Abstract: FR-PO817
Intradialytic Relative Blood Volume Changes and All-Cause Mortality Among Hemodialysis Patients
Session Information
- Dialysis: Hospitalization and Mortality
October 26, 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
- 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
- Kooman, Jeroen, Maastricht University Medical Centre, Maastricht, Netherlands
- van der Sande, Frank, Maastricht University Medical Centre, Maastricht, Netherlands
- Kotanko, Peter, Renal Research Institute, New York, New York, United States
Background
Adequate volume control is a major challenge in hemodialysis (HD) patients, as both fluid overload and depletion are associated with increased mortality. Ultrafiltration is the only means for fluid removal in anephric patients. Whenever the ultrafiltration rate (UFR) exceeds the plasma refilling rate, the blood volume declines and hypotension may ensue. Relative blood volume (RBV) monitoring during HD is used as a means to tailor UFR. Our goal was to explore the association between intradialytic RBV levels and all-cause mortality in maintenance HD patients
Methods
We conducted a retrospective analysis of data from HD patients dialyzed in 17 Renal Research Institute clinics between 1/2012 and 12/2016. A 6-months baseline period preceded a follow-up. Censoring events were change in treatment modality, transfer to another clinic, and study end. RBV was measured using the Critline monitor. RBV was assessed after 25%, 50%, 75% and 100% of the elapsed treatment time. The relationship between mortality and RBV at these four time points was analyzed using Cox proportional hazards models with spline terms
Results
We studied 842 patients with a total of 28,119 HD treatments (mean age 61.0±14.8 years, 50% whites, 62% males, 56% had diabetes mellitus, 22% had congestive heart failure). Median follow-up time was 30.8 months. The mortality rate was 11.5/100 patient years. We identified specific intradialytic RBV levels after 25%, 50%, 75% and 100% of the elapsed dialysis treatment time that were associated with a significantly lower all-cause mortality [Fig 1].
Conclusion
We showed in a large cohort of HD patients that specific RBV levels are associated with better outcomes. These findings corroborate the notion that RBV monitoring has the potential to improve outcomes. Prospective studies are warranted to explore if active attainment of these RBV levels translates into improved patient outcomes.
Fig 1. Intradialytic RBV ranges associated with hazard ratios significantly below 1.0 for all-cause mortality.