Associations between hemodialysis facility practices to manage fluid volume and intradialytic hypotension and patient outcomes

Research output: Contribution to journalArticlepeer-review

Authors

  • Indranil Dasgupta
  • Brian Bieber
  • Manfred Hecking
  • Ronald Pisoni
  • Friedrich Port
  • Bruce Robinson
  • Hugh Rayner

Colleges, School and Institutes

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 a priori), 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.

Details

Original languageEnglish
JournalClinical Journal of the American Society of Nephrology
Volume14
Issue number2
Early online date5 Feb 2019
Publication statusPublished - 7 Feb 2019

Keywords

  • cardiovascular disease, dialysis volume, hemodialysis, hospitalization, mortality risk, renal dialysis, blood pressure, body mass index, sodium, frailty, temperature, dialysis solutions, hypotension, diabetes mellitus, prediabetic state, comorbidity, smoking