Dataset Information

Ultrafiltration Rate and Mortality in Maintenance Hemodialysis Patients.

ABSTRACT:

Background

Observational data have demonstrated an association between higher ultrafiltration rates and greater mortality among hemodialysis patients. Prior studies were small and did not consider potential differences in the association across body sizes and other related subgroups. No study has investigated ultrafiltration rates normalized to anthropometric measures beyond body weight. Also, potential methodological shortcomings in prior studies have led to questions about the veracity of the ultrafiltration rate-mortality association.

Study design

Retrospective cohort.

Setting & participants

118,394 hemodialysis patients dialyzing in a large dialysis organization, 2008 to 2012.

Predictors

Mean 30-day ultrafiltration rates were dichotomized at 13 and 10mL/h/kg, separately and categorized using various cutoff points. Ultrafiltration rates normalized to body weight, body mass index, and body surface area were investigated.

Outcomes

All-cause mortality.

Measurements

Multivariable survival models were used to estimate the association between ultrafiltration rate and all-cause mortality.

Results

At baseline, 21,735 (18.4%) individuals had ultrafiltration rates > 13mL/h/kg and 48,529 (41.0%) had ultrafiltration rates > 10mL/h/kg. Median follow-up was 2.3 years, and the mortality rate was 15.3 deaths/100 patient-years. Compared with ultrafiltration rates ≤ 13mL/h/kg, ultrafiltration rates > 13mL/h/kg were associated with greater mortality (adjusted HR, 1.31; 95% CI, 1.28-1.34). Compared with ultrafiltration rates ≤ 10mL/h/kg, ultrafiltration rates > 10mL/h/kg were associated with greater mortality (adjusted HR, 1.22; 95% CI, 1.20-1.24). Findings were consistent across subgroups of sex, race, dialysis vintage, session duration, and body size. Higher ultrafiltration rates were associated with greater mortality when normalized to body weight, body mass index, and body surface area.

Limitations

Residual confounding cannot be excluded given the observational study design.

Conclusions

Regardless of the threshold implemented, higher ultrafiltration rate was associated with greater mortality in the overall study population and across key subgroups. Randomized controlled trials are needed to investigate whether ultrafiltration rate reduction improves clinical outcomes.

SUBMITTER: Assimon MM

PROVIDER: S-EPMC5123913 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Ultrafiltration Rate and Mortality in Maintenance Hemodialysis Patients.

Assimon Magdalene M MM Wenger Julia B JB Wang Lily L Flythe Jennifer E JE

American journal of kidney diseases : the official journal of the National Kidney Foundation 20160826 6

<h4>Background</h4>Observational data have demonstrated an association between higher ultrafiltration rates and greater mortality among hemodialysis patients. Prior studies were small and did not consider potential differences in the association across body sizes and other related subgroups. No study has investigated ultrafiltration rates normalized to anthropometric measures beyond body weight. Also, potential methodological shortcomings in prior studies have led to questions about the veracity ...[more]

PMID: 27575009

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Dataset Information

Ultrafiltration Rate and Mortality in Maintenance Hemodialysis Patients.

Background

Study design

Setting & participants

Predictors

Outcomes

Measurements

Results

Limitations

Conclusions

Publications

Ultrafiltration Rate and Mortality in Maintenance Hemodialysis Patients.

Similar Datasets

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