Impacts of dialysis adequacy and intradialytic hypotension on changes in dialysis recovery time

Abstract

Background Dialysis recovery time (DRT) surveys capture the perceived time after HD to return to performing regular activities. Prior studies suggest the majority of HD patients report a DRT > 2 h. However, the profiles of and modifiable dialysis practices associated with changes in DRT relative to the start of dialysis are unknown. We hypothesized hemodialysis (HD) dose and rates of intradialytic hypotension (IDH) would associate with changes in DRT in the first years after initiating dialysis. Methods We analyzed data from adult HD patients who responded to a DRT survey ≤180 days from first date of dialysis (FDD) during 2014 to 2017. DRT survey was administered with annual KDQOL survey. DRT survey asks: “How long does it take you to be able to return to your normal activities after your dialysis treatment?” Answers are: < 0.5, 0.5-to-1, 1-to-2, 2-to-4, or > 4 h. An adjusted logistic regression model computed odds ratio for a change to a longer DRT (increase above DRT > 2 h) in reference to a change to a shorter DRT (decrease below DRT < 2 h, or from DRT > 4 h). Changes in DRT were calculated from incident (≤180 days FDD) to first prevalent (> 365-to- ≤ 545 days FDD) and second prevalent (> 730-to- ≤ 910 days FDD) years. Results Among 98,616 incident HD patients (age 62.6 ± 14.4 years, 57.8% male) who responded to DRT survey, a higher spKt/V in the incident period was associated with 13.5% (OR = 0.865; 95%CI 0.801-to-0.935) lower risk of a change to a longer DRT in the first-prevalent year. A higher number of HD treatments with IDH episodes per month in the incident period was associated with a 0.8% (OR = 1.008; 95%CI 1.001-to-1.015) and 1.6% (OR = 1.016; 95%CI 1.006-to-1.027) higher probability of a change to a longer DRT in the first- and second-prevalent years, respectively. Consistently, an increased in incidence of IDH episodes/months was associated to a change to a longer DRT over time. Conclusions Incident patients who had higher spKt/V and less sessions with IDH episodes had a lower likelihood of changing to a longer DRT in first year of HD. Dose optimization strategies with cardiac stability in fluid removal should be tested.

Post‐dialysis recovery time in ESRD patients receiving more frequent hemodialysis in skilled nursing facilities

“…Reduced cumulative mortality or hospitalization was associated with shorter recovery time (≤2 h), consistent with a similar relationship demonstrated previously 6,10 and providing further evidence that DRT reported in this study retained biologic plausibility. Our study is the first to demonstrate this relationship in the SNF, on-site, MFD-treated ESRD population.…”

“…Intradialytic hypotension was expected to tax the patient's system and reduce the proportion experiencing rapid recovery. Consistent with these expectations and some prior studies, 9,10,30 IDH was associated with reduced rapid return to baseline with 0.91 odds ratio (CI: 0.84-0.99; p = 0.025) (Table 3). We expected patients missing their previous dialysis session to be less likely to have short DRT.…”

“…The finding of better recovery time in Hispanics is unexplained by gender or age differences, but we did observe a higher proportion of Hispanics (19% vs. 11%) with pre‐HD sBP in the range 160–179 mmHg, which conferred higher odds of rapid recovery time. Of note, gender was not a statistically significant influence on recovery, a finding that agreed with Bossola 33 and Awuah 35 but contrasts with reports by other researchers 6,9,10,30,36 …”

“…The duration of this period, known as post-dialysis recovery time (DRT), has been characterized through a validated patient questionnaire. 1 In the general ESRD population receiving conventional dialysis, DRT is inversely correlated with multiple quality of life and physical symptom assessments, [2][3][4][5] and several studies document more than half of patients with DRT greater than 2 h. [6][7][8][9] Prolonged DRT is associated with increased hospitalization 6,10 and mortality. 6 A more frequent dialysis (MFD) treatment schedule has been associated with improvements in patient quality of life and laboratory measurements, 11 and in a randomized controlled trial, six times per week MFD compared to conventional dialysis resulted in improved fluid management 12 and reduced hospitalization rates 13 and mortality.…”

Dialysis recovery time: associated factors and its association with quality of life of hemodialysis patients

“…in more than 75% of patients, and was associated with depression, and post-dialysis hypotension [ 8 ]. Other researchers reported an association between the DRT and UFR, dialysis adequacy, comorbidities [ 9 , 10 ]. Prolonged DRT restricts the ability of the patients to perform their daily activities [ 11 ].…”