Effect of Dialysis Dose and Membrane Flux in Maintenance Hemodialysis

2002 ◽  
Vol 347 (25) ◽  
pp. 2010-2019 ◽  
Author(s):  
Garabed Eknoyan ◽  
Gerald J. Beck ◽  
Alfred K. Cheung ◽  
John T. Daugirdas ◽  
Tom Greene ◽  
...  
Keyword(s):  
Maintenance Hemodialysis ◽  
Dialysis Dose ◽  
Membrane Flux

scholarly journals O10 Effect of hemodialysis dose (spKt/V) on survival in patients on maintenance hemodialysis since childhood – a retrospective analysis

2019 ◽  
Vol 104 (6) ◽  
pp. e4.3-e5
Author(s):  
V Gotta ◽  
A Atkinson ◽  
O Marsenic ◽  
M Pfister
Keyword(s):  
Retrospective Analysis ◽  
Rank Test ◽  
Maintenance Hemodialysis ◽  
Nephrol Dial Transplant ◽  
List Type ◽  
Dialysis Dose ◽  
Term Survival ◽  
Kaplan Meier ◽  
Urea Distribution Volume

BackgroundHemodialysis (HD) prescription significantly differs between pediatric and adult patients on maintenance HD, resulting in greater difference between prescribed and delivered HD dose.1,2 HD dose targets have formally not been evaluated for children, hence targets are mainly derived from adults (spKt/V >1.4; sp: single-pool model of urea distribution, K: urea clearance, t: duration of HD session, V: urea distribution volume). This analysis aimed to evaluate the relationship between delivered dialysis dose and survival in a large cohort of patients having started HD therapy in childhood.MethodsThis retrospective analysis included a cohort of patients < 30 years (y) on chronic HD treatment since childhood, having received thrice-weekly HD between 2004 and 2016 in outpatient DaVita dialysis centers. Survival while on HD (death from any cause) was investigated using Kaplan-Meier analysis stratified by age at start of HD (0–2, >2–6, >6–12, and >12–18 y), and three mean delivered dialysis dose levels (spKt/V < 1.4, 1.4–1.6, >1.6). Survival curves between subgroups were compared using the Log-rank test.Results1773 patients were included in the analysis, among n=34 having started HD at age of 0–2y, n=57 at >2–6y, n=244 at >6–12y, and n=1438 at >12–18y. Median follow-up on HD ranged between 1.5 (>2–6y) to 4.7 years (>6–12y) with maximal follow-up of 23 years. Death while on HD occurred in 1/34, 6/57, 26/244, and 101/1438 patients during recorded follow-up (p=0.075, n.s.). Patients with mean spKt/V < 1.4 had lower survival on HD than those with spKt/V >1.4–1.6 (p=0.019) and those with spKt/V >1.6 (p=0.035), with 10-year survival estimated to 75% (65.2–86.2%) versus 84.5% (78.5–90.9%) and 85.0% (80.8–89.5%), respectively.ConclusionsThis is the first study to report long term survival and its relationship with delivered HD dose in patients starting HD in childhood. Our results support targeting spKt/V(urea)>1.4 in children on chronic HD treatment.ReferencesGotta V, Marsenic O, Pfister M. Age- and weight-based differences in haemodialysis prescription and delivery in children, adolescents and young adults. Nephrol Dial Transplant 2018 Apr 18.Gotta V, Marsenic O, Pfister M. Understanding urea kinetic factors that enhance personalized hemodialysis prescription in children. ASAIO J 2019 Jan 14.Disclosure(s)M Pfister is a consultant at Quantitative Solutions a Certara Company. V Gotta has been supported for this project by the Research Fund for Junior Researchers, University of Basel, Switzerland. O Marsenic and A Atkinson declare no financial conflict of interest.

Effect of dialysis dose and membrane flux on hemoglobin cycling in hemodialysis patients

2014 ◽  
Vol 19 (2) ◽  
pp. 263-269 ◽  
Author(s):  
Liyu He ◽  
Min Fu ◽  
Xian Chen ◽  
Hong Liu ◽  
Xing Chen ◽  
...  
Keyword(s):  
Hemodialysis Patients ◽  
Dialysis Dose ◽  
Membrane Flux ◽  
Hemoglobin Cycling

scholarly journals P1253ASSOCIATION OF PREDIALYSIS PULSE PRESSURE (PP) AND ITS INTRADIALYTIC VARIATIONS IN 5 YEAR MULTICENTER COHORT STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Valeriy Shilo ◽  
Ivan Drachev
Keyword(s):  
Regression Model ◽  
Cox Regression ◽  
Cox Model ◽  
Surrogate Marker ◽  
Maintenance Hemodialysis ◽  
Intradialytic Hypotension ◽  
Multicenter Cohort Study ◽  
Dialysis Dose ◽  
Cox Regression Model ◽  
Total Cohort

Abstract Background and Aims Elevated PP, as a surrogate marker of elastic properties the arteries vessel wall, is important characteristics of the cardiovascular system and may be associated with poor survival both in the general eldery population with arterial hypertension and in patients on maintenance hemodialysis (HD). It has been shown, that increase predialysis PP in HD patients was associated with a higher risk of hospitalization or death, but the relationship between PP changes during HD was not well investigated in large prospective cohort studies. The aim of the study was to assess the effect of elevated predialisis PP and its intradialytic PP variations on survival in the Kaplan-Meir curves and in the Cox regression models. Method The retrospective cohort included patients who underwent maintenance HD in the large chain of B. Braun Avitum free standing HD units in Russia from 2011 to 2016 years (n = 3704). The mean age of the patients was 54,8±13,7 years, 45% were women and 55% men. All patients were on B. Braun Dialog+ Evolution dialysis machines with Adimea option for on-line KT/V measurement and synthetic alpha-polysulphone Xevonta series dialyzers (surface area 1,8, 2,0 and 2,3 sq. m.) The delivered dialysis dose, according to the Daugirdas 2nd generation formula was 1,6 ± 0.23 (spKt/V). Statistical analysis in a Kaplan-Meier curves and proportional Cox regression model were performed. The study used averaged BP data measured over the entire observation period and PP calculation. Patients were divided into subgroups according PP calculation &lt;35, 35-55, 55-75 and more than 75 mm Hg. Variations in intradialytic PP (ΔPP) were divided into groups according to PP average change during HD procedure: -25 and lower decrease, -25 - -10, -10 - 0, 0 - 10, and 10 - 25 increase, mm Hg. Results From total cohort of 3704 patients, 207 (5,6%) has highly elevated PP (&gt; 75 mmHg) and another 1549 (41,8%) has slightly elevated PP (55-75 mm hg). During the study, 393 deaths occurred. The Kaplan-Meyer survival curves clearly demonstrate that the worst survival rate occurs in the subgroup of patients with the markedly elevated predialysis PP (n=207, 35 deaths; HR = 1,7 CI = 1,3 – 2,6; p &lt;0,001; Pic. 1). Then we analyze association of intradialytic PP changes and mortality in total cohort (n=3704) and the subgroups with elevated PP (n=1756). Both marked PP drop down and PP increase during HD worsen survival: the most poor demonstrate patients with highest decrease in PP (-25 mm Hg and more) and then with highest increase in PP (+10-25 mm hg) within HD procedure (Pic. 2). In unadjusted Cox model predialytic PP and survival remain significant (p=0,01), but not PP changes (p=0,3). After multivariable adjustments in the Cox regression model with main demographic factors (age, treatment duration) and key laboratory indices (spKT/V, urea, creatinine, hemoglobin, albumin, Ca, PO4, PTH) there were no association between both predialysis PP and PP changes and mortality (p=0,9 and 0,1, respectively). Among the independent risk factors in our model, highest hazard ratio affecting survival has for ultrafiltration (UF) speed both for predialytic PP and PP variations (tabl. 1 and table 2). Conclusion In our study PP and its intradialytic variations show statistical significant association with mortality in single factor survival analysis and in unadjusted Cox regression model, but were not independent factor in adjusted multivariate HR model. UF speed has the highest impact on mortality in our model. We can hypothesize, that patients with elevated PP are vulnerable for high UF rate and prone for intradialytic hypotension and higher mortality on maintenance HD.

scholarly journals MP610IMPACT OF DELIVERED DIALYSIS DOSE ON 1 YEAR MORTALITY OF NONDIABETIC MAINTENANCE HEMODIALYSIS PATIENTS

2016 ◽  
Vol 31 (suppl_1) ◽  
pp. i544-i544
Author(s):  
Ekrem Kara ◽  
Tuncay Sahutoglu ◽  
Elbis Ahbap ◽  
Tamer Sakaci ◽  
Yener Koc ◽  
...  
Keyword(s):  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Dialysis Dose ◽  
Maintenance Hemodialysis Patients

scholarly journals SaO045RELATIONSHIP BETWEEN DIALYSIS DOSE (spKt/V) AND SURVIVAL IN PATIENTS ON MAINTENANCE HEMODIALYSIS FROM CHILDHOOD

2019 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Verena Gotta ◽  
Andrew Atkinson ◽  
Olivera Marsenic ◽  
Marc Pfister
Keyword(s):  
Maintenance Hemodialysis ◽  
Dialysis Dose

scholarly journals SO087RISK OF INTRADIALYTIC HYPOTENSION BY DAY OF THE WEEK IN MAINTENANCE HEMODIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Simon Correa ◽  
Xavier E Guerra-Torres ◽  
Sushrut S Waikar ◽  
Finnian R Mc Causland
Keyword(s):  
Regression Models ◽  
Maintenance Hemodialysis ◽  
Intradialytic Hypotension ◽  
Peripheral Vascular ◽  
Progressive Reduction ◽  
Ultrafiltration Rate ◽  
Logistic Regression Models ◽  
Monotonic Increase ◽  
Membrane Flux ◽  
Day Of The Week

Abstract Background and Aims Intradialytic hypotension (IDH) affects up to 50% of maintenance hemodialysis (HD) patients and is associated with a higher risk of cardiovascular (CV) events and mortality. CV events are more common on the days of dialysis and are most pronounced following the longer interdialytic interval. We wished to investigate if the rates of IDH differed according to dialysis day. Method We examined data from adult patients undergoing in-center thrice-weekly maintenance HD (N= 975 patients/n=59,004 sessions from a large dialysis organization [LDO] and N=1,838 patients/n=64,407 sessions from the Hemodialysis [HEMO] Study). We fit random effects logistic regression models to determine the association of day of HD (Mon/Tue [HD1]; Wed/Thu [HD2]; Fri/Sat [HD3]) with various definitions of IDH. Models were adjusted for age, sex, race, Kt/V, membrane flux, heart failure, peripheral vascular disease, diabetes, access type (catheter vs. fistula vs. graft), pre-dialysis blood urea nitrogen, ultrafiltration rate, pre-HD systolic blood pressure (SBP). IDH definitions included Nadir90 (nadir intra-HD SBP &lt;90mmHg), Nadir90/100 (nadir intra-HD SBP &lt;90mmHg if pre-HD SBP &lt;160mmHg or &lt;100mmHg if pre-HD SBP ≥160mmHg), Fall20 (pre-SBP minus nadir SBP ≥20mmHg) and Fall30 (pre-SBP minus nadir SBP ≥30mmHg). Results Mean age was 60 years, 44% were female and 38% were black in the LDO cohort, while mean age was 58 years, 56% were female and 63% were black in HEMO. Nadir90 occurred in 15% of LDO and 11% of HEMO sessions; Nadir90/100 occurred in 18% of LDO and 14% of HEMO sessions; Fall20 occurred in 76% of LDO and 68% of HEMO sessions; Fall30 occurred in 60% of LDO and 50% of HEMO sessions. Overall, a monotonic increase in the risk of IDH was observed for HD2 and HD3 compared with HD1 for all IDH definitions in both cohorts (see Table and Figure). Conclusion We observed a consistent monotonic increase in the risk of IDH for HD2 and HD3, compared with HD1 in two separate cohorts of maintenance HD patients. Potential explanations may relate to progressive reduction in post-HD weight during the dialytic week, or perhaps more aggressive ultrafiltration in advance of the longer interval. Further research to determine the underling mechanisms is necessary to guide practicing nephrologists when individualizing the HD prescription.

168: Time-Dependent Association Between Dialysis Dose and 5-Year Survival in Contemporary Maintenance Hemodialysis Patients

2008 ◽  
Vol 51 (4) ◽  
pp. B69
Author(s):  
Jessica E. Miller ◽  
Elani Streja ◽  
Csaba Kovesdy ◽  
Charles J. McAllister ◽  
David Van Wyck ◽  
...  
Keyword(s):  
Hemodialysis Patients ◽  
Time Dependent ◽  
Maintenance Hemodialysis ◽  
Dialysis Dose ◽  
Maintenance Hemodialysis Patients
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