Effect of bioimpedance-defined overhydration parameters on mortality and cardiovascular events in patients undergoing dialysis: a systematic review and meta-analysis

Yajie Wang, Zejuan Gu, Yajie Wang, Zejuan Gu

Abstract

Objective: To evaluate the role of bioimpedance-defined overhydration (BI-OH) parameters in predicting the risk of mortality and cardiovascular (CV) events in patients undergoing dialysis.

Methods: We searched multiple electronic databases for studies investigating BI-OH indicators in the prediction of mortality and CV events through 23 May 2020. We assessed the effect of BI-OH indexes using unadjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Sensitivity analysis was used for each outcome.

Results: We included 55 studies with 104,758 patients in the meta-analysis. Extracellular water/total body water (ECW/TBW) >0.4 (HR 5.912, 95% CI: 2.016-17.342), ECW/intracellular water (ICW) for every 0.01 increase (HR 1.041, 95% CI: 1.031-1.051), and OH/ECW >15% (HR 2.722, 95% CI: 2.005-3.439) increased the risk of mortality in patients receiving dialysis. ECW/TBW >0.4 (HR 2.679, 95% CI: 1.345-5.339) and ECW/ICW per increment of 10% (HR 1.032, 95% CI: 1.017-1.047) were associated with an increased risk of CV events in patients undergoing dialysis. A 1-degree increase in phase angle was a protective factor for both mortality (HR 0.676, 95% CI: 0.474-0.879) and CV events (HR 0.736, 95% CI: 0.589-0.920).

Conclusions: BI-OH parameters might be independent predictors for mortality and CV events in patients undergoing dialysis.

Keywords: Bioimpedance-defined overhydration; cardiovascular event; dialysis; meta-analysis; mortality; outcome.

Conflict of interest statement

Declaration of conflicting interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow chart of the literature search.
Figure 2.
Figure 2.
Forest plots of mortality among patients receiving dialysis with a 1-degree increase in phase angle. (a) Overall analysis; (b) subgroup analysis for dialysis method; (c) subgroup analysis for quality assessment. TE, hazard ratio; seTE, standard error; HR, hazard ratio; CI, confidence interval; RRT, dialysis method; PD, peritoneal dialysis; HD, hemodialysis; HQ, high quality; LQ, low quality.
Figure 3.
Figure 3.
Forest plots of mortality among patients receiving dialysis with overhydration/extracellular water ratio >15% (a) overall analysis; (b) subgroup analysis for dialysis method; (c) subgroup analysis for quality assessment. TE, hazard ratio; seTE, standard error; HR, hazard ratio; CI, confidence interval; RRT, dialysis method; PD, peritoneal dialysis; HD, hemodialysis; HQ, high quality; LQ, low quality.

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