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Abstract: TH-PO229

Higher Dialysis Dose and Less Intradialytic Hypotension Are Associated with Improvements in Longitudinal Changes in Dialysis Recovery Time

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Guedes, Murilo Henrique, Pontificia Universidade Catolica do Parana, Curitiba, Brazil
  • Pecoits-Filho, Roberto, Pontificia Universidade Catolica do Parana, Curitiba, Brazil
  • Leme, Juliana El ghoz, Pontificia Universidade Catolica do Parana, Curitiba, Brazil
  • Jiao, Yue, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Raimann, Jochen G., Renal Research Institute , New York, New York, United States
  • Wang, Yuedong, University of California - Santa Barbara, Santa Barbara, California, United States
  • Kotanko, Peter, Renal Research Institute , New York, New York, United States
  • Moraes, Thyago Proença de, Pontificia Universidade Catolica do Parana, Curitiba, Brazil
  • Thadhani, Ravi I., Cedars-Sinai, Los Angeles, California, United States
  • Maddux, Franklin W., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Usvyat, Len A., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Larkin, John W., Fresenius Medical Care North America, Waltham, United States
Background

We studied if higher hemodialysis (HD) dose and less intradialytic hypotension (IDH) would associate with longitudinal improvements in dialysis recovery time (DRT).

Methods

We used data from adult HD patients at a large dialysis organization who responded to DRT survey ≤180 days from first date of dialysis (FDD) during 2014 to 2017. DRT survey asks: “How long does it take you to be able to return to your normal activities after your dialysis treatment?”. Answers are: <0.5, 0.5-1, 1-2, 2-4, or >4 hours. A logistic regression model computed odds ratio for increased/maintained longer DRT (increase above DRT >2 hours) in reference to decreased/maintained shorter DRT (decrease below DRT <2 hours, or from DRT >4 hours). Changes in DRT were calculated from incident (≤180 days FDD) to prevalent (>365-to-≤545 days FDD) year. Model included/adjusted for incident DRT, age, comorbidities, HD with IDH episodes/month, Kt/V, and HD start before/after 1200 hours.

Results

Among 98616 incident HD patients (age 62.6±14.4 years), higher incident spKt/V associated with 13.5% (OR=0.865; 95%CI 0.801-to-0.935) lower odds of increased/maintained longer DRT in the prevalent year (Figure 1). A higher incident number of HD sessions with IDH episodes/month and change to a higher number associated with 0.8% (OR=1.008; 95%CI 1.001-to-1.015) and 2.2% (OR=1.022 ;95%CI 1.015-to-1.028) higher odds of increased/maintained longer DRT in the prevalent year, respectively.

Conclusion

Incident patients who had higher spKt/V with a low number of HD sessions with IDH episodes had a lower likelihood of increased/maintained longer DRT in first year of HD. Dose optimization strategies with cardiac stability in fluid removal should be tested.

Funding

  • Commercial Support