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Abstract: FR-PO814

Association Between Reduction of Extracellular Volume by In-Center Short Daily Hemodialysis and Survival

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Barra, Ana Beatriz Lesqueves, Fresenius Medical Care, Rio de Janeiro, Brazil
  • Silva, Ana Paula Roque da, Fresenius Medical Care, Rio de Janeiro, Brazil
  • D'almeida, Eufronio, Fresenius Medical Care, Rio de Janeiro, Brazil
  • Vasconcelos, Marcos Sandro Fernandes de, Fresenius Medical Care, Rio de Janeiro, Brazil
  • Strogoff-de-Matos, Jorge P., Universidade Federal Fluminense, Niteroi, RIo de Janeiro, Brazil
Background

Overhydration (OH) is associated with a higher mortality risk in maintenance hemodialysis. A better management of OH through daily hemodialysis (DHD) could improve survival.

Methods

Retrospective analysis of patients on hemodialysis 3 sessions/week for >3 months who shifted to in-center short DHD (≥ 5 sessions / week) between 2012 and 2016 at 23 dialysis units in Brazil. Hydration status was evaluated before and 6 months after initiating DHD by bioimpedance spectroscopy. Pre-dialysis hydration state was considered adequate when OH ≤15% of extracellular volume. For survival analysis, data were censored 2 years after initiating DHD.

Results

A total of 208 patients were included in the analysis (56±16 years old, 64% males, 38% diabetics, 56% on dialysis 6 sessions/week, treatment time was 12.5±1.8 h/week. After 6 months on DHD, 177 patients were re-evaluated. OH was reduced from 13.9% (IQR 5.4 – 22.3%) to 8.9% (IQR 0.4 – 15.9%), P<0.0001, the rate of patients with OH>15% dropped from 47% to 29% (P= 0.0005) and pre-dialysis systolic blood pressure fell from 139±21 mmHg to 134±21 mmHg (P= 0.029).
The 2-year survival rate was 76%, with no difference according to the OH status before DHD initiation (P= 0.92). However, survival was higher for patients reached OH ≤15% after the beginning of DHD than those with OH >15% (83% vs. 70%; P= 0.02). In a Cox regression model, after adjustment for demographic, clinical and laboratory variables, OH ≤15% persisted associated with a lower mortality risk (hazard ratio 0.40 [95% confidence interval 0.18 – 0.90]).

Conclusion

Moving from standard hemodialysis to short DHD was associated with a better control of excessive extracellular volume and blood pressure. Patients who reached OH ≤15% after initiating DHD presented a lower risk of death.