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Impedance ratio: a novel marker and a powerful predictor of mortality in hemodialysis patients

  • Nephrology - Original Paper
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Abstract

Purpose

Impedance ratio (Imp-R) obtained by multifrequency bioimpedance analysis (BIA) has been shown to be associated with volume and nutrition status. In this prospective study, the predictive role of Imp-R for mortality in hemodialysis (HD) patients was investigated.

Methods

Multifrequency (5–50–100–200 kHz) BIA was applied to 493 prevalent HD patients in March–April 2006. Imp-R was defined as the ratio of 200–5 kHz impedance values. Demographical, clinical and laboratory data at the time of the analysis were recorded. All-cause and cardiovascular (CV) mortality were assessed during 3 years of follow-up.

Results

Mean age was 57.7 ± 13.9 years, HD duration 52.1 ± 42.6 months and prevalence of diabetes 21.7 %. Imp-R was negatively correlated with nutritional markers including albumin, creatinine and hemoglobin levels. In addition, there was a positive correlation between Imp-R and age, ratio of extracellular water to total body water and high-sensitive C-reactive protein. Over a mean follow-up period of 27.9 ± 11.1 months, 93 deaths (52 from CV reasons) were observed. In the multivariate analysis, Imp-R was significantly associated with all-cause and CV mortality after adjustments [HR 1.13, 95 % CI (1.04–1.23); p = 0.004 and HR 1.15, 95 % CI (1.03–1.27); p = 0.01, respectively]. The risk of all-cause mortality was 3.4 times higher in the fourth quartile of Imp-R (>83.5 %) compared to the first Imp-R quartile (<78.8 %) as reference. Cutoff value of Imp-R for all-cause mortality was 82.0 % with a sensitivity of 65.5 % and specificity of 64 %.

Conclusion

Impedance ratio measured by multifrequency in standardized conditions BIA is an independent and powerful predictor of both all-cause and CV mortality in hemodialysis patients.

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Author information

Authors and Affiliations

  1. FMC Turkey Clinics, Izmir, Turkey

    C. Demirci & S. Erten

  2. Division of Nephrology, Ege University School of Medicine, Izmir, Turkey

    G. Aşcı, M. S. Demirci, M. Özkahya, H. Töz, S. Duman & E. Ok

  3. Sakarya University Training and Research Hospital, Sakarya, Turkey

    S. Sipahi

  4. Tepecik Training and Research Hospital, Izmir, Turkey

    M. Tanrısev

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  1. C. Demirci
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  2. G. Aşcı
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  3. M. S. Demirci
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  4. M. Özkahya
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  6. S. Duman
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  10. E. Ok
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Correspondence to C. Demirci.

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Conflict of interest

CD and SE are employees of FMC Turkey. EO is a scientific consultant for Fresenius Medical Care, Turkey. Other authors declare no conflict of interest.

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Demirci, C., Aşcı, G., Demirci, M.S. et al. Impedance ratio: a novel marker and a powerful predictor of mortality in hemodialysis patients. Int Urol Nephrol 48, 1155–1162 (2016). https://doi.org/10.1007/s11255-016-1292-1

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  • DOI: https://doi.org/10.1007/s11255-016-1292-1

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