Minimized Weight Gain between Hemodialysis Contributes to a Reduced Risk of Death

Stegmayr, Bernd; Brännström, Mats; Bucht, S; Dimény, Emöke; Ekspong, A; Granroth, B; Gröntoft, KC; Hadimeri, Henrik; Holmberg, Benny; Ingman, B; Isaksson, B; Johansson, Gerd; Lindberger, Kerstin; Lundberg, Lennart; Lundström, Ola; Mikaelsson, L; Mörtzell, Monica; Olausson, Eric; Persson, Bengt; Svensson, Lise-Lotte; Wikdahl, Ann Marie

doi:10.1177/039139880602900705

Cited by 26 publications

(34 citation statements)

References 13 publications

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“…Of note, we lacked data on interdialytic weight gain, which may influence decisions on session length and may also be directly related to mortality and morbidity. However, inasmuch as patients with larger interdialytic weight gains are more likely to have longer session lengths and are more likely to die,30–33 any bias would be toward the null and would not explain our findings. In addition, we tracked prescribed (not delivered ) session length.…”

Section: Discussionmentioning

confidence: 78%

Shorter dialysis times are associated with higher mortality among incident hemodialysis patients

Brunelli

Chertow

Ankers

et al. 2010

Kidney International

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There is an association between hemodialysis session length and mortality independent of the effects of session duration on urea clearance. However, previous studies did not consider changes in session length over time nor did they control for the influence of time-dependent confounding. Using data from a national cohort of 8552 incident patients on thrice-weekly, in-center hemodialysis, we applied marginal structural analysis to determine the association between session length and mortality. Exposure was based on prescribed session length with the outcome being death from any cause. On the 31st day after initiating dialysis, the patients were considered at-risk and remained so until death, censoring, or completion of 1 year on dialysis. On primary marginal structural analysis, session lengths <4 h were associated with a 42% increase in mortality. Sensitivity analyses showed a dose–response relationship between session duration and mortality, and a consistency of findings across prespecified subgroups. Our study suggests that shorter hemodialysis sessions are associated with higher mortality when marginal structural analysis was used to adjust for time-dependent confounding. Further studies are needed to confirm these findings and determine causality.

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Section: Discussionmentioning

confidence: 78%

Shorter dialysis times are associated with higher mortality among incident hemodialysis patients

Brunelli

Chertow

Ankers

et al. 2010

Kidney International

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“…These findings could have widespread implications in the treatment of patients with ESRD undergoing HD, considering that IDH is estimated to occur in 20%-30% of all dialysis treatments (depending on the definition used for IDH) (4), and that IDWG has been shown to increase the risk of CV events and mortality (10,11).…”

Section: Discussionmentioning

confidence: 99%

Intradialytic Hypotension and Risk of Cardiovascular Disease

Stefánsson

Brunelli

Cabrera

et al. 2014

Clinical Journal of the American Society of Nephrology

264

192

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Background and objectives Patients undergoing hemodialysis have an elevated risk of cardiovascular diseaserelated morbidity and mortality compared with the general population. Intradialytic hypotension (IDH) is estimated to occur during 20%-30% of hemodialysis sessions. To date, no large studies have examined whether IDH is associated with cardiovascular outcomes. This study determined the prevalence of IDH according to interdialytic weight gain (IDWG) and studied the association between IDH and outcomes for cardiovascular events and mortality to better understand its role.

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“…This was associated with greater interdialytic weight gains. Studies have reported that limiting interdialytic weight gain is associated with improved survival in haemodialysis patients [19]. …”

Section: Discussionmentioning

confidence: 99%

Blood Pressure Control and Symptomatic Intradialytic Hypotension in Diabetic Haemodialysis Patients: A Cross-Sectional Survey

Davenport

Cox²,

Thuraisingham

2008

Nephron Clin Pract

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Background:Cardiovascular disease remains the most common cause of mortality in end-stage kidney failure patients with diabetes. To improve blood pressure control, and reduce cardiovascular risk, in 2002 the UK Renal Association Standards’ Committee introduced pre- and post-dialysis target blood pressures of <140/90 and <130/80 mm Hg, respectively. Methods: We audited blood pressure control and symptomatic intradialytic hypotension during 1 week in the eleven renal centres in the Greater London Urban Area in 2,193 patients, capturing 6,579 haemodialysis sessions. Results: Although 73.9% of the 658 diabetic patients were prescribed antihypertensive medications, compared to 57.8% of the 1,535 non-diabetic patients (p < 0.001), both the mean pre- and post-dialysis blood pressures were greater in the diabetic patients: before dialysis 152 ± 23/77 ± 13 versus 144 ± 23/79 ± 13 mm Hg and after dialysis 138 ± 24/71 ± 12 versus 132 ± 26/73 ± 13 mm Hg, and fewer diabetic patients achieved the pre- and post-dialysis blood pressure targets: 28.6 versus 40.8% and 37.9 versus 46.3%, respectively (p < 0.01). In addition, more diabetic patients suffered symptomatic intradialytic hypotension, 20.3 versus 14.9% (p < 0.01), associated with greater interdialytic weight gains. Conclusion: Diabetic haemodialysis patients had higher blood pressures, both before and after dialysis, associated with greater interdialytic weight gains and more frequent symptomatic intradialytic hypotension.

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Minimized Weight Gain between Hemodialysis Contributes to a Reduced Risk of Death

Cited by 26 publications

References 13 publications

Shorter dialysis times are associated with higher mortality among incident hemodialysis patients

Shorter dialysis times are associated with higher mortality among incident hemodialysis patients

Intradialytic Hypotension and Risk of Cardiovascular Disease

Blood Pressure Control and Symptomatic Intradialytic Hypotension in Diabetic Haemodialysis Patients: A Cross-Sectional Survey

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