Abstract
BackgroundFluid overload (FO) assessed by bioimpedance spectroscopy (BIS) is associated with higher mortality risk in maintenance haemodialysis (HD). The aim was to assess if a better management of FO through short daily haemodialysis (SDHD) could improve survival.MethodsRetrospective analysis of patients who were on HD 3 sessions/week for at least 3 months and shifted to in-centre SDHD (5 or 6 sessions/week, 2 to 3 h/session) between July 2012 and June 2016 at 23 dialysis units in Brazil. The 12-month risk of death was analysed according to the predialysis hydration status measured before and 6 months after initiation of SDHD. Predialysis hydration status was considered adequate when FO ≤15% of extracellular volume.ResultsA total of 297 patients on SDHD were included in the analysis. Their median age was 57 (IQR 45–67) years, 62% were males, 44% diabetics, 57% on 6 dialysis sessions/week, with a median session duration of 130 (IQR 120–150) minutes. BIS assessment at initiation of the SDHD regimen was performed in 220 patients and FO > 15% was found in 46.4%. Twelve-month survival rates for those with FO ≤15 and > 15% before initiating SDHD were 87.4 and 88.0%, respectively (P = 0.92). BIS analysis when completing 6 months on SDHD were available for 229 patients, 26.6% with FO > 15%. The survival rates for the next 12 months (from the 6th to the 18th month of follow-up) for those with FO ≤15 and > 15% were 91.0 and 72.0%, respectively (P = 0.0006). In a Cox regression model, after adjustment for demographic, clinical and laboratory variables, FO ≤ 15% persisted associated with a lower mortality risk (hazard ratio 0.34, 95%CI 0.13–0.87).ConclusionsMoving from conventional HD to SDHD was associated with better control of excessive extracellular volume. Patients who reached or maintained predialysis fluid overload ≤15% after initiating SDHD presented a lower risk of death.
Highlights
Fluid overload (FO) assessed by bioimpedance spectroscopy (BIS) is associated with higher mortality risk in maintenance haemodialysis (HD)
We analyse if better management of overhydration through short daily haemodialysis (SDHD) could have a positive impact on survival. This is a retrospective analysis of adult patients (≥18 years old) from 23 dialysis facilities in Brazil on HD 3 sessions/week for at least three months who were shifted to in-centre SDHD between July 2012 and June 2016
Clinical, laboratory and BIS data were extracted from the European Clinical Dialysis Database (EuCliD®), a standardized electronic medical record used by all participating centres
Summary
Fluid overload (FO) assessed by bioimpedance spectroscopy (BIS) is associated with higher mortality risk in maintenance haemodialysis (HD). The establishment of HD prescription of a 3 to 4 h sessions, 3 times a week was not based on clinical outcomes. Such dialysis schedule was conceived in the 1970s to face economical and logistic challenges and devised to accommodate a greater number of patients with end-stage renal disease [3]. Short daily haemodialysis (SDHD) can improve extra-cellular volume management leading to a better blood pressure control and reduction of left ventricular mass as compared to the 3-session per week HD regimen [4]. Small clinical trials have shown that the use of bioimpedance to guide the volume management improved blood pressure control, decreased left ventricular mass and reduced mortality [5, 6]
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