Impacts of dialysis adequacy and intradialytic hypotension on changes in dialysis recovery time

BMC Nephrology

Yue Jiao¹  Franklin W. Maddux¹  Len A. Usvyat¹  Ravi Thadhani²  Peter Kotanko³  Jochen G. Raimann³  Juliana El Ghoz Leme⁴  John W. Larkin⁴  Murilo Guedes⁴  Thyago Proença de Moraes⁴  Roberto Pecoits-Filho⁴  Yuedong Wang⁵ 

[1] Global Medical Office, Fresenius Medical Care;Partners HealthCare;Research Division, Renal Research Institute;School of Medicine, Pontifícia Universidade Católica do Paraná;University of California Santa Barbara;

关键词: Dialysis recovery time;    Patient reported outcomes;    Health related quality of life;    Adequacy;    Intradialytic hypotension;   

DOI  :  10.1186/s12882-020-02187-9

来源: DOAJ

【 摘 要 】

Abstract Background Dialysis recovery time (DRT) surveys capture the perceived time after HD to return to performing regular activities. Prior studies suggest the majority of HD patients report a DRT > 2 h. However, the profiles of and modifiable dialysis practices associated with changes in DRT relative to the start of dialysis are unknown. We hypothesized hemodialysis (HD) dose and rates of intradialytic hypotension (IDH) would associate with changes in DRT in the first years after initiating dialysis. Methods We analyzed data from adult HD patients who responded to a DRT survey ≤180 days from first date of dialysis (FDD) during 2014 to 2017. DRT survey was administered with annual KDQOL survey. DRT survey asks: “How long does it take you to be able to return to your normal activities after your dialysis treatment?” Answers are: < 0.5, 0.5-to-1, 1-to-2, 2-to-4, or > 4 h. An adjusted logistic regression model computed odds ratio for a change to a longer DRT (increase above DRT > 2 h) in reference to a change to a shorter DRT (decrease below DRT < 2 h, or from DRT > 4 h). Changes in DRT were calculated from incident (≤180 days FDD) to first prevalent (> 365-to- ≤ 545 days FDD) and second prevalent (> 730-to- ≤ 910 days FDD) years. Results Among 98,616 incident HD patients (age 62.6 ± 14.4 years, 57.8% male) who responded to DRT survey, a higher spKt/V in the incident period was associated with 13.5% (OR = 0.865; 95%CI 0.801-to-0.935) lower risk of a change to a longer DRT in the first-prevalent year. A higher number of HD treatments with IDH episodes per month in the incident period was associated with a 0.8% (OR = 1.008; 95%CI 1.001-to-1.015) and 1.6% (OR = 1.016; 95%CI 1.006-to-1.027) higher probability of a change to a longer DRT in the first- and second-prevalent years, respectively. Consistently, an increased in incidence of IDH episodes/months was associated to a change to a longer DRT over time. Conclusions Incident patients who had higher spKt/V and less sessions with IDH episodes had a lower likelihood of changing to a longer DRT in first year of HD. Dose optimization strategies with cardiac stability in fluid removal should be tested.

【 授权许可】

Unknown