Ultrafiltration Rate, Residual Kidney Function, and Survival Among Patients Treated With Reduced-Frequency Hemodialysis.
- Lee YJ
American journal of kidney diseases : the official journal of the National Kidney Foundation[Am J Kidney Dis] 2020 Mar; Vol. 75 (3), pp. 342-350. Date of Electronic Publication: 2019 Dec 06.
- Publication Date:
- Rationale & Objective: Patients receiving twice-weekly or less-frequent hemodialysis (HD) may need to undergo higher ultrafiltration rates (UFRs) to maintain acceptable fluid balance. We hypothesized that higher UFRs are associated with faster decline in residual kidney function (RKF) and a higher rate of mortality.
Study Design: Retrospective cohort study.
Setting & Participants: 1,524 patients with kidney failure who initiated maintenance HD at a frequency of twice or less per week for at least 6 consecutive weeks at some time between 2007 and 2011 and for whom baseline data for UFR and renal urea clearance were available.
Predictor: Average UFR during the first patient-quarter during less-frequent HD (<6, 6-<10, 10-<13, and≥13mL/h/kg).
Outcome: Time to all-cause and cardiovascular death, slope of decline in RKF during the first year after initiation of less-frequent HD (with slopes above the median categorized as rapid decline).
Analytical Approach: Cox proportional hazards regression for time to death and logistic regression for the analysis of rapid decline in RKF.
Results: Among 1,524 patients, higher UFR was associated with higher all-cause mortality; HRs were 1.43 (95% CI, 1.09-1.88), 1.51 (95% CI, 1.08-2.10), and 1.76 (95% CI, 1.23-2.53) for UFR of 6 to<10, 10 to<13, and≥13mL/h/kg, respectively (reference: UFR < 6mL/h/kg). Higher UFR was also associated with higher cardiovascular mortality. Baseline RKF modified the association between UFR and mortality; the association was attenuated among patients with renal urea clearance≥5mL/min/1.73m 2 . Higher UFR had a graded association with rapid decline in RKF; ORs were 1.73 (95% CI, 1.18-2.55), 1.89 (95% CI, 1.12-3.17), and 2.75 (95% CI, 1.46-5.18) at UFRs of 6 to<10, 10 to<13, and≥13mL/h/kg, respectively (reference: UFR < 6mL/h/kg).
Limitations: Residual confounding from unobserved differences across exposure categories.
Conclusions: Higher UFR was associated with worse outcomes, including shorter survival and more rapid loss of RKF, among patients receiving regular HD treatments at a frequency of twice or less per week.
(Published by Elsevier Inc.)
Cause of Death trends
Kidney Failure, Chronic mortality
Kidney Failure, Chronic physiopathology
Survival Rate trends
United States epidemiology
Glomerular Filtration Rate physiology
Kidney Failure, Chronic therapy
Renal Dialysis methods
Ultrafiltration statistics numerical data
- Academic Journal
- American journal of kidney diseases : the official journal of the National Kidney Foundation
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