Water intake and progression of chronic kidney disease: the CKD-REIN cohort study
Wagner S, Merkling T, Metzger M, Bankir L, Laville M, Frimat L, Combe C, Jacquelinet C, Fouque D, Massy ZA, Stengel B, CKD-REIN study group
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 31 citations
How it was studied
- Design
- Cohort study (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Independent funding
- Government
- Agence Nationale de la Recherche
- Grants
- Agence Nationale de la Recherche (ANR-10-COHO-0001)
Based on 1 listed funder(s).
Publication
- Published
- 2021-02-11 · Nephrol Dial Transplant · vol. 37 · issue 4 · pp. 730–739
- Publisher
- Oxford University Press
- Cited
- 52 citations · more than 93% of similar papers · 3.5× the field average
- Impact
- Top 10% most cited in its field
- References
- 28 works
- Access
- Open access (repository copy) · CC-BY-NC-ND
- Research areas
- Sodium Intake and Health · Chronic Kidney Disease and Diabetes · Thermoregulation and physiological responses
- Keywords
- Medicine, Kidney disease, Interquartile range, Renal function, Hazard ratio, Urine osmolality, Internal medicine, Urine, Osmole, Urology, Kidney, Cohort, Confidence interval
- MeSH
- humans, disease progression, water, glomerular filtration rate, risk factors, cohort studies, drinking, aged, female, male, renal insufficiency, chronic
12 authors
From FR
- Sandra WagnerInserm; French Clinical Research Infrastructure Network; Défaillance Cardiovasculaire Aiguë et Chronique; Université de Lorraine
- Thomas MerklingInserm; French Clinical Research Infrastructure Network; Défaillance Cardiovasculaire Aiguë et Chronique; Université de Lorraine
- Marie MetzgerInserm; Université Paris-Saclay; Centre de recherche en Epidémiologie et Santé des Populations
- Lise BankirInserm; Sorbonne Université; Centre de Recherche des Cordeliers
- Maurice LavilleLyon 1 Université; Hôpital Lyon Sud
- Luc FrimatUniversité Paris Cité; Centre Hospitalier Régional et Universitaire de Nancy; Interdisciplinarité en Santé Publique Interventions et Instruments de mesure complexes – Région Est; Université de Lorraine
Abstract
Background
Optimal daily water intake to prevent chronic kidney disease (CKD) progression is unknown. Taking the kidney's urine-concentrating ability into account, we studied the relation of kidney outcomes in patients with CKD to total and plain water intake and urine volume.
Methods
Including 1265 CKD patients [median age 69 years; mean estimated glomerular filtration rate (eGFR) 32 mL/min/1.73 m2] from the Chronic Kidney Disease-Renal Epidemiology and Information Network cohort (2013-19), we assessed fluid intake at baseline interviews, collected 24-h urine volumes and estimated urine osmolarity (eUosm). Using Cox and then linear mixed models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for kidney failure and eGFR decline associated with hydration markers, adjusting for CKD progression risk factors and eUosm.
Results
Patients' median daily intake was 2.0 L [interquartile range (IQR) 1.6-2.6] for total water and 1.5 L (1-1.7) for plain water, median urine volume was 1.9 L/24 h (IQR 1.6-2.4) and mean eUosm was 374 ± 104 mosm/L. Neither total water intake nor urine volume was associated with either kidney outcome. Kidney failure risk increased significantly with decreasing eUosm ˂292 mosm/L. Adjusted HRs (95% CIs) for kidney failure associated with plain water intake were 1.88 (1.02-3.47), 1.59 (1.06-2.38), 1.76 (0.95-3.24) and 1.55 (1.03-2.32) in patients drinking 2.0 L/day compared with those drinking 1.0-1.5 L/day. High plain water intake was also significantly associated with faster eGFR decline.
Conclusions
In patients with CKD, the relation between plain water intake and progression to kidney failure appears to be U-shaped. Both low and high intake may not be beneficial in CKD.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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