Ultrafiltration intensification in hemodialysis patients improves hypertension but increases AV fistula complications and cardiovascular events.

Curatola, Giuseppe; Bolignano, Davide; Rastelli, Stefania; Caridi, Graziella; Tripepi, Rocco; Tripepi, Giovanni; Politi, Raffaele; Catalano, F. A.; Delfino, Diego; Ciccarelli, Maurizio; Mallamaci, Francesca; Zoccali, Carmine

doi:10.5301/jn.2011.7735

Cited by 34 publications

(26 citation statements)

References 17 publications

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“…Available evidence indicates that rapid fluid removal during dialysis may contribute to all-cause and cardiovascular mortality in this population (3)(4)(5)(6). Ultrafiltration rate (UFR) is determined by both the amount of fluid removed, which at steady state is equivalent to interdialytic weight gain (IDWG), and the time over which this fluid is removed (dialysis session length [DSL]).…”

Section: Introductionmentioning

confidence: 99%

Disentangling the Ultrafiltration Rate–Mortality Association

Flythe

Curhan

Brunelli

2013

Clinical Journal of the American Society of Nephrology

103

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SummaryBackground and objectives Rapid ultrafiltration rate is associated with increased mortality among hemodialysis patients. Ultrafiltration rates are determined by interdialytic weight gain and session length. Although both interdialytic weight gain and session length have been linked to mortality, the relationship of each to mortality, independent of the other, is not adequately defined. This study was designed to evaluate whether shorter session length independent of weight gain and larger weight gain independent of session length are associated with increased mortality.Design, setting, participants, & measurements Data were taken from a national cohort of 14,643 prevalent, thriceweekly, in-center hemodialysis patients dialyzing from 2005 to 2009 (median survival time, 25 months) at a single dialysis organization. Patients with adequate urea clearance and delivered dialysis session $240 and ,240 minutes were pair-matched on interdialytic weight gain (n=1794), and patients with weight gain #3 and .3 kg were pair-matched on session length (n=2114); mortality associations were estimated separately.Results Compared with delivered session length $240, session length ,240 minutes was associated with increased all-cause mortality (adjusted hazard ratio [95% confidence interval], 1.32 [1.03 to 1.69]). Compared with weight gain #3, weight gain .3 kg was associated with increased mortality (1.29 [1.01 to 1.65]). The associations were consistent across strata of age, sex, weight, and weight gain and session length. Secondary analyses demonstrated dose-response relationships between both and mortality.Conclusions Among patients with adequate urea clearance, shorter dialysis session length and greater interdialytic weight gain are associated with increased mortality; thus, both are viable targets for directed intervention.

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Section: Introductionmentioning

confidence: 99%

Disentangling the Ultrafiltration Rate–Mortality Association

Flythe

Curhan

Brunelli

2013

Clinical Journal of the American Society of Nephrology

103

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“…Aggressive attempts to control BP and/or fluid overload without bioimpedance guidance have been associated with an increased frequency of IDH, 7 and possibly increased risk of arteriovenous access failure and even cardiovascular hospitalization. 8 By contrast, increasing the postdialysis ECF level based on bioimpedance guidance in a subset of patients has been reported to reduce interdialytic weight gain, and even to result in resumption of residual kidney function (J.E. Tattersal, personal communication).…”

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confidence: 99%

Measuring Intradialytic Hypotension to Improve Quality of Care

Daugirdas

2015

Journal of the American Society of Nephrology

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“…Chronic hypervolemia leads to hypertension, left ventricular hypertrophy, heart failure, and increased mortality and hospitalization rates [2]. On the other hand, hypovolemia is associated with hypotension, decreased quality of life, interruptions of dialysis sessions with reduced solute removal, vascular access thrombosis and loss of residual renal function [3,4,5,6]. …”

Section: Introductionmentioning

confidence: 99%

Can Nephrologists Use Ultrasound to Evaluate the Inferior Vena Cava A Cross-Sectional Study of the Agreement between a Nephrologist and a Cardiologist

Pazeli

Vidigal²,

Grossi³

et al. 2014

Nephron Extra

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Background/Aims: The costs and the need for a specialist impair the implementation of ultrasonography for evaluating the inferior vena cava (IVC) to assess the volemic status in hemodialysis patients. We investigated whether a nephrologist with limited ultrasound training can accurately assess the IVC in patients undergoing hemodialysis. Methods: A cardiologist and a nephrologist consecutively measured the indexed IVC expiratory diameter (VCDi) and the IVC collapsibility index (IVCCI) of 52 patients during hemodialysis sessions. In protocol I, the nephrologist used a regular ultrasound system (RUS) and the cardiologist used a cardiovascular ultrasound equipment; in protocol II, the machines were interchanged. Pearson and kappa coefficients and the interexaminer agreement by the Bland-Altman method were calculated. Results: The VCDi measurements showed a strong correlation in both protocols (r = 0.88 and 0.84 in protocols I and II, respectively). The volemic classifications were excellent in protocol I (kappa = 0.82 and 0.93 by VCDi and IVCCI, respectively) and substantial in protocol II (kappa = 0.77 and 0.75 by VCDi and IVCCI, respectively). The interexaminer agreement on the VCDi measurements was very good in both protocols. Conclusions: Ultrasound evaluation of the IVC can be performed by nephrologists using an RUS to assess the volemic status in hemodialysis patients.

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Ultrafiltration intensification in hemodialysis patients improves hypertension but increases AV fistula complications and cardiovascular events.

Abstract: Longer and/or more frequent dialyses and better efforts to increase compliance to low salt diets than those put in place in this study are needed to reduce the high prevalence of hypertension in the HD population.

Cited by 34 publications

References 17 publications

Disentangling the Ultrafiltration Rate–Mortality Association

Disentangling the Ultrafiltration Rate–Mortality Association

Measuring Intradialytic Hypotension to Improve Quality of Care

Can Nephrologists Use Ultrasound to Evaluate the Inferior Vena Cava A Cross-Sectional Study of the Agreement between a Nephrologist and a Cardiologist

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