Dose of Hemodialysis and Survival

Abstract

Context.-Although blacks receive lower doses of hemodialysis than whites, their survival when receiving dialysis treatment is better than that for whites. Previous studies of the relationship between the dose of dialysis and patient survival have not controlled for differences in patient characteristics.Objective.-To examine the association of mortality with the dose of hemodialysis for clusters of patients categorized by race and sex.Design.-Retrospective analysis of laboratory data and mortality outcomes from 1994, using a national database of hemodialysis patients.Patients.-A total of 18 144 black and white patients receiving hemodialysis 3 times weekly who either lived the entire year receiving hemodialysis or died.Main Outcome Measures.-The fractional reduction of urea in a single dialysis session as the measured hemodialysis dose (urea reduction ratio [URR]) after controlling for race, sex, age, and diabetes mellitus. Mortality was determined by strata of URRs and albumin and creatinine levels.Results.-Across all age categories, blacks had lower URRs than whites, and men had lower URRs than women. In an age-adjusted model for evaluating interactions among URRs, race, sex, and diabetes, the association of URR with mortality risk was weak among blacks, particularly black men. After adjustment for age and diabetes, death probability curves were most steep for white women with URR values less than 60%. The death probability curves were least steep for black men. There was no meaningful difference between death probability and albumin or creatinine concentration among the race by sex clusters.Conclusion.-Using URR, the usual measure of hemodialysis dose, the assumption that the association between dialysis dose and survival is uniform across demographic groups appears incorrect. Comparisons of the quality of dialysis patient care should not rely on URR alone to predict patient survival.

Intradialytic Exercise in Hemodialysis Patients: A Systematic Review and Meta-Analysis

“…Additional analyses showed that ‘dose-target bias' may be the reason of discrepancies [45]. Several studies showed that sex and body mass also influence the outcomes, and women and low-weight patients may benefit more from a higher dialysis dose [46,47,48,49]. So it is still difficult to find an optimal dialysis dose for HD patients.…”

The Effects of Racial Differences on Body Composition and Total Body Water Measured by Multifrequency Bioelectrical Impedance Analysis Influence Delivered Kt/V Dialysis Dosing

“…Previous studies from the USA reported greater mortality for Caucasoid patients, particularly women, than for African-Americans [23], whereas women in the general population outsurvive men. On the other hand, there appears to be a survival advantage for the morbidly obese (BMI >35) haemodialysis patient whereas in the general population, the morbidly obese have increased mortality.…”

“…The body composition of Caucasoids and African/Afro-Caribbean subjects was different, particularly for women. This may help explain, to some extent, some of the differences in mortality previously reported between different ethnic groups and sexes [23], as female Caucasoids are more likely to receive lower dialysis doses than Africans/Afro-Caribbean subjects. In addition to ethnic differences, we also noted changes with diabetes, again leading to increased body fat and loss of muscle mass.…”

Prealbumin is Associated With Visceral Fat Mass in Patients Receiving Hemodialysis

“…A recent meta-analysis showed that 9 out of 14 studies reported lower all-cause mortality with greater serum prealbumin levels in hemodialysis (HD) patients (4). Cardiovascular mortality is also inversely associated with prealbumin levels (5, 6). It was also demonstrated that lower prealbumin concentrations were associated with mortality and hospitalization rates due to infection, independently of serum albumin.…”