Kidney Week

Abstract: TH-PO288

Interactions Between Intradialytic Central Venous Oxygen Saturation, Ultrafiltration Rate, and All-Cause Mortality in Maintenance Hemodialysis Patients

Session Information

• Hemodialysis: Volume, Metabolic Complications, Clinical Outcomes
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Zhang, Hanjie, Renal Research Institute, New York, New York, United States

Hanjie Zhang,

• Preciado, Priscila, Renal Research Institute, New York, New York, United States

Priscila Preciado,

• Rosales M., Laura, Renal Research Institute, New York, New York, United States

Laura Rosales M.,

• Kooman, Jeroen, Maastricht University Medical Center, Maastricht, Netherlands

Jeroen Kooman,

• van der Sande, Frank, Maastricht University Medical Center, Maastricht, Netherlands

Frank van der Sande,

• Kotanko, Peter, Renal Research Institute, New York, New York, United States

Peter Kotanko,

Background

In hemodialysis patients, low central venous oxygen saturation (ScvO₂) and high ultrafiltration rate (UFR) have been associated with adverse outcomes. Here we explore the interactions between ScvO₂ and UFR in relation to all-cause mortality.

Methods

We conducted a retrospective study in maintenance hemodialysis patients with central venous catheters as vascular access. During a 6-month baseline period, Crit-Line (Fresenius Medical Care, Waltham, MA) was used to measure continuously intradialytic ScvO₂. We defined four groups by median ScvO₂ and median UFR. The follow-up period was 3 years. We constructed a Cox proportional hazards model with adjustment for age, diabetes, and dialysis vintage to assess the association between ScvO₂ and UFR and all-cause mortality during follow-up.

Results

Baseline comprised 5,231 dialysis sessions in 216 patients. The median ScvO₂ was 58.8% and median UFR was 6.8 mL/kg/h. During follow-up, 44 patients (20.4%) died. Kaplan-Meier analysis (Figure 1A) showed that worst survival was observed in patients with lower ScvO2 combined with higher UFR (group 4). The same result was observed in univariate Cox analysis. In multivariate analysis with adjustment for age, diabetes, and vintage, this association was mitigated (Figure 1 B).

Conclusion

Intradialytic ScvO₂ is an important effect modifier that should be considered when interpreting the relationship between UFR and outcomes. In patients with higher intradialytic ScvO₂, high UFR may be better tolerated, and fluid overload can be prevented easier while imposing high UFR in patients with low intradialytic ScvO₂ may lead to worse outcomes.

Figure 1A.
Kaplan-Meier analysis of survival probabilities in the four subgroups of patients based on the level of ScvO₂ and UFR above and below the median of 58.8% and 6.8 mL/kg/h, respectively.
Figure 1B.
Crude and adjusted hazard ratios (HR) for all-cause mortality associated with ScvO₂ and UFR levels below or above the median population. CI, confidence interval.

Funding

• Commercial Support – Renal Research Institute