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We studied the association between extracellular volume status and chronic kidney disease (CKD) progression; and the role of extracellular volume excess as a potential mediator in the relationship between matrix metalloproteinases (MMP)-2 and CKD progression in Type 2 diabetes mellitus (T2DM). We conducted a prospective cohort study of 1079 T2DM patients. Bioelectrical impedance analysis (BIA) was performed to assess body fluid status. After up to 8.6 years of follow-up, 471 (43.7%) patients experienced CKD progression. In the fully adjusted model, extracellular water (ECW)/ total body water (TBW)ratios 0.39-0.40 and > 0.40 were associated with 45% and 78% higher risk of CKD progression respectively. Patients with an increase in ECW/TBW ratio had 40% higher risk of CKD progression compared to those with no change or reduction of ECW/TBW ratio. Higher ECW/TBW ratio accounted for 17.4% of the relationship between MMP-2 and CKD progression in T2DM (p = 0.026). Extracellular volume excess was independently associated with CKD progression in T2DM. Higher ECW/TBW ratio mediated the positive association between MMP-2 and CKD progression. Further studies are needed to elucidate the role of extracellular volume excess in deterioration of renal function. Copyright © 2021 Elsevier Inc. All rights reserved.


Serena Low, Sharon Pek, Yan Lun Liu, Angela Moh, Keven Ang, Wern Ee Tang, Ziliang Lim, Tavintharan Subramaniam, Chee Fang Sum, Chin Leong Lim, Yusuf Ali, Su Chi Lim. Higher extracellular water to total body water ratio was associated with chronic kidney disease progression in type 2 diabetes. Journal of diabetes and its complications. 2021 Jul;35(7):107930

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PMID: 33902998

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