DOI QR코드

DOI QR Code

The impact of blood flow rate during hemodialysis on all-cause mortality

  • Chang, Kyung Yoon (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kim, Su-Hyun (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Kim, Young Ok (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Jin, Dong Chan (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Song, Ho Chul (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Choi, Euy Jin (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kim, Yong-Lim (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Kim, Yon-Su (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kang, Shin-Wook (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Nam-Ho (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Yang, Chul Woo (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kim, Yong Kyun (Department of Internal Medicine, College of Medicine, The Catholic University of Korea)
  • Received : 2015.04.22
  • Accepted : 2015.07.08
  • Published : 2016.11.01

Abstract

Background/Aims: Inadequacy of dialysis is associated with morbidity and mortality in chronic hemodialysis (HD) patients. Blood flow rate (BFR) during HD is one of the important determinants of increasing dialysis dose. However, the optimal BFR is unclear. In this study, we investigated the impact of the BFR on all-cause mortality in chronic HD patients. Methods: Prevalent HD patients were selected from Clinical Research Center registry for end-stage renal disease cohort in Korea. We categorized patients into two groups by BFR < 250 and ${\geq}250mL/min$ according to the median value of BFR 250 mL/min in this study. The primary outcome was all-cause mortality. Results: A total of 1,129 prevalent HD patients were included. The number of patients in the BFR < 250 mL/min was 271 (24%) and in the $BFR{\geq}250mL/min$ was 858 (76%). The median follow-up period was 30 months. Kaplan-Meier analysis showed that the mortality rate was significantly higher in patients with BFR < 250 mL/min than those with $BFR{\geq}250mL/min$ (p = 0.042, log-rank). In the multi-variate Cox regression analyses, patients with BFR < 250 mL/min had higher all-cause mortality than those with $BFR{\geq}250mL/min$ (hazard ratio, 1.66; 95% confidence interval, 1.00 to 2.73; p = 0.048). Conclusions: Our data showed that BFR < 250 mL/min during HD was associated with higher all-cause mortality in chronic HD patients.

Keywords

Acknowledgement

Supported by : Ministry of Health and Welfare

References

  1. Held PJ, Port FK, Wolfe RA, et al. The dose of hemodialysis and patient mortality. Kidney Int 1996;50:550-556. https://doi.org/10.1038/ki.1996.348
  2. Mandolfo S, Borlandelli S, Ravani P, Imbasciati E. How to improve dialysis adequacy in patients with vascular access problems. J Vasc Access 2006;7:53-59. https://doi.org/10.1177/112972980600700203
  3. Jadoul M, Thumma J, Fuller DS, et al. Modifiable practices associated with sudden death among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Clin J Am Soc Nephrol 2012;7:765-774. https://doi.org/10.2215/CJN.08850811
  4. Singh S, Choi P, Power A, et al. Ten-year patient survival on maintenance haemodialysis: association with treatment time and dialysis dose. J Nephrol 2013;26:763-770. https://doi.org/10.5301/jn.5000234
  5. Hassell DR, van der Sande FM, Kooman JP, Tordoir JP, Leunissen KM. Optimizing dialysis dose by increasing blood flow rate in patients with reduced vascular-access flow rate. Am J Kidney Dis 2001;38:948-955. https://doi.org/10.1053/ajkd.2001.28580
  6. Kimata N, Karaboyas A, Bieber BA, et al. Gender, low Kt/V, and mortality in Japanese hemodialysis patients: opportunities for improvement through modifiable practices. Hemodial Int 2014;18:596-606. https://doi.org/10.1111/hdi.12142
  7. Tentori F, Zhang J, Li Y, et al. Longer dialysis session length is associated with better intermediate outcomes and survival among patients on in-center three times per week hemodialysis: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 2012;27:4180-4188. https://doi.org/10.1093/ndt/gfs021
  8. Pisoni RL, Arrington CJ, Albert JM, et al. Facility hemodialysis vascular access use and mortality in countries participating in DOPPS: an instrumental variable analysis. Am J Kidney Dis 2009;53:475-491. https://doi.org/10.1053/j.ajkd.2008.10.043
  9. Arbor Research Collaborative for Health. DOPPS practice monitor [Internet]. Ann Arbor (MI): Arbor Research Collaborative for Health, c2015 [cited 2015 Dec 16]. Available from: http://www.dopps.org/DPM/Default.aspx.
  10. Bloembergen WE, Stannard DC, Port FK, et al. Relationship of dose of hemodialysis and cause-specific mortality. Kidney Int 1996;50:557-565. https://doi.org/10.1038/ki.1996.349
  11. Borzou SR, Gholyaf M, Zandiha M, Amini R, Goodarzi MT, Torkaman B. The effect of increasing blood flow rate on dialysis adequacy in hemodialysis patients. Saudi J Kidney Dis Transpl 2009;20:639-642.
  12. Kim YO, Song WJ, Yoon SA, et al. The effect of increasing blood flow rate on dialysis adequacy in hemodialysis patients with low Kt/V. Hemodial Int 2004;8:85.
  13. Eknoyan G, Beck GJ, Cheung AK, et al. Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 2002;347:2010-2019. https://doi.org/10.1056/NEJMoa021583
  14. Gutzwiller JP, Schneditz D, Huber AR, Schindler C, Garbani E, Zehnder CE. Increasing blood flow increases kt/V(urea) and potassium removal but fails to improve phosphate removal. Clin Nephrol 2003;59:130-136. https://doi.org/10.5414/CNP59130
  15. Vanholder R, Glorieux G, Eloot S. Once upon a time in dialysis: the last days of Kt/V? Kidney Int 2015;88:460-465. https://doi.org/10.1038/ki.2015.155

Cited by

  1. CD62P and P10 as predictive markers for assessing the efficacy of hemodialysis in treating end‐stage renal disease vol.33, pp.2, 2016, https://doi.org/10.1002/jcla.22662
  2. Assessment of hemodialysis clinical practices using polyaryl ether sulfone-polyvinylpyrrolidone (PAES: PVP) clinical membrane: Modeling of in vitro fibrinogen adsorption, in situ synchrotron-based ima vol.259, pp.None, 2016, https://doi.org/10.1016/j.seppur.2020.118136
  3. Improvement of clinical outcomes in dialysis: No convincing superiority in dialysis efficacy using hemodiafiltration vs high‐flux hemodialysis vol.25, pp.4, 2016, https://doi.org/10.1111/1744-9987.13492
  4. Novel Cellulose Acetate-Based Monophasic Hybrid Membranes for Improved Blood Purification Devices: Characterization under Dynamic Conditions vol.11, pp.11, 2016, https://doi.org/10.3390/membranes11110825