Abstract: FR-PO890

Ultrafiltration Profiling: Association with Clinical Outcomes among Incident Dialysis Patients

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Sibbel, Scott, DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Walker, Adam G, DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Brunelli, Steven M., DaVita Clinical Research, Minneapolis, Minnesota, United States
Background

Ultrafiltration (UF) profiling is the practice of varying the UF rate during dialysis in order to mitigate the consequences of decreased effective circulating volume. In practice, UF profiling may be used on a standing basis, a PRN basis, or not at all. We conducted parallel matched analyses comparing standing UF profiling to PRN UF profiling and to no profiling.

Methods

We considered all incident hemodialysis patients at a large dialysis organization (Jan 2010-Jun 2015). We identified all patients who received a first-ever order for standing UF profiling. We considered eligible controls of two types: PRN profile patients, who initiated a first-ever order for UF profiling on a PRN basis in the same vintage month; and patients who had not used UF profiling through the same vintage month. Each standing UF profile patient was matched (separately) to an eligible control of each type based on race and Charlson comorbidity index score using intention-to-treat methods. Rates of death, all-cause hospitalizations, missed dialysis treatments, and episodes of intradialytic hypotension (IDH) were assessed over the subsequent 12 months on an intention-to-treat basis.

Results

No UF profiling (vs standing UF profiling) was associated with lower rates of IDH and hospitalization, but indistinguishable rates of death and missed treatments. PRN UF profiling (vs standing UF profiling) was associated with lower rates of IDH, but higher rates of hospitalization and missed treatments; no difference in death rate was observed.

Conclusion

We did not detect a benefit of standing vs no UF profiling, nor evidence to suggest that PRN UF profiling is superior to standing UF profiling. These data call into question the rationale underlying commonplace use of UF profiling in clinical practice.

Funding

  • Commercial Support