann, G. and Port, F.K. (2012) Dialysate Sodium Concentration and the Association with Interdialytic Weight Gain, Hospitalization, and Mortality. Clinical Journal of the American Society of Nephrology, 7, 92-100. https://doi.org/10.2215/CJN.05440611
Flythe, J.E., Xue, H., Lynch, K.E., Curhan, G.C. and Brunelli, S.M. (2015) Association of Mortality Risk with Various Definitions of Intradialytic Hypotension. Journal of the American Society of Nephrology, 26, 724-734. https://doi.org/10.1681/ASN.2014020222
Stefánsson, B.V., Brunelli, S.M., Cabrera, C., Rosenbaum, D., Anum, E., Ramakrishnan, K., et al. (2014) Intradialytic Hypotension and Risk of Cardiovascular Disease. Clinical Journal of the American Society of Nephrology, 9, 2124-2132. https://doi.org/10.2215/CJN.02680314
Assa, S., Hummel, Y.M., Voors, A.A., Kuipers, J., Westerhuis, R., de Jong, P.E., et al. (2012) Hemodialysis-Induced Regional Left Ventricular Systolic Dysfunction: Prevalence, Patient and Dialysis Treatment-Related Factors, and Prognostic Significance. Clinical Journal of the American Society of Nephrology, 7, 1615-1623. https://doi.org/10.2215/CJN.00850112
Burton, J.O., Jefferies, H.J., Selby, N.M. and McIntyre, C.W. (2009) Hemodialysis-Induced Cardiac Injury: Determinants and Associated Outcomes. Clinical Journal of the American Society of Nephrology, 4, 914-920. https://doi.org/10.2215/CJN.03900808
Assimon, M.M., Wang, L. and Flythe, J.E. (2019) Cumulative Exposure to Frequent Intradialytic Hypotension Associates with New-Onset Dementia among Elderly Hemodialysis Patients. Kidney International Reports, 4, 603-606. https://doi.org/10.1016/j.ekir.2019.01.001
Seong, E.Y., Zheng, Y., Winkelmayer, W.C., Montez-Rath, M.E. and Chang, T.I. (2018) The Relationship between Intradialytic Hypotension and Hospitalized Mesenteric Ischemia: A Case-Control Study. Clinical Journal of the American Society of Nephrology, 13, 1517-1525. https://doi.org/10.2215/CJN.13891217
Mitsides, N., Pietribiasi, M., Waniewski, J., Brenchley, P. and Mitra, S. (2019) Transcapillary Refilling Rate and Its Determinants during Haemodialysis with Standard and High Ultrafiltration Rates. American Journal of Nephrology, 50, 133-143. https://doi.org/10.1159/000501407
Aronoff, G.R. (2017) The Effect of Treatment Time, Dialysis Frequency, and Ultrafiltration Rate on Intradialytic Hypotension. Seminars in Dialysis, 30, 489-491. https://doi.org/10.1111/sdi.12625
Keane, D.F., Baxter, P., Lindley, E., Rhodes, L. and Pavitt, S. (2018) Time to Reconsider the Role of Relative Blood Volume Monitoring for Fluid Management in Hemodialysis. ASAIO Journal, 64, 812-818. https://doi.org/10.1097/MAT.0000000000000795
Machek, P., Jirka, T., Moissl, U., Chamney, P. and Wabel, P. (2010) Guided Optimization of Fluid Status in Haemodialysis Patients. Nephrology Dialysis Transplantation, 25, 538-544. https://doi.org/10.1093/ndt/gfp487
Chen, H.-S., et al. (2016) Application of Bioimpedance Spectroscopy in Asian Dialysis Patients (ABISAD-III): A Randomized Controlled Trial for Clinical Outcomes. International Urology and Nephrology, 48, 1897-1909. https://doi.org/10.1007/s11255-016-1415-8
Keane, D.F., Bowra, K., Kearney, K. and Lindley, E. (2017) Use of the Body Composition Monitor for Fluid Status Measurements in Elderly Malnourished Subjects. ASAIO Journal, 63, 507-511. https://doi.org/10.1097/MAT.0000000000000508