Kidney Week

Abstract: SA-OR034

Residual Kidney Function and Ultrafiltration Rate: Their Association with Mortality

Session Information

• Non-Cardiovascular Outcomes in Hemodialysis
  November 04, 2017 | Location: Room 292, Morial Convention Center
  Abstract Time: 05:06 PM - 05:18 PM

Category: Dialysis

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

Authors

• Chou, Jason Albert, UC Irvine, Orange, California, United States

Jason Albert Chou, MD

• Obi, Yoshitsugu, UC Irvine, Orange, California, United States

Yoshitsugu Obi,

• Rhee, Connie, UC Irvine, Orange, California, United States

Connie Rhee,

• Streja, Elani, UC Irvine, Orange, California, United States

Elani Streja,

• Nguyen, Danh V., UC Irvine, Orange, California, United States

Danh V. Nguyen,

• Soohoo, Melissa, UC Irvine, Orange, California, United States

Melissa Soohoo,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Sim, John J., Kaiser Permanente Southern California, Pasadena, California, United States

John J. Sim,

• Kalantar-Zadeh, Kamyar, UC Irvine, Orange, California, United States

Kamyar Kalantar-Zadeh,

Background

Residual kidney function (RKF) among both peritoneal dialysis and hemodialysis (HD) patients has been associated with improved survival. Although faster ultrafiltration rates (UFR) with HD have been observed to have greater mortality risk among incident HD patients with RKF, the ideal UFR goals are unknown. We hypothesize that in incident HD patients with RKF, a lower UFR will have improved survival.

Methods

We examined the association of RKF measured as Kru (mL/min/1.73m²) and UFR (mL/kg/hr) in combined groups with 1- and 5-year all-cause mortality in a cohort of 34,546 incident HD patients with Cox regression models adjusted for case-mix, comorbidities and selected lab covariates. A total of 9 groups were analyzed, composed of the following groups: Kru <1.5, 1.5-<3.0 and ≥3.0 mL/min/1.73m² and UFR <6, 6-<10, and ≥10 mL/kg/hr with reference group of Kru ≥3.0 and UFR 6-<10.

Results

We found that Kru-UFR groups with a higher Kru and lower UFR demonstrated a graded association with survival where the Kru ≥3.0 mL/min/1.73m² and UFR <6 ml/kg/hr group had a 1 year mortality HR (CI 95%) of 0.83 (0.74-0.93) (p-for-interaction 0.002) in the fully adjusted model. All associations were robust to all levels of adjustment on both 1- and 5- year mortality outcomes.

Conclusion

Among incident HD patients with RKF, lower UFR rates were associated with improved survival. Targeting different UFR goals may be a focus of intervention given its potential impact on RKF and mortality.

Figure

Funding

• NIDDK Support