Hemodialysis Facility Practices Linked to Patient Outcomes
Protocol that specifies how often to assess dry weight tied to lower all-cause, CVD mortality
(HealthDay News) -- Certain practices in hemodialysis facilities relating to management of fluid volume and intradialytic hypotension are associated with patient outcomes, according to a study published online in the Clinical Journal of the American Society of Nephrology.
Indranil Dasgupta, DM, from the Heartlands Hospital in Birmingham, England, and colleagues analyzed data from 10,250 patients in 273 facilities across 12 countries to examine correlations between hemodialysis facility practices related to fluid volume and intradialytic hypotension and patient outcomes.
The researchers found that having a protocol that specifies how often to assess dry weight in most patients correlated with lower all-cause and cardiovascular mortality (hazard ratios, 0.78 and 0.72, respectively). There was a correlation for routine orthostatic blood pressure measurement to assess dry weight with lower all-cause hospitalization and cardiovascular events (hazard ratios, 0.86 and 0.85, respectively). Lower cardiovascular mortality was seen in association with routine use of lower dialysate temperature to limit or prevent intradialytic hypotension (hazard ratio, 0.76). Increased all-cause hospitalization was seen with routine use of an on-line volume indicator to assess dry weight (hazard ratio, 1.19). Increased all-cause mortality, cardiovascular mortality, and cardiovascular events were seen in association with routine use of sodium modelling/profiling to limit or prevent intradialytic hypotension (hazard ratios, 1.36, 1.34, and 1.21, respectively).
"The results emphasize the importance of regular and careful clinical assessment of target weight and fluid balance," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
Dasgupta I, Thomas GN, Clarke J, et al. Associations between Hemodialysis Facility Practices to Manage Fluid Volume and Intradialytic Hypotension and Patient Outcomes. Clin J Am Soc Nephrol. DOI:10.2215/CJN.08240718
Davenport A. Differences in Dialysis Center Practices in Determining Hemodialysis Patient Postdialysis Target Weight and Patient Survival and Hospitalizations. Clin J Am Soc Nephrol. February 2019, CJN.15181218 DOI:10.2215/CJN.15181218