Ultrafiltration Rate Effects Declines in Residual Kidney Function in Hemodialysis Patients

Lee, Yu‐Ji; Okuda, Yusuke; Sy, John; Kim, Sung Rok; Obi, Yoshitsugu; Kövesdy, Csaba P.; Rhee, Connie M.; Streja, Elani; Kalantar-Zadeh, Kamyar

doi:10.1159/000503918

Cited by 18 publications

(20 citation statements)

References 25 publications

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“…Previous studies have reported the association between higher UFR and poor outcomes such as an increased risk of mortality and rapid decline in residual kidney function [5,10,11,13,14]. However, they had the limitation that the objective extracellular volume status was not considered in their analyses.…”

Section: Discussionmentioning

confidence: 99%

“…Various risk factors for worse survival rates have been reported [3][4][5][6][7][8][9]. High ultrafiltration rate (UFR), that is, rapid fluid removal, is recognized as one of the risk factors responsible for these poor outcomes [10][11][12][13][14]. High UFR could increase the development of intradialytic hypotension (IDH), which might be associated with end-organ ischemia of the heart, brain, DOI: 10.1159/000509350 and gut, and this may consequently lead to increased mortality risk [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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

Lim

Yang

Cho

et al. 2020

Nephron

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Background: The association between ultrafiltration rate (UFR) and mortality may be affected by the muscle mass or volume status in hemodialysis (HD) patients. However, there is an absence of data regarding this association. Methods: We performed an observational study on patients (≥18 years old) who had been on HD for at least 3 months. A body composition monitor (BCM) was used for baseline bioimpedance analysis measurement. The primary composite outcome was defined as the time to death or the first cardiovascular event. Results: The median (interquartile range) UFR, volume excess measured by the BCM, and lean tissue index (LTI) (calculated as lean tissue mass/height 2) were 11.4 (8.0-15.0) mL/h/kg, 2.4 (1.4-4.1) L, and 12.5 (10.4-14.4) kg/m 2 , respectively. During 284 person-years of follow-up, the primary outcome occurred in 44 of the 167 patients (26%). Higher UFR was associated with an increased outcome of death or cardiovascular event; the adjusted hazard ratio (HR) was 1.044 (95% confidence interval [CI]: 1.006-1.083). This association remained consistent even after adjusting for volume excess. However, the association between UFR and the primary outcome was modified by LTI (p interaction = 0.027); the association was significant in patients with LTI < 12.5 kg/m 2 , and the HR (95% CI) was 1.050 (1.001-1.102). Conclusion: Higher UFR was associated with an increased risk of a composite outcome of death or cardiovascular event regardless of volume status in HD patients. However, muscle mass may modify the association between higher UFR and increased risk of a composite outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Lim

Yang

Cho

et al. 2020

Nephron

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“…The continual decline in RKF over several HD sessions necessitates an increase in ultrafiltration to account for increased interdialytic weight gain. Nevertheless, higher ultrafiltration rate was associated with a faster decline in RKF among conventional HD dialysis patients [20]. In addition, intradialytic hypotension during HD was negatively associated with RKF after HD initiation [9].…”

Section: Discussionmentioning

confidence: 99%

Estimated glomerular filtration rate at dialysis initiation and subsequent decline in residual kidney function among incident hemodialysis patients

Lertdumrongluk

Tantisattamo

Obi

et al. 2020

Nephrology Dialysis Transplantation

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Background Higher estimated glomerular filtration rate (eGFR) at dialysis initiation, known as earlier start of dialysis, is often a surrogate of poor outcomes including higher mortality. We hypothesized that earlier dialysis initiation is associated with a faster decline in residual kidney function (RKF), which is also associated with higher mortality among incident hemodialysis (HD) patients. Methods In a cohort of 4911 incident HD patients who initiated HD over a 5-year period (July 2001 to June 2006), we examined the trajectories of RKF, ascertained by renal urea clearance (KRU), over 2 years after HD initiation across strata of eGFR at HD initiation using case-mix adjusted linear mixed-effect models. We then investigated the association between annual change in RKF and mortality using Cox proportional hazard models. Results The median (interquartile range) baseline KRU was 2.20 (1.13–3.63) mL/min/1.73 m2. The decline of KRU was faster in patients who initiated HD at higher eGFR. The relative changes with 95% confidence intervals (CIs) in KRU at 1 year after HD initiation were −1.29 (−1.28 to −1.30), −1.17 (−1.16 to −1.18), −1.11 (−1.10 to −1.12) and −0.78 (−0.78 to −0.79) mL/min/1.73 m2 in the eGFR categories of ≥10, 8–<10, 6–<8 and <6 mL/min/1.73 m2, respectively. The faster decline of KRU at 1 year was associated with higher all-cause mortality (reference: ≥0 mL/min/1.73 m2): hazard ratios (95% CIs) for change in KRU of −1.5 to <0, −3 to less than −1.5 and less than −3 mL/min/1.73 m2 were 1.20 (1.03–1.40), 1.42 (1.17–1.72) and 1.88 (1.47–2.40), respectively. Conclusions The faster decline of RKF happens with earlier dialysis initiation and is associated with higher all-cause mortality.

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“…Both of these complications might impair renal recovery. For instance, studies in patients with end-stage renal disease and incident hemodialysis suggest that higher ultrafiltration rates are associated with a decline in residual kidney function [14]. Small observational studies in critically ill patients also suggest that higher UF NET rates are associated with dependence on RRT [15, 16].…”

Section: Introductionmentioning

confidence: 99%

Association between Net Ultrafiltration Rate and Renal Recovery among Critically Ill Adults with Acute Kidney Injury Receiving Continuous Renal Replacement Therapy: An Observational Cohort Study

et al. 2021

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Introduction: Higher net ultrafiltration (UFNET) rates are associated with mortality among critically ill patients with acute kidney injury (AKI) and treated with continuous renal replacement therapy (CRRT). Objective: The aim of the study was to discover whether UFNET rates are associated with renal recovery and independence from renal replacement therapy (RRT). Methods: Retrospective cohort study using data from the Randomized Evaluation of Normal versus Augmented Level of Renal Replacement Therapy trial that enrolled 1,433 critically ill patients with AKI and treated with CRRT between December 2005 and November 2008 across 35 intensive care units in Australia and New Zealand. We examined the association between UFNET rate and time to independence from RRT by day 90 using competing risk regression after accounting for mortality. The UFNET rate was defined as the volume of fluid removed per hour adjusted for patient body weight. Results and Conclusions: Median age was 67.3 (interquartile range [IQR], 57–76.3) years, 64.4% were male, median Acute Physiology and Chronic Health Evaluation-III score was 100 (IQR, 84–118), and 634 (44.2%) died by day 90. Kidney recovery occurred in 755 patients (52.7%). Using tertiles of UFNET rates, 3 groups were defined: high, >1.75; middle, 1.01–1.75; and low, <1.01 mL/kg/h. Proportion of patients alive and independent of RRT among the groups were 47.8 versus 57.2 versus 53.0%; p = 0.01. Using competing risk regression, higher UFNET rate tertile compared with middle (cause-specific hazard ratio [csHR], 0.79, 95% CI, 0.66–0.95; subdistribution hazard ratio [sHR], 0.80, 95% CI, 0.67–0.97) and lower (csHR, 0.69, 95% CI, 0.56–0.85; sHR, 0.78, 95% CI 0.64–0.95) tertiles were associated with a longer time to independence from RRT. Every 1.0 mL/kg/h increase in rate was associated with a lower probability of kidney recovery (csHR, 0.81, 95% CI, 0.74–0.89; and sHR, 0.87, 95% CI, 0.80–0.95). Using the joint model, longitudinal increases in UFNET rates were also associated with a lower renal recovery (β = −0.29, p < 0.001). UFNET rates >1.75 mL/kg/h compared with rates 1.01–1.75 and <1.01 mL/kg/h were associated with a longer duration of dependence on RRT. Randomized clinical trials are required to confirm this UFNET rate-outcome relationship.

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Ultrafiltration Rate Effects Declines in Residual Kidney Function in Hemodialysis Patients

Cited by 18 publications

References 25 publications

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

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

Estimated glomerular filtration rate at dialysis initiation and subsequent decline in residual kidney function among incident hemodialysis patients

Association between Net Ultrafiltration Rate and Renal Recovery among Critically Ill Adults with Acute Kidney Injury Receiving Continuous Renal Replacement Therapy: An Observational Cohort Study

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