ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO2517

Could Targeting Dry Weight on Hemodialysis Patients Before Kidney Transplantation Leave Them Too Dry?

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Al Dohani, Hayam Hamed, Queen's University, Kingston, Ontario, Canada
  • Iliescu, Eduard A., Queen's University, Kingston, Ontario, Canada
  • Macleod, Frances, Kingston Health Sciences Centre, Kingston, Ontario, Canada
  • Shamseddin, M. Khaled, Queen's University, Kingston, Ontario, Canada
Background

Delayed graft function (DGF) after kidney transplantation is associated with inferior kidney and patient outcomes. Studies suggest that avoidance of hypovolemia peri-kidney transplantation is associated with a reduced risk of DGF. Hemodialysis (HD) patients that have HD prior to transplant targeting their usual dry weight may be volume contracted pre-transplant and at increased risk for DGF. By definition the dry weight is the state of near maximal volume contraction for most HD patients. The objective of this study is to examine the proportion of HD patients who have a pre-transplant post-HD weight at or below their usual dry weight.

Methods

This is a retrospective study of sequential kidney transplants in HD patients at our center from Jan 2015 to Dec 2019. The primary outcome was the proportion of patients who had an HD session before transplantation that resulted in a post-HD weight equal to or less than their prevalent set target dry weight. Data was extracted from the electronic medical record and chart review. Recipients on home therapies and pre-emptive transplants were excluded.

Results

Of 68 kidney transplants done in the study period, 40 were in-center HD patients with available HD data. They were mean age 54.8±14.5 years, 12 (30%) female, and majority were Caucasian. Twenty-five (62.5%) patients had a pre-transplant post-HD weight equal to or less than their prevalent set target dry weight (mean - 0.26±0.25 kg). The other 15 (37.5%) patients achieved post-HD weights higher than their usual targets (+0.72±0.41 Kg).

Conclusion

The results of this study suggest that a high proportion of HD patients are at below dry weight after their dialysis and may be hypovolemic before kidney transplantation. This may represent at potentially avoidable increased risk for DGF. Further studies are planned to examine possible associations of achieved post-HD weight prior to transplant with perioperative central venous pressure, IV fluid administration, and graft function. There may be strategies to optimize volume status pre-transplantation to mitigate this risk of DGF including targeting a higher weight on HD or administration of IV fluid to raise weight above the prevalent set target dry weight before transplantation when feasible.