Kidney Week

Abstract: TH-PO337

Effects of Ultrafiltration Rate on Decline in Residual Kidney Function Among Patients Receiving Less-Frequent Hemodialysis

Session Information

• Dialysis: Dialysate and Clearance
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Lee, Yuji, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Yuji Lee,

• Okuda, Yusuke, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Yusuke Okuda,

• Obi, Yoshitsugu, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Yoshitsugu Obi,

• Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Connie Rhee,

• Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Elani Streja,

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

Csaba P. Kovesdy,

• Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Kamyar Kalantar-Zadeh,

Background

High ultrafiltration rate (UFR) may lead to poor preservation of residual kindey function (RKF) by causing hemodynamic instability. However, there are no data about the association between UFR and decline in RKF in patients receiving less-frequent hemodialysis (HD).

Methods

This study included the patients who started less-frequent HD from 2007 to 2011 and had available UFR and renal urea clearance (KRU) data at baseline and KRU data at 1 year after less-frequent HD initiation. Less-frequent HD was defined as dialysis with a consistent treatment schedule of <3 times per week for 6 or more continuous weeks. Patients were grouped into 4 UFR categories (<6, 6 to <10, 10 to <13, and ≥13 mL/h/kg). We defined rapid decline in RKF as a decline in KRU of more than 20% per year. We explored the association between UFR and rapid decline in RKF using logistic regression models with adjustments for case-mix variables, baseline RKF, and maximal change of blood pressure during dialysis.

Results

Among eligible patients, mean (SD) UFR level was 7.0 (4.7) mL/h/kg. Median (interquartile range) baseline KRU was 5.6 (3.6 – 7.7) mL/min/1.72m². In adjusted cubic spline models, we found a nonlinear association between higher UFR and the risk for rapid decline in KRU. In an adjusted logistic regression analysis, UFR ≥13 mL/h/kg had a 2.1-fold higher risk of rapid decline in RKF compared to UFR of 6 to <10 mL/h/kg (odds ratio (OR) and 95% confidence intervals (CI): 2.09 (1.14 – 3.82)). In subgroup analyses based on vintage, the association between UFR and decline of KRU was attenuated in patients who started less-frequent HD more than 6 months after dialysis initiation [Figure 1].

Conclusion

High UFR increased the risk for rapid decline in RKF among patients receiving less-frequent HD.

Funding

• NIDDK Support