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Abstract: FR-OR24

Ultrafiltration Rate and Mortality in Hemodialysis: The Dialysis Outcomes and Practice Patterns Study (DOPPS)

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Flanagin, Erin, Tufts Medical Center, Boston, Massachusetts, United States
  • Lopes, Marcelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • McCullough, Keith, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Port, Friedrich K., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Hartman, John, Visonex, Green Bay, Wisconsin, United States
  • Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Schaeffner, Elke, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Nitta, Kosaku, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Vega, Almudena, Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
  • Young, Eric W., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background

Fluid management is an essential component of hemodialysis (HD) practice. Both insufficient fluid removal and rapid ultrafiltration rate (UFR) are associated with higher cardiovascular and all-cause mortality risk, particularly in US populations, but it is uncertain whether adhering to a single UFR limit will mitigate this risk.

Methods

This retrospective cohort study includes 47,640 adult in-center HD patients from phases 4-6 of DOPPS (2009-2018) from the US, Japan, Australia, New Zealand, Russia, 7 European and 6 GCC countries. Mean UFR was calculated over one week occurring during the first four-month DOPPS data collection interval. Follow-up for all-cause mortality began after this interval. Risk was estimated using Cox models adjusting for DOPPS phase, country, years on dialysis, age, sex, race, 7 comorbidities, body mass index (BMI), catheter use, 5 labs, Kt/V, residual urine volume, and pre-HD session systolic BP.

Results

Mean UFR for the entire cohort was 8.3 (SD 3.8) ml/hr/kg and median follow up time was 1.3 (IQR 0.7-2.3) years. In adjusted analyses, compared to patients with mean UFR of 7 to <10 ml/hr/kg, those with higher UFR had greater risk of mortality: HR 1.09 (95% CI 1.03-1.17) for UFR 10 to <13 ml/hr/kg, HR 1.21 (1.09-1.33) for UFR of 13 to <15 ml/hr/kg, and HR 1.38 (1.24-1.55) for UFR >15 ml/hr/kg). Higher UFR was associated with a greater mortality risk for patients with higher weight or BMI (p-value <0.001 for both). DOPPS region did not modify the relationship between UFR and mortality despite differences in patient characteristics and HD practices across regions (p-value 0.67).

Conclusion

In a large international cohort, higher mean UFR, was associated with an increased risk of mortality. Patients with higher weight or BMI have a greater mortality risk from higher UFR, suggesting that a single UFR threshold to identify risk may not be equally beneficial for all patients.

Funding

  • Commercial Support