Association between Ultrafiltration Rate and Clinical Outcome Is Modified by Muscle Mass in Hemodialysis Patients

Lim, Yuntac; Yang, Gyeonghun; Cho, Seong; Kim, Sung Rok; Lee, Yu‐Ji

doi:10.1159/000509350

Cited by 3 publications

(4 citation statements)

References 32 publications

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“…Compared with other studies (8)(9)(10)(11)(12)14,15), the UFR noted in this cohort are lower than previously reported. The median UFR for the entire cohort was 6.5 ml/kg per hour (IQR 4.9-8.5 ml/kg per hour), and only 3% of patients had an average UFR .13 ml/kg per hour compared with 18% of patients in Assimon et al's study (12).…”

Section: Discussioncontrasting

confidence: 97%

“…The Centers for Medicare & Medicaid Services (CMS) have recently included target weight achievement and ultrafiltration rate (UFR) as part of the ESKD quality metrics (5)(6)(7). Several studies have examined the increased risk of death as average UFR increases, and an upper limit of 13 ml/kg per hour has been suggested as a quality metric (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Most studies place the inflection point for increased risk of death above 13 ml/kg per hour, and this finding is consistent across all groups of sex, race, dialysis session duration, and body size.…”

Section: Introductionmentioning

confidence: 99%

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Proportion of Hemodialysis Treatments with High Ultrafiltration Rate and the Association with Mortality

et al. 2022

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Background: Rapid fluid removal during hemodialysis has been associated with increased mortality. The limit of ultrafiltration rate (UFR) monitored by the Centers for Medicare and Medicaid Services is 13 ml/kg/hr. It is not clear if the proportion of treatments with high UFR is associated with higher mortality. We examined the association of proportion of dialysis treatments with high UFR and mortality in end stage kidney failure patients receiving hemodialysis Methods: retrospective study of incident patients initiating hemodialysis between January 1, 2010 to December 31, 2019 at Emory dialysis centers. The proportion of treatments with high UFR (>13ml/kg/hr) per patient was calculated using data from the initial 3 months of dialysis therapy. Patients were categorized based on quartiles of proportion of dialysis sessions with high UFR. Risk of death and survival probabilities were calculated and compared for all quartiles. Results: Of 1050 patients eligible, the median age was 59 years, 56% were male and 91% were black. The median UFR was 6.5 ml/kg/hr and the proportion of sessions with high UFR was 5%. 31% of patients never experienced high UFR. Male gender, younger age, shorter duration of hemodialysis sessions, lower weight, diabetic status, higher albumin and history of heart failure were associated with higher proportion of sessions with high UFR. Patients in the higher quartile (26% dialysis with high UFR, average UFR 9.8ml/kg/hr, median survival of 5.6 years) had a higher risk of death (adjusted hazard-ratio 1.54, CI: 1.13-2.10) compared to those in the lower quartile (0% dialysis with high UFR, average UFR 4.7ml/kg/hr, median survival 8.8 years). Conclusions: Hemodialysis patients that did not experience frequent episodes of elevated UFR during the first three months of their dialysis tenure had a significantly lower risk of death compared to patients with frequent episodes of high UFR.

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Section: Discussioncontrasting

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Proportion of Hemodialysis Treatments with High Ultrafiltration Rate and the Association with Mortality

et al. 2022

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“…While reporting is inconsistent, an association between body mass index (BMI) and IDH was postulated in patients with lower lean tissue index because skeletal muscle serves as a water reservoir with approximately 20% of this being dynamically mobile. 54 , 55 Other schools of thought propose the lean tissue index to fat tissue index ratio as a better indicator of IDH than BMI alone because obesity and sarcopenia are known to have a synergistic and negative impact on performance status. 56 …”

Section: Risk Factors Of Intra Hemodialysis Hypotensionmentioning

confidence: 99%

Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects

Hamrahian,

Vilayet,

Herberth

et al. 2023

IJNRD

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Intradialytic hypotension, defined as rapid decrease in systolic blood pressure of greater than or equal to 20 mmHg or in mean arterial pressure of greater than or equal to 10 mmHg that results in end-organ ischemia and requires countermeasures such as ultrafiltration reduction or saline infusion to increase blood pressure to improve patient's symptoms, is a known complication of hemodialysis and is associated with several potential adverse outcomes. Its pathogenesis is complex and involves both patient-related factors such as age and comorbidities, as well as factors related to the dialysis prescription itself. Key factors include the need for volume removal during hemodialysis and a suboptimal vascular response which compromises the ability to compensate for acute intravascular volume loss. Inadequate vascular refill, incorrect assessment or unaccounted changes of target weight, acute illnesses and medication interference are further potential contributors. Intradialytic hypotension can lead to compromised tissue perfusion and endorgan damage, both acutely and over time, resulting in repetitive injuries. To address these problems, a careful assessment of subjective symptoms, minimizing interdialytic weight gains, individualizing dialysis prescription and adjusting the dialysis procedure based on patients' risk factors can mitigate negative outcomes.

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“…Skeleton muscle atrophy is a common body composition abnormality in patients with chronic kidney disease (CKD), especially end stage renal disease 1 , 2 . Low muscle mass or strength is associated with poor physical function, frailty, and higher risk of all-cause mortality in CKD patients 3 – 6 . Furthermore, individuals who have low muscle mass are more likely to have cardiovascular (CV) events, such as coronary artery disease, cerebrovascular disorders, heart failure, peripheral artery disease, arrhythmias 7 – 10 .…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-assessed diaphragm dysfunction predicts clinical outcomes in hemodialysis patients

Zheng

Yin²,

Wang³

et al. 2022

Sci Rep

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Skeletal muscle atrophy is prevalent and remarkably increases the risk of cardiovascular (CV) events and mortality in hemodialysis (HD) patients. However, whether diaphragm dysfunction predicts clinical outcomes in HD patients is unknown. This was a prospective cohort study of 103 HD patients. After assessment of diaphragm function by ultrasonography and collection of other baseline data, a 36-month follow-up was then initiated. Participants were divided into diaphragm dysfunction (DD+) group and normal diaphragm function (DD−) group, according to cutoff value of thickening ratio (i.e. the change ratio of diaphragm thickness) at force respiration. The primary endpoint was the first nonfatal CV event or all-cause mortality. A secondary endpoint was less serious CV events (LSCEs, a composite of heart failure readmission, cardiac arrhythmia or myocardial ischemia needed pharmacological intervention in hospital). 98 patients were eligible to analysis and 57 (58.16%) were men. 28 of 44 patients(63.64%) in DD+ group and 23 of 54 patients (42.59%) in DD− group had at least one nonfatal CV event or death (p = 0.038). Compared to DD− group, DD+ group had significantly higher incidence of LSCEs (21 vs.14, p = 0.025) and shorter survival time (22.02 ± 12.98 months vs. 26.74 ± 12.59 months, p = 0.046). Kaplan–Meier analysis revealed significantly higher risks of primary endpoint (p = 0.039), and LSCEs (p = 0.040) in DD+ group. Multivariate hazard analysis showed that DD+ group had significantly higher risk of primary endpoint [hazard ratio (HR) 1.59; 95% confident interval (CI) 1.54–1.63], and LSCEs (HR 1.47; 95%CI 1.40–1.55). Ultrasound-assessed diaphragm dysfunction predicts clinical outcomes in HD patients.Trial registration: This study was registered with Chinese Clinical Trials Registry (www.chictr.org.cn) as ChiCTR1800016500 on Jun 05, 2018.

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Association between Ultrafiltration Rate and Clinical Outcome Is Modified by Muscle Mass in Hemodialysis Patients

Cited by 3 publications

References 32 publications

Proportion of Hemodialysis Treatments with High Ultrafiltration Rate and the Association with Mortality

Proportion of Hemodialysis Treatments with High Ultrafiltration Rate and the Association with Mortality

Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects

Ultrasound-assessed diaphragm dysfunction predicts clinical outcomes in hemodialysis patients

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