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Kidney Week

Abstract: FR-PO789

The Interdialytic Creatinine Rise Is a Novel Marker of Volume Overload and Mortality Risk in Hemodialysis Patients

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Ilic, Ljubomir M., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Brown, Robert S., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Davis, Roger B., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Lecker, Stewart H., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Background

Volume overload is a major contributor to morbidity and mortality in maintenance hemodialysis (HD) patients. Since serum creatinine increases between HD treatments, we theorized that the Interdialytic Creatinine Rise (IDCR), a change dependent upon net creatinine retention and dilution by fluid intake, might be used to evaluate volume overload and predict patient mortality. IDCR is calculated using two serum creatinine values from the same interdialytic period obtained at least 18h apart.

Methods

Three analyses were undertaken. A prospective cohort of 47 maintenance HD patients admitted to our hospital had IDCRs measured serially over a period of one week. IDCR change with time and after HD sessions were analyzed using mixed effects model. A prospective cohort of 25 outpatient maintenance HD patients was followed for 2 weeks with determination of the sensitivity and specificity of different IDCR cutoff values using patient volume assessments by their nephrologist as the gold standard. A retrospective cohort of 39 maintenance HD patients was studied longitudinally during inpatient admissions from 2012 until 2017 or death. The data were analyzed using Cox proportional hazards model with IDCR as a time varying covariate. In the same cohort, mixed effects logistic regression was used to correlate IDCR with mortality risk.

Results

IDCR decreases, changing by −0.014 per day without HD (95%CI −0.017, −0.010; p<0.001) due to volume gain. IDCR increases by 0.013 from before to after each successive hemodialysis session (95%CI 0.008, 0.017; p<0.001) due to fluid removal by ultrafiltration. An IDCR cutoff value of ≤ 0.1 mg/dL/h has a sensitivity of 82 %, specificity of 79 %, and accuracy of 80 % in diagnosing volume overload with AUC of ROC curve = 0.78 (95%CI 0.59, 0.97). The hazard ratio of death for each 0.01 mg/dL/h decrease in IDCR is 1.64 (95%CI 1.31, 2.07; p<0.001). If IDCR decreases to less than 0.05 mg/dL/h, the odds ratio of death within 2 months is 38 (95%CI 8, 131; p<0.001).

Conclusion

IDCR decreases with volume retention, can help detect volume overload, and has excellent prognostic value in identifying HD patients who are at high risk of dying over the following 60 days.