Post-dialysis Weight Research Articles

Safety and efficacy of very low calorie diet in patients receiving haemodialysis therapy.

Very low calorie diets (VLCDs) are an obesity treatment option in the general population, but their efficacy and safety in patients on haemodialysis (HD) is unknown. Prospective single arm study of VLCD in haemodialysis patients. All participants received 2.5-3.3MJ/day for 12weeks. Weekly assessment of VLCD, pre- and post-dialysis weight, inter-dialytic weight gain, and blood electrolytes occurred for the first 4 weeks, then fortnightly for another 8 weeks. Linear mixed models compared the change in weight over time as well as biochemical outcomes including potassium. Twenty-two participants [nine home HD (HHD) and 13 satellite HD (SHD)] enrolled with 19 completing the 12-week intervention. Mean post-dialysis weight declined from 121.1kg at baseline to 109.9 at week 12 resulting in average decline of 0.88kg per week (95% C.I. 0.71, 1.05, P<.001) with 12-week mean percentage weight loss9.3% (SD 3.5). Mean post-dialysis body mass index declined from 40.9kg/m2 at baseline to 37.1kg/m2 at week 12 (95% C.I. 0.25, 0.35, P<.001). Serum potassium rose from week 1 to 3, stabilized during weeks 4 to 6, and fell from week 8, returning near baseline by week 12. Six of the nine (66.6%) HHD participants and seven of the 13 (70%) SHD participants had at least one episode of hyperkalaemia (K>6mmol/l). There were no clinical changes in serum sodium, corrected calcium, or phosphate levels during the study. VLCD with dietitian supervision was effective in producing significant weight reduction, with an acceptable safety profile in patients treated with haemodialysis.

#811 Effect of GLP-1 receptor agonists on the weight, urea distribution volume and blood pressure of hemodialysis (HD) patients

Abstract Background and Aims Glucagon-like-peptide-1 receptor agonists (GLP-1) drugs are a class of medications commonly used to treat type-2 diabetes. Diabetes is prevalent in almost 60% of the end stage kidney disease (ESKD) patients and an increasing number of dialysis patients use GLP-1 drugs. It is important to note that GLP-1 drugs may have additional benefits such as weight loss and potential cardiovascular benefits. However, little is known about the effects of these drugs in dialysis patients. We analysed the changes in body weight and blood pressure in hemodialysis (HD) patients who start using these drugs. We also analysed whether there are changes in patients’ urea distribution volume, a proxy of lean body mass, to understand whether these medications affect muscle mass. Method We retrospectively evaluated 236 ESKD patients who were prescribed GLP-1 drugs as part of routine clinical care in October of 2023 at clinics in a large dialysis organization. All patients received dialysis for at least 60 days before and after they started using the medication. We looked at the changes in the average post dialysis weight, urea distribution volume, and pre dialysis systolic blood pressure (pre-SBP) between the 60 days before using GLP-1 drugs (pre-GLP1 period) and 60 days after initiating the drug (post-GLP1 phase). For each metric, we performed a paired t-test to evaluate the changes between pre-GLP1 and post-GLP1. Results The average post dialysis weight pre-GLP1 was 103.98 kg and the average post dialysis weight post-GLP1 was 102.02 kg (difference: −1.96 kg, 95% CI :1.37 to 4.27, p-value &amp;lt;0.001). The average urea distribution volume was 36.0 L pre-GLP1, and 35.6 L post-GLP1 (difference: −0.47 L, 95% CI: −0.99 to 3.56, p-value=0.07). The mean pre-SBP was 147.83 mmHg pre-GLP1 and 149.67 mmHg post-GLP1 (difference: 1.85 mmHg, 95% CI: −5.49 to 24.93, p=0.29). Conclusion Our analysis showed a significant decrease in the average post dialysis weight of HD patients using GLP-1 drugs. While the decline in patients' urea distribution volume, which can be considered as a proxy for lean tissue mass, was not statistically significant, it may be clinically meaningful. We do not see a significant change in pre-SBP. Reductions in weight may suggest reduction in fat and muscle mass but can also be due to “regression to the mean” phenomena as patients who were on these medications tended to be larger. Further studies are necessary to evaluate this association.

Dialysis parameters associated with SARS-CoV-2 infection and prognosis in end-stage kidney disease

Background The Covid-19 pandemic has affected patients with end-stage kidney disease (ESKD). Whether dialysis parameters have a prognostic value in ESKD patients with Covid-19 remains unclear. Materials and Methods We retrospectively evaluated clinical characteristics, blood pressure (BP) and dialysis parameters in ESKD patients undergoing maintenance outpatient hemodialysis, with (Covid-ESKD) and without (No-Covid-ESKD) Covid-19, at four Brazilian hemodialysis facilities. The Covid-ESKD (n = 107; 54% females; 60.8 ± 17.7 years) and No-Covid-ESKD (n = 107; 62% females; 58.4 ± 14.6 years) groups were matched by calendar time. The average BP and dialysis parameters were calculated during the pre-infection, acute infection, and post-infection periods. The main outcomes were Covid-19 hospitalization and all-cause mortality. Results Covid-ESKD patients had greater intradialytic and postdialysis systolic BP and lower predialysis weight, postdialysis weight, ultrafiltration rate, and interdialytic weight gain during acute-illness compared to 1-week-before-illness, while these changes were not observed in No-Covid-ESKD patients. After 286 days of follow-up (range, 276–591), there were 18 Covid-19-related hospitalizations and 28 deaths among Covid-ESKD patients. Multivariable logistic regression analysis showed that increases in predialysis systolic BP from 1-week-before-illness to acute-illness (OR, 95%CI = 1.06, 1.02–1.10; p = .004) and Covid-19 vaccination (OR, 95%CI = 0.16, 0.04–0.69; p = .014) were associated with hospitalization in Covid-ESKD patients. Multivariable Cox-regression analysis showed that Covid-19-related hospitalization (HR, 95%CI = 5.17, 2.07–12.96; p < .001) and age (HR, 95%CI = 1.05, 1.01–1.08; p = .008) were independent predictors of all-cause mortality in Covid-ESKD patients. Conclusion Acute Covid-19 illness is associated with variations in dialysis parameters of volume status in patients with ESKD. Furthermore, increases in predialysis BP during acute Covid-19 illness are associated with an adverse prognosis in Covid-ESKD patients.

Association between home meal preparers and salt intake in haemodialysis patients: a cross-sectional study

ObjectivesThis study aimed to examine the association between home meal preparer and salt intake among haemodialysis patients, including daily dietary status. We hypothesised that salt intake is higher among individuals...

Comparison of uremic toxin removal between expanded hemodialysis and high volume online hemodiafiltrations in different modes.

Various high-efficiency hemodialysis techniques exist, including different online high- volume hemodiafiltration (HDF) modes and expanded hemodialysis (HDx) utilizing dialyzers with medium cut-off (MCO) membranes. This study aimed to evaluate the efficacy of uremic toxin removal among four modalities: (I) HDx, (II) pre-dilution HDF (PRE-HDF), (III) mixed-dilution HDF (MIX-HDF), and (IV) post-dilution HDF (POST-HDF), each applied for 1week in a randomized order. This research was a single-center, prospective, open-label, exploratory crossover study. The reduction ratio (RR) for small molecular toxins (urea and phosphate), a middle molecular toxin (beta-2-microglobulin, β2M), a large-middle molecular toxin (Chitinase-3-like protein 1, YKL-40), and a protein- bound uremic toxin (indoxyl sulfate, IS) was evaluated during a single mid-week dialysis session. Twelve patients were included, with an average age of 52.5 ± 15.47years and an average dialysis duration of 42.05 ± 31.04months. The dialysis parameters, including; post-dialysis weight, session duration, dialysate composition, blood and dialysate flow; rates, dialysate temperature, and anticoagulation dosage, were maintained consistently across all modalities. No significant differences in RR for urea, phosphate, β2M, YKL-40, and IS were observed between the treatments. Although the highest IS clearance, though not statistically significant, was observed with POST-HDF and HDx, the differences were not substantial enough to favor any particular modality as the most effective.

#3525 TRANSITION BETWEEN NUTRITION CATEGORIES IN HEMODIALYSIS PATIENTS

Abstract Background and Aims We have previously characterized four nutritional categories in hemodialysis (HD) patients, evaluated by the method of ICNDS (Integrative Clinical Nutrition Dialysis Score) and slope of three subsequent monthly scores. Category 1 appeared to have the best and category 4 the worst nutritional status [1]. The aim of this study was to explore the association between nutritional category at dialysis initiation, survival, Length of Stay in hospital (LOS), and transition between nutrition categories up to 12 months following dialysis initiation. Methods Two hundred twenty-six patients who started dialysis between March 2009 and March 2019 were enrolled in the study. Scoring method of the ICNDS is based on the following 7 parameters: albumin, percentage post dialysis weight change, creatinine, urea, cholesterol, CRP, and Kt/V. We calculated the slope of first three subsequent monthly scores of each patient at HD commencement and 12 months later. Cox proportional hazard model was used to present differences in mortality hazard ratio (HR) during the first year in dialysis between four categories of patients. We used the analysis of variance and post hoc Bonferroni test to analyze differences in hospitalization frequency and LOS between the four categories during first year in dialysis. We used the Pearson chi-square test to analyze transition between categories between dialysis initiation and one year after. Results Baseline nutritional category is associated to all-cause mortality HR (χ2 = 16.402, df = 3, P = 0.051). Patients enrolled to category 2,3 and 4 at dialysis initiation were significantly associated with increased mortality HR compared to patients in category 1 (category 4: HR = 3.951, 95% CI 1.218-12.812, P = 0.022; category 3: HR = 2.705, 95% CI 1.126-6.497, P = 0.026; category 2: HR = 1.778, 95% CI 0.631-5.064, P = 0.027). LOS during first year in dialysis is significantly affected by patient nutritional category at dialysis initiation, (F = 4.671, df = 3, P = 0.003). LOS is lower in patients of category 1 and 2 compared with category 3 and 4 (between categories 1 and 4, P = 0.006; between categories 1 and 3, P = 0.03). Hospitalization frequency is not affected by patient nutritional category (F = 1.705, df = 3, P = 0.167). Pearson chi-square showed no differences in transition between the four categories between dialysis initiation and one year after (χ2 = 6.763, df = 3, P = 0.149). Conclusion Nutrition status at dialysis commencement is a main prognostic factor, transition between nutrition categories during first year in dialysis exists and may prove in future to be associated with patients’ survival.

Results of Salt Intake Restriction Monitored with the New Sodium Control Biosensor

Introduction: Adherence to a low-sodium (Na) diet is crucial in patients under hemodialysis, as it improves cardiovascular outcomes and reduces thirst and interdialytic weight gain. Recommended salt intake is lower than 5 g/day. The new 6008 CAREsystem monitors incorporate a Na module that offers the advantage of estimating patients’ salt intake. The objective of this study was to evaluate the effect of dietary Na restriction for 1 week, monitored with the Na biosensor. Methods: A prospective study was conducted in 48 patients who maintained their usual dialysis parameters and were dialyzed with a 6008 CAREsystem monitor with activation of the Na module. Total Na balance, pre-/post-dialysis weight, serum Na (sNa), changes in pre- to post-dialysis sNa (ΔsNa), diffusive balance, and systolic and diastolic blood pressure were compared twice, once after 1 week of patients’ usual Na diet and again after another week with more restricted Na intake. Results: Restricted Na intake increased the percentage of patients on a low-Na diet (<85 Na mmol/day) from 8% to 44%. Average daily Na intake decreased from 149 ± 54 to 95 ± 49 mmol, and interdialytic weight gain was reduced by 460 ± 484 g per session. More restricted Na intake also decreased pre-dialysis sNa and increased both intradialytic diffusive balance and ΔsNa. In hypertensive patients, reducing daily Na by more than 3 g Na/day lowered their systolic blood pressure. Conclusions: The new Na module allowed objective monitoring of Na intake, which in turn could permit more precise personalized dietary recommendations in patients under hemodialysis.

Pilot Study of a Wearable Hydration Monitor in Haemodialysis Patients: Haemodialysis Outcomes & Patient Empowerment Study 02

Introduction: We aimed to assess the validity and reproducibility of a wearable hydration device in a cohort of maintenance dialysis patients. Methods: We conducted a prospective, single-arm observational study on 20 haemodialysis patients between January and June 2021 in a single centre. A prototype wearable infrared spectroscopy device, termed the Sixty device, was worn on the forearm during dialysis sessions and nocturnally. Bioimpedance measurements were performed 4 times using the body composition monitor (BCM) over 3 weeks. Measurements from the Sixty device were compared with the BCM overhydration index (litres) pre- and post-dialysis and with standard haemodialysis parameters. Results: 12 out of 20 patients had useable data. Mean age was 52 ± 12.4 years. The overall accuracy for predicting pre-dialysis categories of fluid status using Sixty device was 0.55 [K = 0.00; 95% CI: −0.39–0.42]. The accuracy for the prediction of post-dialysis categories of volume status was low [accuracy = 0.34, K = 0.08; 95% CI: −0.13–0.3]. Sixty outputs at the start and end of dialysis were weakly correlated with pre- and post-dialysis weights (r = 0.27 and r = 0.27, respectively), as well as weight loss during dialysis (r = 0.31), but not ultrafiltration volume (r = 0.12). There was no difference between the change in Sixty readings overnight and the change in Sixty readings during dialysis (mean difference 0.09 ± 1.5 kg), [t(39) = 0.38, p = 0.71]. Conclusion: A prototype wearable infrared spectroscopy device was unable to accurately assess changes in fluid status during or between dialysis sessions. In the future, hardware development and advances in photonics may enable the tracking of interdialytic fluid status.

Ultrafiltration Rate Levels in Hemodialysis Patients Associated with Weight-Specific Mortality Risks.

We hypothesized that the association of ultrafiltration rate with mortality in hemodialysis patients was differentially affected by weight and sex and sought to derive a sex- and weight-indexed ultrafiltration rate measure that captures the differential effects of these parameters on the association of ultrafiltration rate with mortality. Data were analyzed from the US Fresenius Kidney Care (FKC) database for 1 year after patient entry into a FKC dialysis unit (baseline) and over 2 years of follow-up for patients receiving thrice-weekly in-center hemodialysis. To investigate the joint effect of baseline-year ultrafiltration rate and postdialysis weight on survival, we fit Cox proportional hazards models using bivariate tensor product spline functions and constructed contour plots of weight-specific mortality hazard ratios over the entire range of ultrafiltration rate values and postdialysis weights (W). In the studied 396,358 patients, the average ultrafiltration rate in ml/h was related to postdialysis weight (W) in kg: 3W+330. Ultrafiltration rates associated with 20% or 40% higher weight-specific mortality risk were 3W+500 and 3W+630 ml/h, respectively, and were 70 ml/h higher in men than in women. Nineteen percent or 7.5% of patients exceeded ultrafiltration rates associated with a 20% or 40% higher mortality risk, respectively. Low ultrafiltration rates were associated with subsequent weight loss. Ultrafiltration rates associated with a given mortality risk were lower in high-body weight older patients and higher in patients on dialysis for more than 3 years. Ultrafiltration rates associated with various levels of higher mortality risk depend on body weight, but not in a 1:1 ratio, and are different in men versus women, in high-body weight older patients, and in high-vintage patients.

Optimization of Dry Weight Assessment in Hemodialysis Patients via Reinforcement Learning.

Dry weight (DW), defined as the lowest tolerated postdialysis weight following the ultrafiltration (UF) of excess fluid volume, is essential for any dialysis prescription for hemodialysis (HD) patients. However, there is no gold standard for DW assessment, and the difficulty of its accurate assessment increases given individual variations and the dynamic changes caused by the uncertainty of patients' condition. Therefore, the current empirical evaluation process is often crude, imprecise, experience-dependent, and energy-consuming. Here, we highlight the personalized dynamic changes in DW over time rather than the more accurate DW assessments at some point in time and formulate the DW evaluation problem into a sequential decision-making process using the Markov decision process (MDP) framework. A reinforcement learning (RL) algorithm based on a dueling double deep Q-network (Duel-DDQN) is proposed to optimize the DW assessment policy, and a multifaceted inspection is applied to assess policy effectiveness and safety. We utilize ten years of data from the Kidney Disease Center, enrolling 750 HD patients and 243,287 dialysis sessions. Good model calibration is confirmed, and off-policy evaluation demonstrates that our policy outperforms other policies, suggesting a decrease of 7.71% in the expected 5-year mortality rate and of 13.44% in the incidence of intradialytic symptoms compared with those of clinicians' strategy. The RL policy adjusts DW more frequently, responds to DW changes more actively, and observes a larger feature space. It is hoped that the proposed solution will help clinicians assess and monitor DW dynamically, making the estimation process more refined, personalized, and intelligent.

Ultrafiltration Rate Thresholds Associated With Increased Mortality Risk in Hemodialysis, Unscaled or Scaled to Body Size

IntroductionOne proposed threshold ultrafiltration rate (UFR) of concern in hemodialysis patients is 13 ml/h per kg. We evaluated associations among UFR, postdialysis weight, and mortality to determine whether exceeding such a threshold would result in similar levels of risk for patients of different body weights.MethodsData were analyzed in this retrospective cohort study for 1 year following dialysis initiation (baseline) and over 2 years of follow-up in incident patients receiving thrice-weekly in-center hemodialysis. Patient-level UFR was averaged over the baseline period. To investigate the joint effect of UFR and postdialysis weight on survival, we fit Cox proportional hazards models using bivariate tensor product spline functions, adjusting for sex, race, age, diabetes, and predialysis serum albumin, phosphorus, and systolic blood pressure (BP). We constructed contour plots of mortality hazard ratios (MHRs) over the entire range of UFR values and postdialysis weights.ResultsIn the studied 2542 patients, UFR not scaled to body weight was strongly associated with MHR, whereas postdialysis weight was inversely associated with MHR. MHR crossed 1.5 when unscaled UFR exceeded 1000 ml/h, and this relationship was largely independent of postdialysis weight in the range of 80 to 140 kg. A UFR warning level associated with a lower MHR of 1.3 would be 900 ml/h, whereas the UFR associated with an MHR of 1.0 was patient-size dependent. The MHR when exceeding a UFR threshold of 13 ml/h per kg was dependent on patient weight (MHR = 1.20, 1.45, and >2.0 for a 60, 80, and 100 kg patient, respectively).ConclusionUFR thresholds based on unscaled UFR give more uniform risk levels for patients of different sizes than thresholds based on UFR/kg.

Association of the COVID-19 pandemic with increased adherence among prevalent hemodialysis patients.

During the COVID-19 pandemic, there has been a reduction in emergency department visits and hospital admissions. We hypothesized that hemodialysis patients were decreasing their hospital visits and increasing their dialysis adherence during the COVID-19 pandemic. This is a retrospective analysis of hemodialysis patients treated in the seven American Renal Associates (ARA) dialysis centers in the Dallas-Fort Worth metropolitan area. We conducted a "before-and-after" study using existing clinical data to examine patient adherence with hemodialysis between January 1 and March 14, 2020 (pre-COVID) and March 15 to May 18, 2020 (COVID) time periods. Data points included missed treatments, shortened treatments, post-dialysis weight, and hospital visits. Finally, we conducted an anonymous survey in which patients reported their hemodialysis adherence. Data analysis was performed on 556 patients. Significantly fewer patients missed a single treatment in the COVID vs. pre-COVID time periods (44.1 vs. 58.6%; p < 0.001). Significantly fewer patients finished their treatment with a post-dialysis weight more than 1 kg above their estimated dry weight in the COVID vs. pre-COVID time periods (31.7 vs. 38.9%, p = 0.01). Finally, there was a reduction in total hospital visits during the COVID vs. pre-COVID periods (12.6 vs. 19.4%; p = 0.002). The anonymous survey showed patients reporting increased adherence with hemodialysis and restriction of salt and water intake. The COVID time period was associated with increased adherence with hemodialysis and decreased hospital visits, and patients were conscious of these changes.

Evaluation of dialysis adequacy based on Kt/V and its related factors among patients undergoing hemodialysis in Guilan dialysis centers

Introduction: Adequate and effective dialysis can improve patients’ quality of life and reduce kidney failure complications and mortality in end-stage renal disease on hemodialysis. Objectives: This study aimed to evaluate dialysis adequacy based on Kt/V and its related factors among patients undergoing hemodialysis. Patients and Methods: This cross-sectional, multi-center study was conducted during six months on hemodialysis patients referred to dialysis centers of the Guilan province in the north of Iran. Dialysis adequacy was evaluated using Kt/V (&gt;1.2) criteria. Results: The mean Kt/V was 1.24±0.36 with a median of 1.2. Adequacy of dialysis was desirable in 51.2% of the patients. There was a significant and inverse relationship between body mass index (BMI) and Kt/V (r=-0.139, P=0.013). The relationship between Kt/V criterion and pre-dialysis weight (r=-0.310, P=0.00) and post-dialysis weight (r=-0.314, P=0.00) were inverse. The Kt/V criterion was significantly associated with calcium (Ca) level and the patients with normal Ca level had a higher adequacy than those in the other levels of Ca [normal versus low level, mean difference (MD]: 0.19±0.06; normal versus high level, MD: 0.07±0.04, P&lt;0.001). The Kt/V criterion was inversely related to blood pressure and temperature before and after dialysis (P&lt;0.05). Conclusion: The present study showed a close correlation between blood pressure, Ca level and BMI with dialysis adequacy based on Kt/V criteria. The findings obtained here suggested treatment strategies based on correction of Ca levels, BMI and blood pressure prior to dialysis to increase the adequacy of dialysis.

Prevalence and Predictors of Heart Failure among Patients on Maintenance Hemodialysis Therapy at Tertiary Care Hospitals

Background and Aim: The incidence of heart failure among hemodialysis patients predicts poor outcomes. Hypertension, aging, and diabetes mellitus are traditional risk factors for heart failure which may not predict heart failure accurately. Heart failure might be caused by other factors. The present study aims to determine the prevalence and predictors of heart failure among patients on maintenance hemodialysis. Methodology: This cross-sectional study was carried out on 142 hemodialysis patients in the department of Cardiology, PNS Shifa Hospital Karachi and King Abdullah Teaching hospital Mansehra for duration of six months from 5th March 2021 to 4th September 2021. All the patients having age above 16 years and who underwent at least three months of dialysis therapy were enrolled. Patients with severe respiratory distress and mentally incapacitated were excluded. Questionnaire-based Pro-forma was used for collecting patient’s demographic details, clinical details such as human immunodeficiency virus (HIV) disease, heart failure symptoms, hyperlipidemia, angina, and presence of diabetes, etc., and dialysis-related clinical information. Stadiometer and standard weight scale were used for height and post-dialysis weight also known as dry weight respectively. A monthly dose of erythropoietin (EPO) was taken from medical records. Based on the blood sample, albumin, ferritin, urea, complete blood count, C-reactive protein (CRP), and total cholesterol were measured. SPSS version 21 was used for data analysis. Results:Out of 142 hemodialysis patients, 105 (73.9%) were male and 37 (26.1%) were females. Overall mean age was 46.74 ± 11.62 years. Of the total 142 patients, the prevalence of hypertension and diabetes mellitus was 138 (97.2%) and 73 (51.4%) respectively. The incidence of heart failure was 21 (14.8%). The incidence of hypertension, anemia, and angina were heart failure autonomousprognosticators on multivariate analysis. A higher score of malnutrition inflammation and resistance index for erythropoietin was found in heart failure patients. Conclusion: Our study found that heart failure is significantly associated with anemia, angina, and hypertension in hemodialysis patients. Malnutrition–inflammation complex and erythropoietin resistance were more prevalent in patients with heart failure. These conditions necessitate a thorough cardiac evaluation and appropriate treatment. Keywords: Heart Failure, Hemodialysis, Hypertension. Angina

Soft Target Weight: Theory and Simulation of a Novel Haemodialysis Protocol Which Reduces Excessive Ultrafiltration

Introduction: Excessive ultrafiltration is associated with intra-dialytic symptoms, loss of residual function, and mortality in haemodialysis patients. A major contributor to excessive ultrafiltration is within-individual variation in pre-dialysis weight and the concept of achieving a fixed target weight by the end of each dialysis session. Haemodialysis protocols which allow variable post-dialysis weight have not been proposed. Methods: Weight variation was observed in haemodialysis patients and healthy controls to estimate the proportion of pre-dialysis weight variation which could be considered natural variation. These estimates were used to derive a novel protocol for setting ultrafiltration, which was evaluated by mathematical modelling. Results: Amongst 20 haemodialysis patients, mean (SD) pre-dialysis weight was 102.74 (0.94)% of target weight after a 2-day gap and 103.50 (0.94)% after a 3-day gap. Amongst 10 healthy individuals, mean (SD) daily weight was 100.0 (0.71)% of average weight. A 4-component model of pre-dialysis weight was derived using these estimates, in which the best estimate of pre-dialysis excess fluid is the midpoint of excess weight and average fluid gain, and used to propose a novel protocol for ultrafiltration setting. In simulations, the novel protocol reduced ultrafiltration variation by more than half (standard deviation 0.6 vs. 1.3% of target weight, p < 0.001), without increasing the variation in post-dialysis fluid excess. Excessive ultrafiltration rates (over 13 mL/h/kg) were far less frequent using this protocol (2.6% vs. 7.5% of sessions, p = 0.001). Conclusion: Considering natural weight variation allows the development of a novel protocol for ultrafiltration in which target weight does not have to be achieved precisely: it is therefore a soft target. This protocol, which is predicted to substantially reduce excessive ultrafiltration variation, is a zero-cost intervention with the potential to improve symptoms and clinical outcome for haemodialysis patients.

Ultrafiltration rate adjusted to body weight and mortality in hemodialysis patients

Background and aimsMortality among hemodialysis patients remains high. An elevated ultrafiltration rate adjusted by weight (UFR/W) has been associated with hypotension and higher risk of death and/or cardiovascular events. MethodsWe evaluated the association between UFR/W and mortality in 215 hemodialysis patients. The mean follow-up was 28 ± 6.12 months. We collected patients’ baseline characteristics and mean UFR/W throughout the follow-up. ResultsMean UFR/W was 9.0 ± 2,4 and tertiles 7.1 y 10.1 mL/kg/h. We divided our population according to the percentage of sessions with UFR/W above the limits described in the literature associated with increased mortality (10.0 ml/kg/h and 13.0 mL/kg/h). Patients with higher UFR/W were younger, with higher interdialytic weight gain and weight reduction percentage but lower dry, pre and post dialysis weight. Throughout the follow-up, 46 (21.4%) patients died, the majority over 70 years old, diabetic or with cardiovascular disease. There were neither differences regarding mortality between groups nor differences in UFR/W among patients who died and those who did not. Contrary to previous studies, we did not find an association between UFR/W and mortality, maybe due to a higher prevalence in the use of cardiovascular protection drugs and lower UFR/W. ConclusionsThe highest UFR/W were observed in younger patients with lower weight and were not associated with an increased mortality.

MO656CORRELATION BETWEEN CHANGES IN THE BODY FLUID VOLUME CALCULATED BY THE URIC ACID KINETIC MODEL AND CHANGES IN THE BODY WEIGHT*

Abstract Background and Aims Uric acid (UA) is a solute unable to cross the cell membranes in general tissues by any of simple diffusion, facilitated diffusion or active transport. These facts imply that UA distribution volume (UDiV) equals to the extracellular fluid volume (ECFV). We have developed a method for calculating UDiV from serum uric acid levels before and after hemodialysis based on a uric acid kinetic model (Shinzato T, Int J Artif Organs 2020). Urea is evenly distributed throughout the body fluids. Therefore, the total body fluid volume (TBFV) can be calculated by using the same method as the calculation of UDiV for the serum urea level. The remaining body fluid volume, which is TBFV minus UDiV, is considered to reflect the intracellular fluid volume (ICFV). In this study, we clarified the relationship between the amount of change over time in UDiV and ICFV calculated by the uric acid kinetic model and the amount of change over time in the actual body weight of hemodialysis patients. Method Subjects were 1,101 patients with chronic maintenance hemodialysis. UDiV and ICFV before and after dialysis were calculated for two time points, December 2019 and June 2020. Results The amount of change in UDiV per body during the dialysis session showed a very good correlation with the amount of body weight change during the same dialysis (UDiV change = 0.950 x body weight change - 0.158, R-square 0.90, p &amp;lt; 0.0001). The amount of change in ICFV during the 6 months from December 2019 to June 2020 showed a good correlation with the amount of change in post-dialysis body weight during the same period (ICFV change = 0.270 x post-dialysis body weight change + 0. 240, R-square 0.21, p &amp;lt;0.0001). Conclusion These results suggest that the body fluid volume calculated by the uric acid kinetic model has high accuracy.

40. THE RELATION BETWEEN INTERDIALYTIC WEIGHT GAIN AND INTRADIALYTIC HYPERTENSION IN PATIENTS WITH CHRONIC KIDNEY DISEASE WITH ROUTINE HEMODIALYSIS IN PROF. DR. R.D. KANDOU GENERAL HOSPITAL MANADO

Background: Chronic kidney disease (CKD) is a pathological process hallmarked by progressive decline of kidney function and most likely end up in kidney failure state. Hemodialysis (HD) is one of the main therapy for CKD, where the goal is to replace renal function in maintaining fluid and acid-base-electrolyte balance, excreting metabolism waste and controlling blood pressure. Intradialytic hypertension (IDH) is a possible complication during HD. Interdialytic Weight Gain (IDWG) is a risk factor of IDH. Objective: To acknowledge relation between IDWG and IDH incidence in CKD patients. Method: This is analytic observational cross sectional study that was carried out from November–December 2020. Patients with CKD aged ≥18 years old and had routine HD twice a week for at least 3 months. IDWG = [(current pre dialysis weight – previous post dialysis weight)/dry weight × 100%]. Dry weight was defined by body weight without clinical sign of fluid retention. IDWG were categorized into 3 groups: &lt;3% (group I); 3.1–3.9% (group II); &gt;3.9% (group III). IDH was defined by increasing in systolic blood pressure &gt;10 mmHg after at least 4 of 6 consecutive HD sessions. Blood pressure was measured 30 minutes before and after HD. Patients who did not finish at least 4 HD sessions, refused informed consent, and whose body weight unobtainable were excluded. Data was analyzed using chi square with significance level of p &lt; 0.05 and confidence interval (CI) 95%. Result: 140 patients were included in this study (70 male, 70 female). IDH were found in all 3 IDWG groups: group I 37%, group II 80%, and group III 93.1%. Data analysis showed a significant relation between IDWG and IDH (p = 0.0001). Conclusion: There is a significant relation between IDWG and incidence of IDH.

Tasa de ultrafiltración horaria ajustada a peso corporal y mortalidad en hemodiálisis

Background and aimsMortality among hemodialysis patients remains high. An elevated ultrafiltration rate adjusted by weight (UFR/W) has been associated with hypotension and higher risk of death and/or cardiovascular events. MethodsWe evaluated the association between UFR/W and mortality in 215 hemodialysis patients. The mean follow-up was 28 ± 6.12 months. We collected patientś baseline characteristics and mean UFR/W throughout the follow-up. ResultsMean UFR/W was 9.0 ± 2,4 and tertiles 7.1 y 10.1 mL/kg/h. We divided our population according to the percentage of sessions with UFR/W above the limits described in the literature associated with increased mortality (10.0 mL/kg/h and 13.0 mL/kg/h). Patients with higher UFR/W were younger, with higher interdialytic weight gain and weight reduction percentage but lower dry, pre and post dialysis weight. Throughout the follow-up, 46 (21.4%) patients died, the majority over 70 years old, diabetic or with cardiovascular disease. There were neither differences regarding mortality between groups nor differences in UFR/W among patients who died and those who did not. Contrary to previous studies, we did not find an association between UFR/W and mortality, maybe due to a higher prevalence in the use of cardiovascular protection drugs and lower UFR/W. ConclusionsThe highest UFR/W were observed in younger patients with lower weight and were not associated with an increased mortality.

Association between pill burden and interdialytic weight gain in patients with hemodialysis: A multi-center cross-sectional study.

High daily pill burden affects quality of life and mortality. High interdialytic weight gain (IDWG) is associated with increased mortality. We examined the association between pill burden and IDWG in hemodialysis patients. This cross-sectional study was conducted in six dialysis centers in Japan in June 2017. The exposure was the number of daily tablets, and outcome was defined as 1 day of relative IDWG divided by post-dialysis weight from the previous session. Among 188 outpatients (mean age, 68.7 [SD, 10.3] years; men, 67.0%; median dialysis vintage, 76.0 [interquartile range, 36.5, 131.5] months), the mean number of daily tablets was 19.7 ± 9.9, and mean relative weight gain was 3.5 ± 1.2%. Multiple linear regression analysis showed a regression coefficient of 0.021 (95% confidence interval: 0.004-0.039), indicating that one additional tablet prescription increased the IDWG by 0.021%. In hemodialysis patients, the daily pill burden was a significant, independent risk for increased relative IDWG.