Effect of Ultrafiltration Rate in Long Interdialytic Interval Hemodialysis Session versus Average Weekly Ultrafiltration Rate on Mortality Rate and Adverse Cardiovascular Outcomes in Maintenance Hemodialysis Patients

Kornchanok Vareesangthip; Thawee Chanchairujira; Kriengsak Vareesangthip

doi:10.33192/Smj.2020.53

Authors

Kornchanok Vareesangthip Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 http://orcid.org/0000-0003-2071-1996
Thawee Chanchairujira Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 http://orcid.org/0000-0001-7692-2560
Kriengsak Vareesangthip Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok http://orcid.org/0000-0002-8750-8071

DOI:

https://doi.org/10.33192/Smj.2020.53

Keywords:

ultrafiltration rate, cardiovascular outcomes, mortality, maintenance hemodialysis patients, long interdialytic interval hemodialysis, weekly hemodialysis

Abstract

Objective: Cardiovascular events are more commonly observed during hemodialysis sessions after a long interdialytic interval compared to average weekly hemodialysis sessions, and ultrafiltration rate (UFR) was reported to be associated with cardiovascular outcomes. Whether the UFR during hemodialysis sessions after a long interdialytic interval is a better predictor of cardiovascular outcome than the average weekly UFR is unknown.
Methods: The charts of patients aged >18 years with end-stage renal disease that received hemodialysis treatment Siriraj Hospital during January 2008 to December 2017 were retrospectively reviewed.
Results: Two hundred and forty-one patients (52.8% females) were included. During the median time follow-up of 54 months, the rate of adverse cardiovascular outcomes was 7.26 events/100-patient-years, and the mortality rate was 8.40 deaths/100-patient-years. Mean UFR was significantly higher in the long interdialytic interval hemodialysis sessions than in the average weekly UFR sessions (14.07±5.29 vs.13.13±5.14 ml/h/kg, p<0.001). Compared with UFR of ≤10 ml/h/kg, the adjusted hazard ratio (HR) for mortality in the UFR >13 ml/hour/kg subgroup was 1.29 (95% CI: 0.65-2.56) and 1.05 (95% CI: 0.55-2.03) in the long interdialytic interval hemodialysis sessions and the average weekly UFR, respectively. The adjusted HR for adverse cardiovascular outcome in the UFR >13 ml/h/kg subgroup was 1.32 (95% CI: 0.64-2.80) and 0.72 (95% CI: 0.36-1.35) in the long interdialytic interval hemodialysis sessions and the average weekly UFR, respectively.
Conclusion: This study revealed the UFR in long interdialytic hemodialysis sessions to be more strongly associated with adverse cardiovascular outcomes and all-cause mortality than the average weekly UFR.

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