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The associations of malnutrition and aging with fluid volume imbalance between intra- and extracellular water in patients with chronic kidney disease

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The journal of nutrition, health & aging

Abstract

Objectives

Fluid imbalance due to sodium retention and malnutrition can be characterized by the ratio of extracellular water (ECW) to intracellular water (ICW). We investigated whether the ECW/ICW ratio is a risk factor for adverse outcomes.

Design

Retrospective cohort study.

Setting and Participants

149 patients with chronic kidney disease from 2005 to 2009, who were followed until August 2013.

Measurements

Body fluid composition was measured by bioelectrical impedance analysis. Patients were categorized according to the ECW/ICW ratio tertile. Daily nutrient intake was estimated from 24-h dietary recall and analyzed using standard food composition tables. The main outcomes were adverse renal outcomes, as defined by a decline of 50% or more from the baseline glomerular filtration rate or initiation of renal replacement therapy, cardiovascular events, and all-cause mortality.

Results

The ECW/ICW ratio increased with downward ICW slope with age and renal dysfunction besides ECW excess with massive proteinuria. Sodium intake, protein intake, and calorie intake were negatively correlated with the ECW/ICW ratios due to the steeper decreasing ICW content with the decreased dietary intake than the decreasing ECW content. During a median 4.9-year follow up, patients in the highest tertile had the worst adverse renal outcomes (15.9 vs. 5.1 per 100 patient-years, P <0.001), cardiovascular events (4.1 vs. 0.3 per 100 patient-years, P = 0.002), and mortality (11.2 vs. 1.3 per 100 patient-years, P <0.001). The adjusted hazard ratio (95% confidence intervals) for adverse renal outcomes, cardiovascular events, and mortality were 1.15 (1.03–1.26), 1.12 (0.93–1.31), and 1.29 (1.11–1.50), respectively.

Conclusion

Fluid imbalance between ICW and ECW occurring in malnourished and elderly patients with chronic kidney disease may explain the reserve capacity for volume overload and is associated with adverse renal outcomes and all-cause mortality.

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Authors and Affiliations

  1. Department of Nephrology, School of Medicine, Faculty of Medicine, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan

    Yasushi Ohashi, R. Tai, T. Aoki, S. Mizuiri, Y. Tanaka, T. Okada, A. Aikawa & K. Sakai

  2. Division of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan

    S. Mizuiri

  3. Department of Nutrition, Toho University Omori Medical Center, Tokyo, Japan

    T. Ogura

Authors
  1. Yasushi Ohashi
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  2. R. Tai
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  3. T. Aoki
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  4. S. Mizuiri
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Correspondence to Yasushi Ohashi.

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Ohashi, Y., Tai, R., Aoki, T. et al. The associations of malnutrition and aging with fluid volume imbalance between intra- and extracellular water in patients with chronic kidney disease. J Nutr Health Aging 19, 986–993 (2015). https://doi.org/10.1007/s12603-015-0658-x

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  • DOI: https://doi.org/10.1007/s12603-015-0658-x

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