Kidney Week

Abstract: TH-OR094

Association of Ultrafiltration Rate and Decline in Residual Kidney Function among Thrice-Weekly Hemodialysis Patients

Session Information

• Outcomes and Trends in Dialysis
  October 25, 2018 | Location: 2, San Diego Convention Center
  Abstract Time: 05:06 PM - 05:18 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, MD, PhD

• 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,

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

Jason Albert Chou,

• 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,

• 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,

Background

The association between ultrafiltration rate (UFR) and decline in residual kidney function (RKF) has not been well examined in conventional hemodialysis (HD) patients with RKF.

Methods

We retrospectively reviewed a cohort of 7,753 patients who initiated thrice-weekly HD from 2007 to 2011, had available UFR and renal urea clearance (KRU) data at baseline, and had KRU data at 1 year after HD initiation. Patients were categorized into 4 UFR groups (<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

Mean ± SD UFR level was 7.0 ± 3.1 mL/h/kg. Median (interquartile range) baseline KRU was 3.5 (2.1 – 5.3) mL/min/1.72m². Mean annual changes of KRU were -1.1, -1.2, -1.4, and -1.6 mL/min/1.73m² in UFR <6, 6 to <10, 10 to <13, and ≥13 mL/h/kg groups, respectively (P = 0.004). In a cubic spline model, higher UFR was associated with increased risk for rapid decline in KRU [figure 1A]. Additionally, we found a graded association between categorized UFR and rapid decline of RKF in the fully adjusted multivariable regression models: odds ratios (95% confidence intervals) were 0.80 (0.72-0.88), 1.33 (1.14-1.57), and 1.39 (1.08-1.80) in UFR <6, 10 to <13, and ≥13 mL/h/kg groups, respectively (reference: UFR 6 to <10 mL/h/kg) [figure 1B].

Conclusion

In incident thrice-weekly HD, higher UFR was associated with rapid decline in RKF. Strategies to avoid high UFR may be useful for RKF preservation in incident HD patients.

Funding

• NIDDK Support