Abstract: TH-PO354
An Online Ultrafiltration Rate Calculator to Empower Home HD Patients
Session Information
- Vascular Access - I
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Hemodialysis
Authors
- Agar, John W. MacD., University Hospital Geelong, Geelong, Victoria, Australia
- Schatell, Dorian R., Medical Education Institute, Madison, Wisconsin, United States
Background
Despite a 3 decade solute clearance focus, hemodialysis (HD) outcomes correlate more closely with volume factors, especially the rate of change of blood volume. A high ultrafiltration rate (UFR) induces hypotension, hypoperfusion, and functional organ stunning.(1) Thus, a low sessional UFR is critical for circulatory stability. As salt and fluid restriction often manifestly fail to limit interdialytic weight gain, HD sessional duration becomes the governing variable to assure a low, safe UFR. While the ideal safe mean maximum per treatment UFR remains in debate, clinical risk increases as the UFR exceeds 6-8 ml/kg/hr, (2) although US guidelines currently recommend a UFR <13ml/kg/hr. Since home HD (HHD) patients can self-adjust their treatment time to ensure a low UFR, we devised an on-line UFR calculator to display the impact of UFR and encourage patients to safely use this flexibility.
Methods
Using the interdialytic weight gain (IDWG), pre-dialysis weight (pre-DW), and intended upcoming treatment time (t), the mean treatment UFR (ml/kg/hr) can be calculated by UFR = (IDWG ÷ pre-DW) ÷ t. This (1) informs impending treatment UFR safety and (2) allows treatment time adjustment to the desired UFR maximum. On-line since 2/2017, an open-access calculator https://www.homedialysis.org/ufr-calculator on the Home Dialysis Central website has facilitated UFR (ml/kg/hr) and 't' flexibility. We have interrogated the site analytics for patterns of use.
Results
Key data (25/2/2016 - 5/5/2019) are shown (attached diagram: Analytics Overview). Rising through 2017–2018, regular use has stabilised in 2019 at 2000–2250 pageviews/week and 0.36 minutes/view. User feedback is uniformly positive. Many HHD patients now routinely use the calculator to adjust their upcoming sessional duration.
Conclusion
HHD patients and professionals can now be empowered to regulate the UFR by durational adjustments based on the UFR calculator. The calculator encourages and empowers flexibility in treatment time and a safer, gentler rate of volume change.
McIntye et al: CJASN 2016; 11(4):549-551
Charra et al: Blood Purif 2017; 44:89-97
Analytics Overview