Abstract: FR-PO786

Relative Blood Volume Changes and Mortality among Hemodialysis Patients

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Preciado, Priscila, Renal Research Institute, New York, New York, United States
  • Zhang, Hanjie, Renal Research Institute, New York, New York, United States
  • Thijssen, Stephan, Renal Research Institute, New York, New York, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
Background

Ultrafiltration during hemodialysis (HD) is the only means to remove excess fluid.In most HD sessions the ultrafiltration rate exceeds the refilling rate (UFR),leading to decreased blood volume and potentially intradialytic hypotension and increased morbidity.While relative blood volume (RBV) monitoring is widely used,the relationship between RBV levels and outcomes is ill-defined

Methods

Retrospective multi-center study in HD patients from 17 Renal Research Institute (RRI) clinics between 1/2012-12/2016.A 6-months baseline period preceded follow-up period.Hematocrit-based RBV was reported 1x/minute by the Crit-Line® Monitor (CLM;Fresenius Medical Care,Waltham,MA).Hourly RBV levels were defined as the mean RBV between treatment minutes 50 and 70,110 and 130, and 170 and 190.The relationship between mortality and hourly RBV levels was analyzed using Cox proportional hazards models with spline terms

Results

We included 842 patients with 28,119 HD treatments (mean age 61.0±14.8 years,50% whites,62% males,56% diabetes mellitus,22% congestive heart failure).Median follow-up was 2.7 years.Hazard ratios for all-cause mortality were significantly reduced in patients who achieved RBV levels [%] of 93-96 at 1 hour, 89-94 at 2 hours,and 86-92 at 3 hours.Subgroup analysis by age,gender,race,comorbidities,pre-HD blood pressure,and UFR showed similar results

Conclusion

To our knowledge this is the first study to examine the relationship between achieved intradialytic RBV levels and all-cause mortality in a large and diverse HD population.Our key finding is the association of specific RBV levels with reduced mortality.Prospective studies are warranted to test the hypothesis that attainment of these levels improve outcomes

Fig 1 Spline analysis of hazard ratio for all-cause mortality as a function of RBV after 1, 2, and 3 hours