{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:45:17Z","timestamp":1791830717689,"version":"4.3.4"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Volume overload is frequently encountered and is associated with cardiovascular risk factors in patients with chronic kidney disease (\n                      <jats:styled-content style=\"fixed-case\">CKD)<\/jats:styled-content>\n                      . However, the relationship between volume overload and adverse outcomes in\n                      <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n                      is not fully understood.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      A prospective cohort of 338 patients with stage 3 to 5\n                      <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n                      was followed for a median of 2.1\u00a0years. The study participants were stratified by the presence or absence of volume overload, defined as an overhydration index assessed by bioimpedance spectroscopy exceeding 7%, the 90th percentile for the healthy population. The primary outcome was the composite of estimated glomerular filtration rate decline \u226550% or end\u2010stage renal disease. The secondary outcome included a composite of morbidity and mortality from cardiovascular causes. Animal models were used to simulate fluid retention observed in human\n                      <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n                      . We found that patients with volume overload were at a higher risk of the primary and secondary end points in the adjusted Cox models. Furthermore, overhydration appears to be more important than hypertension in predicting an elevated risk. In rats subjected to unilateral nephrectomy and a high\u2010salt diet, the extracellular water significantly increased. This fluid retention was associated with an increase in blood pressure, proteinuria, renal inflammation with macrophage infiltration and tumor necrosis factor\u2010\u03b1 overexpression, glomerular sclerosis, and cardiac fibrosis. Diuretic treatment with indapamide attenuated these changes, suggesting that fluid retention might play a role in the development of adverse outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Volume overload contributes to\n                      <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n                      progression and cardiovascular diseases. Further research is warranted to clarify whether the correction of volume overload would improve outcomes for\n                      <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n                      patients.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.115.001918","type":"journal-article","created":{"date-parts":[[2015,5,5]],"date-time":"2015-05-05T22:50:57Z","timestamp":1430866257000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":142,"title":["Volume Overload and Adverse Outcomes in Chronic Kidney Disease: Clinical Observational and Animal Studies"],"prefix":"10.1161","volume":"4","author":[{"given":"Szu\u2010Chun","family":"Hung","sequence":"first","affiliation":[{"name":"Division of Nephrology Taipei Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation New Taipei City Taiwan"},{"name":"School of Medicine Tzu Chi University Hualien Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010Shin","family":"Lai","sequence":"additional","affiliation":[{"name":"Institute of Physiology National Yang\u2010Ming University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ko\u2010Lin","family":"Kuo","sequence":"additional","affiliation":[{"name":"Division of Nephrology Taipei Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation New Taipei City Taiwan"},{"name":"School of Medicine Tzu Chi University Hualien Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Der\u2010Cherng","family":"Tarng","sequence":"additional","affiliation":[{"name":"Institute of Physiology National Yang\u2010Ming University Taipei Taiwan"},{"name":"Division of Nephrology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ki.5002343"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60952-6"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.12700"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfs469"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001480"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2013.336"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.807362"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2009.159"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2013.06.011"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/85.1.80"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1088\/0967-3334\/29\/5\/009"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03540300056034"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hfc.2005.03.006"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.678342"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfm542"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(96)90357-1"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.03150509"},{"key":"e_1_3_1_19_2","first-page":"1033","article-title":"Raised venous pressure: a direct cause of renal sodium retention in oedema?","volume":"1","author":"Firth JD","year":"1998","unstructured":"Firth JD, Raine AE, Ledingham JG. Raised venous pressure: a direct cause of renal sodium retention in oedema? Lancet. 1998;1:1033\u20131035.","journal-title":"Lancet"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2007060693"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2011040430"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0057511"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2013030285"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2012.406"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1038\/jhh.2009.32"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.1998.274.4.F635"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1038\/nature11984"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2010050536"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1159\/000145453"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.115.001918","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T06:34:37Z","timestamp":1715582077000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.115.001918"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,5]]},"references-count":28,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2015,5]]}},"alternative-id":["10.1161\/JAHA.115.001918"],"URL":"https:\/\/doi.org\/10.1161\/jaha.115.001918","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,5]]},"assertion":[{"value":"2015-02-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-04-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-05-05","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e001918"}}