Increased thoracic fluid content is associated with higher risk for pneumonia in patients undergoing maintenance hemodialysis

Abstract

Background

Pneumonia is the most common infectious disease in patients undergoing maintenance hemodialysis (MHD). The aim of this study is to determine the possible predictive value of thoracic fluid content (TFC) for pneumonia in this population.

Method

Clinical data were recorded for 1412 MHD patients who were hospitalized for certain comorbidities or complications. Each patient underwent an impedance cardiography (ICG) examination before next dialysis session after admission. Patients were divided into Having-, Will-have-, and Non-pneumonia groups based on whether they had pneumonia at the time of ICG examination after the admission and within five months after the examination. Hemodynamic parameters and other clinical data were compared and analyzed.

Results

Patients who were going to develop pneumonia were older, and had a higher proportion of diabetes, poorer nutritional status, a higher level of inflammatory, poorer cardiac function, and more fluid volume load than those who did not develop pneumonia. Multivariate binary logistic analysis revealed that for each 1/KΩ increase in TFC and 1 increase in neutrophil-to-lymphocyte ratio (NLR), the risk of the development of pneumonia increased by 3.1% (p ˂ 0.01) and 7.2% (p = 0.035), respectively, whereas for each 1 g/L increase in hemoglobin and 1 g/L increase in serum albumin, the risk of the development of pneumonia decreased by 1.3% (p = 0.034) and 5% (p = 0.048), respectively.

Conclusions

TFC, NLR, hemoglobin, and serum albumin were independent risk factors for the development of pneumonia in MHD patients. Given the advantages of ICG, TFC can be used clinically as a helpful predictor of pneumonia in MHD patients.

Keywords:

• Thoracic fluid content
• pneumonia
• maintenance hemodialysis
• fluid volume overload

Author contributions

WH and LY conceived and designed the study; YQ, JL, JW, and LY collected the data; JY provided guidance and advice; LY and WH analyzed the data; LY and YQ drafted the manuscript; WH revised the manuscript. All the authors have read and approved the manuscript for submission.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Key Medical Talent in Science & Education Health Project of Jiangsu Province [ZDRCC2016006] awarded to WH, and the Science and Technology Development Foundation of Nanjing Medical University [NMUB20210040] awarded to JL.