Associations between Hemodialysis Facility Practices to Manage Fluid Volume and Intradialytic Hypotension and Patient Outcomes.

Dasgupta, Indranil and Thomas, G Neil and Clarke, Joanne and Sitch, Alice and Martin, James and Bieber, Brian and Hecking, Manfred and Karaboyas, Angelo and Pisoni, Ronald and Port, Friedrich and Robinson, Bruce and Rayner, Hugh C (2019) Associations between Hemodialysis Facility Practices to Manage Fluid Volume and Intradialytic Hypotension and Patient Outcomes. Clinical journal of the American Society of Nephrology : CJASN. ISSN 1555-905X. This article is available to all UHB staff and students via ASK discovery tool http:\\tinyurl.com\795c8c by using their UHB login id ( with one year embargo)

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Official URL: https://cjasn.asnjournals.org/content/early/2019/0...

Abstract

BACKGROUND AND OBJECTIVES

Fluid overload and intradialytic hypotension are associated with cardiovascular events and mortality in patients on hemodialysis. We investigated associations between hemodialysis facility practices related to fluid volume and intradialytic hypotension and patient outcomes.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Data were analyzed from 10,250 patients in 273 facilities across 12 countries, from phase 4 of the Dialysis Outcomes and Practice Patterns Study (DOPPS; 2009-2012). Cox regression models (shared frailty) were used to estimate associations between facility practices reported by medical directors in response to the DOPPS Medical Directors Survey and all-cause and cardiovascular mortality and hospitalization, and cardiovascular events, adjusting for country, age, sex, dialysis vintage, predialysis systolic BP, cardiovascular comorbidities, diabetes, body mass index, smoking, residual kidney function, dialysis adequacy, and vascular access type.

RESULTS

Of ten facility practices tested (chosen ), having a protocol that specifies how often to assess dry weight in most patients was associated with lower all-cause (hazard ratio [HR], 0.78; 99% confidence interval [99% CI], 0.64 to 0.94) and cardiovascular mortality (HR, 0.72; 99% CI, 0.55 to 0.95). Routine orthostatic BP measurement to assess dry weight was associated with lower all-cause hospitalization (HR, 0.86; 99% CI, 0.77 to 0.97) and cardiovascular events (HR, 0.85; 99% CI, 0.73 to 0.98). Routine use of lower dialysate temperature to limit or prevent intradialytic hypotension was associated with lower cardiovascular mortality (HR, 0.76; 99% CI, 0.58 to 0.98). Routine use of an online volume indicator to assess dry weight was associated with higher all-cause hospitalization (HR, 1.19; 99% CI, 1.02 to 1.38). Routine use of sodium modeling/profiling to limit or prevent intradialytic hypotension was associated with higher all-cause mortality (HR, 1.36; 99% CI, 1.14 to 1.63), cardiovascular mortality (HR, 1.34; 99% CI, 1.04 to 1.73), and cardiovascular events (HR, 1.21; 99% CI, 1.03 to 1.43).

CONCLUSIONS

Hemodialysis facility practices relating to the management of fluid volume and intradialytic hypotension are associated with patient outcomes.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK discovery tool http:\\tinyurl.com\795c8c by using their UHB login id ( with one year embargo)
Subjects: WJ Urogenital system. Urology
Divisions: Emergency Services > Renal
Related URLs:
Depositing User: Miss Emily Johnson
Date Deposited: 25 Feb 2019 15:43
Last Modified: 25 Feb 2019 15:43
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1855

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