Hemodialysis patients receiving a greater Kt dose than recommended have reduced mortality and hospitalization risk

Abstract

Achieving an adequate dialysis dose is one of the key goals for dialysis treatments. Here we assessed whether patients receiving the current cleared plasma volume (Kt), individualized for body surface area per recommendations, had improved survival and reduced hospitalizations at 2 years of follow-up. Additionally, we assessed whether patients receiving a greater dose gained more benefit. This prospective, observational, multicenter study included 6129 patients in 65 Fresenius Medical Care Spanish facilities. Patients were classified monthly into 1 of 10 risk groups based on the difference between achieved and target Kt. Patient groups with a more negative relationship were significantly older with a higher percentage of diabetes mellitus and catheter access. Treatment dialysis time, effective blood flow, and percentage of on-line hemodiafiltration were significantly higher in groups with a higher dose. The mortality risk profile showed a progressive increase when achieved minus target Kt became more negative but was significantly lower in the group with 1 to 3 L clearance above target Kt and in groups with greater increases above target Kt. Additionally, hospitalization risk appeared significantly reduced in groups receiving 9 L or more above the minimum target. Thus, prescribing an additional 3 L or more above the minimum Kt dose could potentially reduce mortality risk, and 9 L or more reduce hospitalization risk. As such, future prospective studies are required to confirm these dose effect findings.

Are Currently Used Bioimpedance Methods in Hemodialysis Comparable for Calculating Dialysis Dose?

“…In 2005, prescription of Kt adjusted by body surface area (BSA) was individualized and validated in a subsequent study and, since 2006 in Spain, hemodialysis guidelines have recommended use of Kt in dialysis centers equipped with monitors with ID . In addition, an association between BSA‐individualized Kt with mortality and hospitalization risk has recently been established in a large multicenter Spanish prospective study . In this study the authors could observe that in those patients achieving Kt/ V and Kt target, the risk of mortality was 12.6%, increasing to 23.5% when only Kt/ V target was achieved.…”

Continuing education: online monitoring of haemodialysis dose

“…; Maduell et al . ). It is not clear which is the best predictor, urea clearance, ionic dialysance or UV absorption.…”

“…There are no reports on the predictive value of UV absorbance. Some evidence about ionic dialysance has been presented (Lowrie et al 2005;Lowrie et al 2006;Maduell et al 2013;Maduell et al 2016). It is not clear which is the best predictor, urea clearance, ionic dialysance or UV absorption.…”

Volume of urea cleared as a therapy dosing guide for more frequent hemodialysis

“…For conventional dialysis delivery systems that offer online measurement of dialyzer urea clearance, the volumes of urea cleared shown in Figures 5-7 can be directly targeted during more frequent HD, as has been previously demonstrated during conventional thrice-weekly HD. 14,28 The limitations of the current work are several. First, it is theoretical and an extrapolation of previous work regarding patients treated by conventional thrice-weekly HD.…”

“…Note that this simple approach can be applied when the volume of urea cleared is prescribed based on either KDOQI guidelines or BSA. For conventional dialysis delivery systems that offer online measurement of dialyzer urea clearance, the volumes of urea cleared shown in Figures can be directly targeted during more frequent HD, as has been previously demonstrated during conventional thrice‐weekly HD …”