Hemodialysis International

Prevalence of fluid overload in an urban US hemodialysis population: A cross-sectional study

Ulrich Moissl, Lemuel Rivera Fuentes, Mohamad I Hakim, Manuel Hassler, Dewangi A Kothari, Laura Rosales, Fansan Zhu, Jochen G Raimann, Stephan Thijssen, Peter Kotanko


Introduction: Inadequate fluid status remains a key driver of cardiovascular morbidity and mortality in chronic hemodialysis (HD) patients. Quantification of fluid overload (FO) using bioimpedance spectroscopy (BIS) has become standard in many countries. To date, no BIS device has been approved in the United States for fluid status assessment in kidney patients. Therefore, no previous quantification of fluid status in US kidney patients using BIS has been reported. Our aim was to conduct a cross-sectional BIS-based assessment of fluid status in an urban US HD population.

Methods: We determined fluid status in chronic HD patients using whole body BIS (Body Composition Monitor, BCM). The BCM reports FO in liters; negative FO denotes fluid depletion. Measurements were performed before dialysis. Post-HD FO was estimated by subtracting the intradialytic weight loss from the pre-HD FO.

Findings: We studied 170 urban HD patients (age 61 ± 14 years, 60% male). Pre- and post-HD FO (mean ± SD), were 2.2 ± 2.4 and -0.2 ± 2.7 L, respectively. Pre-HD, 43% of patients were fluid overloaded, 53% normally hydrated, and 4% fluid depleted. Post-HD, 12% were fluid overloaded, 55% normohydrated and 32% fluid depleted. Only 48% of fluid overloaded patients were hypertensive, while 38% were normotensive and 14% hypotensive. Fluid status did not differ significantly between African Americans (N = 90) and Caucasians (N = 61).

Discussion: While about half of the patients had normal fluid status pre-HD, a considerable proportion of patients was either fluid overloaded or depleted, indicating the need for tools to objectively quantify fluid status.

About the Contributors

Fansan Zhu, PhD

Senior Research Scientist

Fansan was a lecturer in Dept of Bioengineering, Huazhong University of Science & Technology (HUST), Wuhan, China from 1992-1996. He holds master’s degrees in biomedical engineering from HUST and in Chemical engineering from Columbia University, New York. He received the PhD degree from University of Maastricht, Netherlands. His current research interests are application of bioimpedance, video image processing, body fluid dynamics and body composition and modeling of electrical properties in tissue. He is author of over 210 publications including peer-reviewed papers (67), chapter of books (5) and international conference proceedings (151). He is an inventor of 17 U.S. patents.

Jochen G. Raimann, MD, PhD, MPH

Director, Data Analytics

Jochen has worked as a full-time scientist at RRI since his start as a postdoctoral research fellow in 2007. As Senior Manager of Clinical Data Analytics, Jochen conducts epidemiological research in dialysis and oversees many analytical projects. He has first- and co-authored numerous papers and also serves as Associate Editor of the journals Trials and Scientific Reports. Jochen earned his MD from the Medical University Graz, his PhD from Maastricht University, and his MPH with a focus on epidemiology and biostatistics from the City University of New York School of Public Health.

Stephan Thijssen, MD

Vice President, Applied and Basic Research

Prior to coming to New York, Stephan worked in the Nephrology Department at the University Hospital Homburg, Germany. He joined RRI in 2005. Stephan brings more than one and a half decades of research experience to the RRI team, covering laboratory research, clinical research, epidemiology research, and mathematical modeling. He has written and published an extensive number of scholarly articles in leading national and international peer-reviewed scientific journals and published several book chapters.

Dr. Peter Kotanko, MD

RRI Research Director

SVP, Corporate Research & Development

Peter Kotanko, MD, is Research Director at the Renal Research Institute (RRI), New York. Prior to joining RRI, from 1997 to 2007 he served as vice chair of a department of internal medicine at an academic teaching hospital in Graz, Austria. Prior to moving to Graz in 1989, he worked from 1982 to 1989 in the Department of Physiology and the University Clinic of Internal Medicine in Innsbruck, Austria. From 1995 to 1996 he trained in nephrology at the Hammersmith Hospital, London, United Kingdom.