Ultrafiltration rate in conventional hemodialysis: Where are the limits and what are the consequences?

Slinin, Yelena; Babu, Megha; Ishani, Areef

doi:10.1111/sdi.12717

Cited by 9 publications

(12 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The higher UFV in males agrees with findings by Ipema, et al [21] who reported that males were more likely to have higher IDWG and therefore higher ultrafiltration rates and volumes. Our finding is however not in agreement with some earlier studies that found higher UFVs with females [19,20]. The higher dialysis dose in males could explain their higher UFV as the positive relationship between the dialysis dose and the UFV is well reported in previous studies [20,21].…”

Section: Discussioncontrasting

confidence: 99%

“…Our finding is however not in agreement with some earlier studies that found higher UFVs with females [19,20]. The higher dialysis dose in males could explain their higher UFV as the positive relationship between the dialysis dose and the UFV is well reported in previous studies [20,21]. Due to solute removal during ultrafiltration, higher UFVs are expected to give higher dialysis doses.…”

Section: Discussioncontrasting

confidence: 98%

“…The mean dialysis dose was al. [19] and Slinin, et al [20] found higher ultrafiltration volume with higher IDWG.…”

Section: Discussionmentioning

confidence: 94%

See 2 more Smart Citations

Ultrafiltration Volume: Surrogate Marker of the Extraction Ratio, Determinants, Clinical Correlates and Relationship with the Dialysis Dose

Kehinde¹,

Omotola²,

Igwebuike³

et al. 2021

J Clin Nephrol Ren Care

View full text Add to dashboard Cite

Background:The ultrafiltration volume, a surrogate maker of inter-dialytic weight gain and extraction ratio plays a significant contributory role in the dialysis dose but in very large amount can lead to intradialysis hypotension and its consequences of myocardial ischemia and stunning and further diminution of kidney function. Measures are needed to prescribe the optimal quantity for each session.Method: A thousand six hundred and eighty eight dialysis sessions for 287 participants were studied. Pre and postdialysis blood samples for electrolytes, urea and creatinine, and hematocrit were taken. Results:The mean age, interdialytic weight gain and ultrafiltration volume were 50.7 ± 11.7 years, 2.23 ± 1.3 kg and 1.3 ± 1.1 L respectively. Greater proportions of participants were males (66.9%), had hypertension associated CKD (44.6%) and were between 35-54 years (44.3%). A greater proportion of the sessions had ultrafiltration volume 1500-1999 mL (23.6%). The ultrafiltration volume was higher in males, was positively related to the inter-dialytic weight gain, fall in interdialytic percentage oxygen saturation and inter-dialytic blood pressure rise but it was negatively correlated with age, predialysis albumin and bicarbonate, blood flow rate, dialysis duration, and dialysis dose (higher in males). Higher ultrafiltration volume was associated with intradialysis hypotension. Dialysis dose was adequate in 15.2% of the sessions. Predictors of the ultrafiltration volume were dialysis frequency, blood flow rate, dialysis duration, predialysis albumin and dialysis dose. Conclusion:The ultrafiltration volume contributes to the dialysis dose but very high quantity could cause intradialysis hypotension. A carefully prescribed ultrafiltration volume is therefore needed to deliver optimal treatment doses and avoid complications.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 98%

See 1 more Smart Citation

Ultrafiltration Volume: Surrogate Marker of the Extraction Ratio, Determinants, Clinical Correlates and Relationship with the Dialysis Dose

Kehinde¹,

Omotola²,

Igwebuike³

et al. 2021

J Clin Nephrol Ren Care

View full text Add to dashboard Cite

show abstract

“…27 As such it is unclear as to whether the association reported with faster ultrafiltration rates is a reflection of greater ECW overhydration. 25 Hypotension could also occur if the amount of ultrafiltration requested was greater than that required to restore patients to a euvolemic state. Volume assessment of dialysis patients can be difficult depending upon the relative gains of water and sodium, as dialysis patients may be well over their target weight without showing the classic signs of ECW excess.…”

Section: Discussionmentioning

confidence: 99%

Hemodialysis patients with less extracellular water overload and smaller cardiac atrial chamber sizes are at greater risk of a fall in blood pressure during dialysis

et al. 2020

View full text Add to dashboard Cite

Intradialytic hypotension is the most common complication of hemodialysis (HD) treatments. Excessive ultrafiltration results in reduced cardiac preload. We aimed to determine whether a fall in systolic blood pressure during HD was greater in patients starting HD with (a) less overhydration measured by extracellular water (ECW) and (b) lower cardiac preload by cardiac magnetic resonance imaging (MRI). Pre‐HD measurements of ECW and total body water (TBW) were performed using multifrequency bioimpedance (MFBIA). Cardiac chamber sizes and functions were determined by MRI. Twenty‐six patients, 18 males (69.2%), 11 (42.3%) with diabetes, mean age 63.9 ± 15.9 years were studied. Systolic blood pressure (SBP) fell in 15 (57.7%) patients, and either did not change or increased in 9. There was no difference in demographics between groups. Patients with a fall in SBP had lower pre‐HD ECW/TBW (0.400 ± 0.018 vs 0.418 ± 0.021), indexed right ventricular end‐diastolic volume (81.2 ± 37.6 vs 100.8 ± 33.7 mL/m2), and indexed left atrial size (13.7 ± 3.9 vs 18.3 ± 5.0 mL/m2), all P < .05, respectively. There were univariate correlations between the change in SBP and pre‐HD ECW/TBW for the trunk (r = .50, P = .009) and indexed left atrial volume (r = .54, P = .005). A fall in blood pressure occurred more commonly in patients starting HD with lower overhydration as measured by bioimpedance, and those with smaller cardiac chamber sizes. Patients with the lowest ECW/TBW and smallest cardiac chamber sizes had the greatest falls in SBP. This study reinforces the importance of determining physiological target weights and avoiding inappropriately low target weights for HD patients.

show abstract

“…Jones and Chan commence this issue and discuss their viewpoints on hemodialysis dose and adequacy by providing the evidence on boundaries of frequency and treatment time in conventional hemodialysis with three important perspectives: balancing convenience, economics, and health outcomes . Slinin et al then expand this topic by featuring ultrafiltration rate (UFR) in conventional hemodialysis, with the discussion of proposed UFR cut‐offs and possible consequences of adapting UFR as a quality metric . In this context, ideal dry weight probing is one of the difficult dilemmas nephrologists are faced with in the management of hemodialysis patients.…”

mentioning

confidence: 99%

Introduction to treatment considerations in conventional hemodialysis ‐ What we know

Sumida

Kövesdy

2018

Seminars in Dialysis

View full text Add to dashboard Cite

Ultrafiltration rate in conventional hemodialysis: Where are the limits and what are the consequences?

Abstract: Evidence supporting UFR limits is weak and confounded. Randomized controlled trials are needed before UFR can be used as a quality of care indicator.

Cited by 9 publications

References 26 publications

Ultrafiltration Volume: Surrogate Marker of the Extraction Ratio, Determinants, Clinical Correlates and Relationship with the Dialysis Dose

Ultrafiltration Volume: Surrogate Marker of the Extraction Ratio, Determinants, Clinical Correlates and Relationship with the Dialysis Dose

Hemodialysis patients with less extracellular water overload and smaller cardiac atrial chamber sizes are at greater risk of a fall in blood pressure during dialysis

Introduction to treatment considerations in conventional hemodialysis ‐ What we know

Contact Info

Product

Resources

About