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Abstract: TH-PO198

Decline in Hemodialysis Ultrafiltration Rate (UFR), 2012-2018

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Young, Eric W., Arbor Research, Ann Arbor, Michigan, United States
  • Wang, Dongyu, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Pearson, Jeffrey, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Kapke, Alissa, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Houseal, Delia, Centers for Medicare and Medicaid Services, Woodlawn, Maryland, United States
  • Szymanski, Amanda, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Turenne, Marc, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Leichtman, Alan B., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background

UFR has received heightened attention due in part to several observational studies that reported higher mortality at UFRs above 10 to 13 ml/kg/hour. Several organizations have proposed quality measures to discourage high UFR. We examined national UFR trends for US patients.

Methods

We evaluated trends in UFR and its components (pre- and post-dialysis weight, dialysis session time) from 2012-18 as reported by dialysis facilities through the CROWNWeb system. Medicare-certified dialysis facilities began reporting UFR data for the last hemodialysis session of each month in 2012, and for a full week of sessions in 2018 in accordance with the ESRD Quality Incentive Program.

Results

Data for monthly UFR were submitted for 88-98% of patients. Average UFR declined steadily from 9.3 to 7.8 ml/hour/kg between 2012 and 2018. The percent of dialysis sessions with a UFR>13 ml/kg/hour declined from 19% to 10%. The percent of dialysis sessions with a UFR>10 ml/kg/hour fell from 39% to 26%. The decline in UFR was largely driven by interdialytic weight gain, which fell from approximately 3.3% to 2.8% of body weight (~2.6 to 2.2 kg). Dialysis treatment time and patient weight trended upward, but these made a relatively small contribution to the decline in average UFR.

Conclusion

The average UFR has declined from 2012 to 2018, largely driven by lower interdialytic weight gain. One possible explanation is that dialysis facilities provide patients with better education about fluid and dietary intake and patients follow such advice more carefully. However, we believe a more likely explanation comes from other studies reporting a secular decline in the average dialysate sodium concentration, which suppresses thirst and fluid intake. Although the strength of current evidence has not supported specific UFR guidelines, the changes responsible for the declining UFR were potentially motivated by published studies and expectations of forthcoming guidelines and incentives related to UFR management.

Patients with UFR ≥ 13 and 10 mL/kg/hour, 2012-2018

Funding

  • Other U.S. Government Support