Interdialytic Weight Gain: Trends, Predictors, and Associated Outcomes in the International Dialysis Outcomes and Practice Patterns Study (DOPPS)

Wong, Michelle M.Y.; McCullough, Keith; Bieber, Brian; Bommer, Juergen; Hecking, Manfred; Levin, Nathan W.; McClellan, William M.; Pisoni, Ronald L.; Saran, Rajiv; Tentori, Francesca; Tomo, Tadashi; Port, Friedrich K.; Robinson, Bruce M.

doi:10.1053/j.ajkd.2016.08.030

Cited by 102 publications

(118 citation statements)

References 44 publications

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“…In our study, hospitalizations for PE contributed to the high hospitalization rates for CVDs after the longest gap, in both the HD schedules (shown in Fig 2, Fig 3 and Fig 4). Our findings support the association between fluid overload and the day of week risk suggested in previous reports [26–30]. …”

Section: Discussionsupporting

confidence: 93%

“…reported that the excess volume accumulation over the long interdialytic interval results in higher left and right arterial enlargement rates as well as right ventricular systolic pressure, on analysis of the echocardiographic parameters [29]. According to a DOPPS report, a relative interdialytic weight gain (IDWG) of at least 5.7% elevated the risk for mortality, and an IDWG of at least 4% elevated the risk for fluid-overload hospitalization [30]. In our study, hospitalizations for PE contributed to the high hospitalization rates for CVDs after the longest gap, in both the HD schedules (shown in Fig 2, Fig 3 and Fig 4).…”

Section: Discussionmentioning

confidence: 99%

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The impact of hemodialysis schedules on the day of the week of hospitalization for cardiovascular and infectious diseases, over a period of 20 years

et al. 2017

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There have been no studies as yet that have evaluated how hemodialysis (HD) schedules affect the day of the week of hospitalization for cardiovascular diseases (CVDs) and infectious diseases (IDs), over a period of time. Herein, we performed a retrospective observational cohort study (1995–2014) evaluating 11,111 hospitalizations in 1,953 patients with end-stage renal disease, receiving HD 3 times a week (following either a Monday-Wednesday-Friday [MWF] schedule or a Tuesday-Thursday-Saturday [TTS] schedule) or receiving frequent HD (FHD) at least 4 times a week. Overall, hospitalization rates for CVDs and IDs were the highest on Monday in the MWF schedule and Tuesday in the TTS schedule compared to the average rates for all the days of the week. When generalized estimating equations (GEEs) were used in conjunction with robust variance estimators of each type of CVD, the risk for pulmonary edema was found to be significantly higher on Sunday and Monday in the MWF schedule and Monday and Tuesday in the TTS schedule. For both cerebrovascular and ischemic heart disease, the risks were significantly higher on Tuesday in the MWF schedule and Wednesday in the TTS schedule. Moreover, there were significant differences in the day of the week risks among the various CVD types. On trend analysis, the overall hospitalization rate for CVDs on the first HD day did not decrease (P = 0.2); however, the hospitalization rate for IDs on the first HD day significantly decreased (P = 0.02) over a span of 20 years. When GEEs were used in the case of FHD patients with severe heart failure, the hospitalization rate on the first HD day (Monday) significantly decreased after FHD initiation (P = 0.04). It was found that HD schedules affected the day of the week of hospitalization for CVDs. FHD may lower the day of the week risk.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

The impact of hemodialysis schedules on the day of the week of hospitalization for cardiovascular and infectious diseases, over a period of 20 years

et al. 2017

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“…Previous studies have documented that hypervolemia, as reflected in IDWG, contributes to higher BP in patients receiving cHD [9,10,12,20]. Furthermore, large IDWG and shorter dialysis duration are both associated with increased adverse outcomes and mortality in observational studies [21,22] and reducing fluid volume excess in cHD patients has been shown to improve BP control [10,22]. Based on such evidence, achieving adequate dry weight control is, understandably, considered to be the primary method for reducing IDWG and controlling BP in the dialysis population [1,10,23].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, we cannot rule out a "threshold effect" by which fluid gains above certain levels exert more potent direct effects on inter-dialytic BP. Indeed, a recent analysis of DOPPS data by Wong et al [22] indicated that increased risk of hospitalization for fluid overload and mortality occurred with %IDWGs of 4.0 and 5.7% respectively. Furthermore, our study does not address the question of whether further reducing IDWG would lower BP in this cohort and the results in no way suggest that dry-weight adjustment should not be performed in otherwise stable cHD patients with poor BP control and/or clinical evidence of fluid excess.…”

Section: Discussionmentioning

confidence: 99%

Increased Weight Gain During the Long Interdialytic Period Is Associated with Minor Effects on Blood Pressure Control in Clinically Stable In-Centre Haemodialysis Patients

Shantier

Martin

Singh

et al. 2018

Nephron

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Background/Aims: Three-day-a-week chronic haemodialysis (cHD) involves 1 long (72 h) and 2 short (48 h) inter-dialytic periods (IDPs). We aimed to determine whether BP control following the long IDP is inferior to the short IDPs. Methods: All pre- and post-dialysis BP and weight measurements over a 4-week period were retrospectively analyzed among 135 clinically stable cHD patients at 2 academic centres with comparisons between measurements recorded following short and long IDPs. Subsequently, 23 clinically stable cHD patients underwent 24-h ambulatory blood pressure monitoring (ABPM) during the final day/night cycle of the long IDP and 1 short IDP within the same week. Results: In combined and separate analyses of the 2 retrospective cohorts, pre-dialysis BP parameters were not different following long and short IDPs despite greater inter-dialytic weight gain (IDWG) during the long IDP. Subgroup analyses of the total cohort showed no evidence for inferior BP control during the long IDP among those with high %IDWG. In the ABPM study, nocturnal hypertension and loss of nocturnal dipping were frequent. Furthermore, daytime systolic blood pressure (SBP) and pulse pressure were modestly higher during the last day/night cycle of the long compared with short IDP. Conclusion: In stable cHD patients, the greater IDWG that occurred during the long IDP was not associated with overtly inferior BP control as reflected in pre-dialysis BP measurements. However, modestly higher daytime SBP was evident towards the end of the long IDP by 24 h ABPM. Thus, while fluid gain has well-documented associations with hypertension and adverse cardiovascular outcomes, the excess IDWG that occurs during the long IDP exerts relatively minor effects on BP control in patients on well-established dialysis regimens that are better identified by ambulatory monitoring.

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“…Treatment of patients receiving maintenance hemodialysis is subject to large variations in practice patterns . Given that such variation is associated with the clinical outcomes of these patients, improving the quality of practice is critical to their management. To achieve this, quality indicators (QIs) are used as precise measures of quality.…”

Section: Introductionmentioning

confidence: 99%

Variations and characteristics of quality indicators for maintenance hemodialysis patients: A systematic review

Niihata

Shimizu

Tsujimoto

et al. 2018

Health Science Reports

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AimsSeveral quality indicators (QIs) to improve the quality of practice for hemodialysis patients have been implemented. However, the variations and characteristics of these indicators in terms of their use and feasibility have not been investigated. We conducted a systematic review to evaluate the variations and characteristics of existing QIs for maintenance hemodialysis patients.MethodsWe conducted a systematic literature search of MEDLINE via PubMed, Scopus, the Cochrane Library, and CINAHL, without date limits, on February 26, 2016. We selected the English‐written articles regarding QIs for patients aged ≥18 years who were on maintenance hemodialysis therapy ≥3 months, and extracted the definition and development process of the reported QIs. We categorized each indicator into one of four types, namely, structure, process, surrogate outcome, and outcome, and assessed the data sources that were necessary to measure it.ResultsWe included 70 articles and identified 101 indicators, and found that most of the consensus processes for selecting indicators were unclear. We also found that most indicators were not process indicators and that the measurement of some indicators required a chart review, which limits their use and feasibility.ConclusionsDevelopment of QIs for hemodialysis patients in the future should use a definitive consensus process and consider process‐centered indicators that can be measured automatically using claims data and test results contained in electronic medical records, to improve usability and feasibility.

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Interdialytic Weight Gain: Trends, Predictors, and Associated Outcomes in the International Dialysis Outcomes and Practice Patterns Study (DOPPS)

Abstract: Reductions in IDWG during the past decade were partially explained by reductions in dialysate sodium concentration. Focusing quality improvement strategies on reducing occurrences of high IDWG may improve outcomes in HD patients.

Cited by 102 publications

References 44 publications

The impact of hemodialysis schedules on the day of the week of hospitalization for cardiovascular and infectious diseases, over a period of 20 years

The impact of hemodialysis schedules on the day of the week of hospitalization for cardiovascular and infectious diseases, over a period of 20 years

Increased Weight Gain During the Long Interdialytic Period Is Associated with Minor Effects on Blood Pressure Control in Clinically Stable In-Centre Haemodialysis Patients

Variations and characteristics of quality indicators for maintenance hemodialysis patients: A systematic review

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