Low dialysate potassium concentration is associated with prolonged recovery time

Abstract

Introduction: Modifiable hemodialysis treatment parameters may impact patient reported outcomes, including recovery time. Answers to the recovery question may predict the impact of treatment parameters on clinical outcomes and health related quality of life. However, the reliability of answers to the recovery question after consecutive and nonconsecutive dialysis treatments in diverse populations has not been established.Objective: To assess the reliability of this instrument and to determine if recovery time was associated with modifiable dialysis parameters, we conducted a quality assurance project in which we asked, "How long did it take you to recover from your last dialysis session?" after consecutive and nonconsecutive treatments. Methods:We asked patients the recovery question seven times. We computed polychoric correlations to assess within patient correlations. We used random intercept ordinal logistic regression models to test for associations of recovery time with patient variables. Results:We obtained answers to the recovery question in association with 1572 treatments in 364 patients. Recovery time was <2 hours in 52.1%; 2 to 7 hours in 20.9%; and >7 hours in 27.0% of treatments. Polychoric correlations demonstrated highly reliable responses within individual patients between consecutive and nonconsecutive treatments. Prolonged recovery was associated with a dialysate potassium of 1 vs. 2 mEq/L (odds ratio [OR] Conclusions: Responses to the recovery question were reliable and low dialysate potassium was associated with prolonged recovery.

Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate

“…Conversely, Hussein et al [9] have demonstrated that a higher UFR was associated with a longer recovery time. Finally, in the study of Harford et al [15], any correlation between recovery time and UFR was found.…”

“…Data on the correlation between recovery time and UFR are few and conflicting [4,9,14,15]. In the study of Rayner et al [4], a longer recovery time was associated with greater intradialytic weight loss, longer dialysis session duration, and dialysate sodium concentration < 140 mEq/L.…”

The effect of blood flow rate on dialysis recovery time in patients undergoing maintenance hemodialysis: A prospective, parallel‐group, randomized controlled trial

“…Dialysis recovery time (DRT) is a measure of post‐dialysis fatigue. DRT is often measured by asking the question, “How long does it take you to recover from dialysis?” This question has been found to be valid and responsive to change, as well as reliable at a variety of intervals . Internationally, it has been found that more than a quarter of maintenance HD patients report >6 hours of DRT …”

“…It is not known whether milder symptoms such as fatigue can occur following treatments in those patients already undergoing maintenance HD regularly. More rapid removal of vasoactive solutes altering hemodynamics and muscle contractility may also contribute to a feeling of fatigue . Dialysis modalities that involve longer or more frequent dialysis sessions allow for slower clearances.…”

“…This question has been found to be valid and responsive to change, as well as reliable at a variety of intervals. 7,8 Internationally, it has been found that more than a quarter of maintenance HD patients report >6 hours of DRT. 9,10 Despite its importance, post-dialysis fatigue remains understudied.…”