Ultrafiltration Rate Thresholds in Maintenance Hemodialysis: An NKF-KDOQI Controversies Report

Kramer, Holly; Yee, Jerry; Weiner, Daniel E.; Bansal, Vinod; Choi, Michael; Brereton, Laura; Berns, Jeffrey S.; Samaniego‐Picota, Milagros; Scheel, Paul J.; Rocco, Michael V.

doi:10.1053/j.ajkd.2016.06.010

Cited by 27 publications

(22 citation statements)

References 74 publications

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“…Among non-end-stage renal disease patients, a high salt intake was found to be associated with an increased risk for cardiovascular events and death in hypertensive populations, while the association between a low salt intake and an increased risk for cardiovascular events and death was observed in those with or without hypertension [32]. Possibly, the increase of cardiovascular death might be observed among hemodialysis patients with a higher salt intake range such as over 15 g/day, which we could not observe in this study and which is in accordance with the recent advisory in the United States to limit the UF rate to < 13 mL/kg/h [33]. These findings suggest that a range of salt intake with targeted upper and lower limits should be discussed in clinical guidelines.…”

Section: Discussionsupporting

confidence: 81%

Salt Intake and All-Cause Mortality in Hemodialysis Patients

Ikenoue¹,

Koike²,

Fukuma³

et al. 2018

Am J Nephrol

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Background: Although some clinical practice guidelines regarding hemodialysis recommend salt restriction, few studies have examined the association between salt intake and clinical outcomes in hemodialysis patients. This study aimed to clarify the association between salt intake and mortality in hemodialysis patients. Methods: This retrospective cohort study was based on the Japanese Society for Dialysis Therapy renal data registry database (2008) and included 88,115 adult patients who had received hemodialysis for at least 2 years. Estimated salt intake was the main predictor and was calculated from intra-dialytic weight loss and pre- and post-dialysis serum sodium levels. Nonlinear logistic regression was used to determine the association between salt intake and mortality, adjusting for potential confounders. The outcomes considered were all-cause mortality and cardiovascular death at 1 year. Results: The median (25–75th percentile) salt intake at baseline was 6.4 (4.6–8.3) g/day. At 1 year, all-cause mortality occurred in 1,845 (2.1%) patients, including 807 cardiovascular deaths. The low salt intake group (< 6 g/day) demonstrated the highest all-cause mortality and cardiovascular deaths. No association was observed between high salt intake, all-cause mortality and cardiovascular deaths. The lowest risk for all-cause mortality and cardiovascular death occurred among patients with an estimated salt intake of 9 g/day. Conclusion: Low salt intake, but not high salt intake, was associated with all-cause and cardiovascular mortality in Japanese hemodialysis patients. Further studies to justify including a lower limit of salt intake for hemodialysis patients are suggested.

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Section: Discussionsupporting

confidence: 81%

Salt Intake and All-Cause Mortality in Hemodialysis Patients

Ikenoue¹,

Koike²,

Fukuma³

et al. 2018

Am J Nephrol

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“…In fact, it is well known that a higher UFR has been associated with increased mortality [19][20][21] and with hemodynamic effects such as reduced myocardial blood and myocardial stunning [22][23][24]. Nevertheless, an ideal UFR has not yet been identified [25].…”

Section: Discussionmentioning

confidence: 99%

Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate

Bossola¹,

Stasio

Monteburini³

et al. 2018

Blood Purif

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Introduction: The present study aimed to determine the variables that are associated with a longer dialysis recovery time (DRT) and to define the relationship that exists between DRT and the ultrafiltration rate (UFR) in prevalent chronic hemodialysis (CHD) patients. Methods: We studied 210 prevalent CHD of 5 hemodialysis units in Central Italy. Patients were invited to answer to the question: “How long does it take you to recover from a dialysis session?” Answers to this question were subsequently converted into minutes. Demographic, clinical and laboratory parameters were recorded for each patient as well as the UFR (mL/kg/h), the dialysate sodium concentration and temperature. Results: Median DRT was 180 min (60–420). Ninety five (45%) patients had a DRT ≥ the median value. Mean UFR was 9.2 ± 3.0 mL/kg/h. Patients with a lower DRT had a less prevalent disability in the instrumental activities daily living, had a higher UFR, and a lower dialysate temperature, as compared with subjects with higher DRT. According to the logistic regression model, UFR was associated with a DRT below the median (i.e., 180) in the unadjusted model (OR 1.12; 95% CI 1.02–1.23; p = 0.019), after adjusting for age and sex (OR 1.11; 95% CI 1.01–1.22; p = 0.025), and in the fully adjusted model (OR 1.11; 95% CI 1.04–1.22; p = 0.040). UFR increase was associated with increasing probability of DRT below the median (p for trend = 0.035). The highest tertile of DRT was associated with UFR below the mean value (i.e., 9.2 mL/kg/h) in multinomial logistic regression having the lowest DRT tertile as reference. DRT was significantly lower in patients with UFR > 13 mL/kg/h than in patients with UFR 10–13 or < 10 mL/kg/h. Conclusion: DRT is inversely associated with UFR in CHD patients. Whether a high UFR should be recommended to reduce the DRT needs to be elucidated through an adequate prospective randomized study.

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“…It is calculated by dividing UF volume (predialysis weight – postdialysis weight) by treatment time and patient weight. In studies assessing UFRs, UFRs were calculated using different parameters, either prescribed or delivered UF volumes, treatment times, and postdialysis weights, affecting validity and generalizability of the results . In addition, UFR is highly variable between dialysis sessions.…”

Section: Predictors Of Ultrafiltration Ratementioning

confidence: 99%

“…Several observational studies have assessed outcomes associated with UFR (Table ). The first study included 22 000 prevalent HD patients from seven countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS) .…”

Section: Ultrafiltration Rate Association With Clinical Outcomesmentioning

confidence: 99%

“…The Center for Medicare and Medicaid Services (CMS) has expressed interest in including UFR in its Quality Incentive Program (QIP). Lack of randomized controlled trials supporting this practice, insufficient current evidence, as well as possible unintended consequences of targeting this parameter in isolation make this policy a matter of controversy . The objective of this review is to summarize the evidence that links UFR to patient outcomes, focus on UFR cut‐offs proposed, and discuss possible consequences of such a policy.…”

Section: Introductionmentioning

confidence: 99%

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