Association between extracellular volume control and survival in patients on short daily haemodialysis

Abstract

Background: Fluid overload (FO) assessed by bioimpedance spectroscopy (BIS) is associated with higher mortality risk in maintenance haemodialysis (HD). The aim was to assess if a better management of FO through short daily haemodialysis (SDHD) could improve survival. Methods: Retrospective analysis of patients who were on HD 3 sessions/week for at least 3 months and shifted to in-centre SDHD (5 or 6 sessions/week, 2 to 3 h/session) between July 2012 and June 2016 at 23 dialysis units in Brazil. The 12-month risk of death was analysed according to the predialysis hydration status measured before and 6 months after initiation of SDHD. Predialysis hydration status was considered adequate when FO ≤15% of extracellular volume. Results: A total of 297 patients on SDHD were included in the analysis. Their median age was 57 (IQR 45-67) years, 62% were males, 44% diabetics, 57% on 6 dialysis sessions/week, with a median session duration of 130 (IQR 120-150) minutes. BIS assessment at initiation of the SDHD regimen was performed in 220 patients and FO > 15% was found in 46.4%. Twelve-month survival rates for those with FO ≤15 and > 15% before initiating SDHD were 87.4 and 88.0%, respectively (P = 0.92). BIS analysis when completing 6 months on SDHD were available for 229 patients, 26.6% with FO > 15%. The survival rates for the next 12 months (from the 6th to the 18th month of follow-up) for those with FO ≤15 and > 15% were 91.0 and 72.0%, respectively (P = 0.0006). In a Cox regression model, after adjustment for demographic, clinical and laboratory variables, FO ≤ 15% persisted associated with a lower mortality risk (hazard ratio 0.34, 95%CI 0.13-0.87). Conclusions: Moving from conventional HD to SDHD was associated with better control of excessive extracellular volume. Patients who reached or maintained predialysis fluid overload ≤15% after initiating SDHD presented a lower risk of death.

Characteristics and predictors of mortality on haemodialysis in Brazil: a cohort of 5,081 incident patients

“…Indeed, the long-term exposition to excessive extracellular volume is a much stronger predictor of death risk than the presence of FO at admission on HD, as shown by Zoccali et al [ 8 ]. We demonstrated in a previous study that even prevalent patients with FO while on conventional HD, after switching to short daily HD and subsequent correction of FO, had the same survival rate as those patients on short daily HD who were not with FO when they were still on conventional HD [ 20 ]. This finding corroborates once again that FO would be a modifiable risk factor and that its correction should be considered a priority in the clinical management.…”

Echocardiographic left ventricular hypertrophy and geometry in Chinese chronic hemodialysis patients: the prevalence and determinants

“…This criterion enabled us to include as many eligible participates as possible, and guaranteed that they are all MHD patients as well. Usually, being on HD treatment more than 3 months is recognized as MHD patients, and most studies in HD population enrolled participants on HD more than 3 months [ 38 – 40 ]. Furthermore, some research suggested that 3 months might be long enough to make a difference on the progression of LVH in HD population [ 41 ].…”

Effect of Guidelines Based Practice on Dialysis Complications in Patients on Permanent Hemodialysis

“…Also causes serious complications; some of the highlighted recurrent clinical conditions as intra-dialytic hypotension, intra-dialytic hypertension, Hyperkalemia, edema and organ failure during dialysis sessions. Uncontrollable high blood pressure and edema are the main risk factor developing heart disease (7) . The prevalence of hypertension during dialysis is 15% to 50% of patients receiving hemodialysis treatment (8) .…”