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Cardiovascular conditions in hemodialysis patients may be worsened by extensive interdialytic weight gain
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
2009 (English)In: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 13, no 1, 27-31 p.Article in journal (Refereed) Published
Abstract [en]

The risk of death is increased for hemodialysis (HD) patients compared with age-matched healthy subjects, the main reason for this being cardiovascular conditions. This prospective study investigated whether the burden of interdialytic weight gain (IDWG) was of importance for cardiovascular end points and survival. A total of 97 HD patients were studied. The end points included death (reasons given), acute myocardial infarction, or coronary vascular intervention. The extent of ultrafiltration was measured at predefined follow-up points. The IDWG was calculated as ultrafiltration/body weight given in weight%. The burden of IDWG was analyzed. End points occurred in 77 (79%) of the patients during the 5-year study period. The extent of IDWG was higher in those with end points due to cardiovascular reasons (3.77 weight% vs. 3.19 P<0.001), cardiac reasons (P<0.001), congestive heart failure (P<0.01), aortic aneurysm, and intracerebral bleeding (P<0.024). To reduce the risk for cardiovascular events, it is important to avoid too extensive IDWG in HD patients.

Place, publisher, year, edition, pages
2009. Vol. 13, no 1, 27-31 p.
Keyword [en]
Interdialytic weight gain, cardiovascular, hemodialysis, survival, prognosis, risk factors
National Category
Urology and Nephrology
URN: urn:nbn:se:umu:diva-32373DOI: 10.1111/j.1542-4758.2009.00335.xPubMedID: 19210274OAI: diva2:302996
Available from: 2010-03-10 Created: 2010-03-10 Last updated: 2013-05-03Bibliographically approved
In thesis
1. Analysis of risk factors in patients with severe chronic kidney disease. The role of atorvastatin.
Open this publication in new window or tab >>Analysis of risk factors in patients with severe chronic kidney disease. The role of atorvastatin.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aim: There had been no randomized end-point studies with statins for patients with severe renal failure. The purpose of this prospective, open, randomized, controlled study was to investigate whether atorvastatin (10 mg/day) would alter cardiovascular end-points and the overall mortality rate of patients with chronic kidney disease stage 4 or 5 (creatinine clearance</30 ml/min) and to influence risk factors.

Material & Methods: This was an open, prospective, randomized study. A total of 143 patients were included: 73 were controls and 70 were prescribed 10 mg/day of atorvastatin. As efficacy variables, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglyceride levels were determined at the start of the study and at 1, 3, 6, 12, 18, 24, 30 and 36 months. The primary end-points were all cause of mortality, non-lethal acute myocardial infarction, and coronary artery intervention. Various risk factors were studied. In the 97 patients on haemodialysis inter dialysis weight gain (IDWG) was calculated as ultrafiltration in kg/body weight in kg given in percentage of the weight. The burden of IDWG was analyzed.

Results: In the atorvastatin group, total cholesterol and low-density lipoprotein cholesterol were significantly reduced, the latter by 35% at 1 month and then sustained. Atorvastatin was withdrawn in 23% of patients due to unacceptable side effects, most frequent complaints being gastrointestinal discomfort and headache. Primary end-points occurred in 74% of the subjects. There was no difference in cardiovascular endpoint and survival between the control and atorvastatin groups. The 5-year end-point-free survival rate from study entry was 20%. There was no evidence of more benefit of atorvastatin for patients with diabetes mellitus and chronic kidney disease versus the other patients; instead plasma fibrinogen increased. The IDWG was significantly larger in patients who suffered from end-points due to cardiovascular reasons, cardiac reasons, congestive heart failure, aortic aneurysm, and intracerebral bleeding.

Conclusion: These data showed that in contrast to other patient groups, patients with severe chronic kidney disease 4 and 5, including those with diabetes mellitus, seem to have no benefit from 10mg/day of atorvastatin. Instead we found a high IDWG to be an important risk factor that should be prevented. There was no evident connection between atorvastatin medication and IDWG.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2013. 86 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1574
Atorvastatin, cholesterol, chronic kidney disease, haemodialysis, cholesterol, lipids, peritoneal dialysis, risk factors, statins, inter dialysis weight gain
National Category
Family Medicine
urn:nbn:se:umu:diva-68682 (URN)978-91-7459-554-3 (ISBN)
Public defence
2013-05-30, Sal E04, by 6E, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Available from: 2013-05-02 Created: 2013-04-23 Last updated: 2013-05-02Bibliographically approved

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