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Cited by 144Dialysis and Renal Disease ManagementParathyroid Disorders and TreatmentsHeart Failure Treatment and Management

Interdialytic Weight Gain: Trends, Predictors, and Associated Outcomes in the International Dialysis Outcomes and Practice Patterns Study (DOPPS)

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Wong, Michelle M.Y., McCullough, Keith P., Bieber, Brian A., Bommer, Juergen, Hecking, Manfred, Levin, Nathan W., McClellan, William M., Pisoni, Ronald L. +5 more·2017·American Journal of Kidney Diseases
DOI 10.1053/j.ajkd.2016.08.030
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Abstract

BACKGROUND: High interdialytic weight gain (IDWG) is associated with adverse outcomes in hemodialysis (HD) patients. We identified temporal and regional trends in IDWG, predictors of IDWG, and associations of IDWG with clinical outcomes. STUDY DESIGN: Analysis 1: sequential cross-sections to identify facility- and patient-level predictors of IDWG and their temporal trends. Analysis 2: prospective cohort study to assess associations between IDWG and mortality and hospitalization risk. SETTING & PARTICIPANTS: 21,919 participants on HD therapy for 1 year or longer in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 2 to 5 (2002-2014). PREDICTORS: Analysis 1: study phase, patient demographics and comorbid conditions, HD facility practices. Analysis 2: relative IDWG, expressed as percentage of post-HD weight (<0%, 0%-0.99%, 1%-2.49%, 2.5%-3.99% [reference], 4%-5.69%, and ≥5.7%). OUTCOMES: Analysis 1: relative IDWG as a continuous variable using linear mixed models; analysis 2: mortality; all-cause and cause-specific hospitalization using Cox regression, adjusting for potential confounders. RESULTS: From phase 2 to 5, IDWG declined in the United States (-0.29kg; -0.5% of post-HD weight), Canada (-0.25kg; -0.8%), and Europe (-0.22kg; -0.5%), with more modest declines in Japan and Australia/New Zealand. Among modifiable factors associated with IDWG, the most notable was facility mean dialysate sodium concentration: every 1-mEq/L greater dialysate sodium concentration was associated with 0.13 (95% CI, 0.11-0.16) greater relative IDWG. Compared to relative IDWG of 2.5% to 3.99%, there was elevated risk for mortality with relative IDWG≥5.7% (adjusted HR, 1.23; 95% CI, 1.08-1.40) and elevated risk for fluid-overload hospitalization with relative IDWG≥4% (HRs of 1.28 [95% CI, 1.09-1.49] and 1.64 [95% CI, 1.27-2.13] for relative IDWGs of 4%-5.69% and ≥5.7%, respectively). LIMITATIONS: Possible residual confounding. No dietary salt intake data. CONCLUSIONS: Reductions in IDWG during the past decade were partially explained by reductions in dialysate sodium concentration. Focusing quality improvement strategies on reducing occurrences of high IDWG may improve outcomes in HD patients.

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Authors
Wong, M. M. Y., McCullough, K. P., Bieber, B. A., Bommer, J., Hecking, M., Levin, N. W., McClellan, W. M., Pisoni, R. L., Saran, R., Tentori, F., Tomo, T., Port, F. K., & Robinson, B. M.
Affiliations
  • University of British Columbia (CA)
  • Arbor Research Collaborative for Health (US)
  • Heidelberg University (DE)
  • Medical University of Vienna (AT)
  • Renal Research Institute (US)
  • Emory University (US)
  • University of Michigan (US)
  • Oita University (JP)
Corresponding author
Wong, Michelle M.Y.
ORCID
Venue
American Journal of Kidney Diseases
Publisher
Elsevier BV
Published
2017-03
Volume
69
Issue
3
Pages
367-379
ISSN
0272-6386 (ISSN-L)
DOI
10.1053/j.ajkd.2016.08.030
OpenAlex
W2552147998
Cited by
144
References
0
Citations by year
2026: 12 · 2025: 16 · 2024: 14 · 2023: 11 · 2022: 14 · 2021: 19 · 2020: 21 · 2019: 13 · 2018: 16 · 2017: 8
FWCI
12.41
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Kidney Diseases (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (1K01DK087762-01A1)
Topics
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Keywords
interdialytic weight gain, hemodialysis, dialysate sodium concentration, fluid overload, mortality, hospitalization, temporal trends, predictors of weight gain, DOPPS, regional variation, dialysis outcomes, fluid balance management, comorbidities, patient demographics, dialysis duration, dialysis adequacy
MeSH terms
Female, Renal Dialysis, Hospitalization, Humans, Kidney Failure, Chronic, Male, Middle Aged, Practice Patterns, Physicians', Prospective Studies, Time Factors, Weight Gain, Outcome Assessment, Health Care

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