Higher admission ePVS (Q3/Q4) is independently associated with CKM2-to-CKM4 progression and may serve as a noninvasive risk biomarker particularly in older high-risk populations, though external cohort validation is required before clinical application.
Over 10 years of follow-up, 15,495 of 36,505 hospitalized CKM stage 2 patients in the TJHFIT cohort progressed to CKM stage 4.
Patients who progressed to CKM4 had significantly higher admission and discharge ePVS than controls.
In quartile analyses of admission ePVS, elevated CKM4 progression risk was independent only in the upper strata (Q3 and Q4), with no significant risk in Q2.
For discharge ePVS, a significant risk signal for CKM4 progression emerged starting from Q2.
The highest admission ePVS quartile was associated with 43% higher risk of CKM4, 88% higher risk of CKM4b, and 76% higher risk of heart failure versus Q1.
Restricted cubic spline analysis showed a spoon-shaped nonlinear association between admission ePVS and CKM4, with an inflection point at approximately 5.14.
The association between ePVS and CKM4 progression was stronger in patients older than 60 years.
The authors conclude external validation is needed before clinical application of ePVS for CKM risk assessment.
This study looked at whether a simple blood-based measure called estimated plasma volume status (ePVS), which reflects how much fluid is in the bloodstream, relates to worsening of cardiovascular-kidney-metabolic (CKM) syndrome. The researchers followed 36,505 hospitalized people in Tianjin, China, who had stage 2 CKM syndrome, for up to 10 years. About 15,495 of them progressed to stage 4, the most advanced stage, which includes cardiovascular disease. People who progressed had higher ePVS values at admission and discharge. Those in the highest admission ePVS group had about 43% higher risk of reaching stage 4, 88% higher risk of one stage 4 subtype (CKM4b), and 76% higher risk of heart failure than those in the lowest group. The relationship was not a straight line, with a turning point around an ePVS of 5.14, and it appeared stronger in people older than 60. This research suggests ePVS, which can be calculated from routine blood tests, might help identify people at higher risk of CKM progression, especially older adults. However, the study was in hospitalized patients from one region, and the authors say the findings need to be confirmed in other groups before ePVS is used in clinical practice.
Huang L, Luo X, Ou X, Liu Y, Zhang L, Xu Q. (2026). Association of estimated plasma volume status with progression from stage 2 to stage 4 cardiovascular-kidney-metabolic syndrome: a cohort from the Tianjin region of China.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1959815