Association of Ultrafiltration Rate with Mortality in Incident Hemodialysis Patients
- Authors
- Kim, Tae Woo; Chang, Tae Ik; Kim, Tae Hee; Chou, Jason A.; Soohoo, Melissa; Ravel, Vanessa A.; Kovesdy, Csaba P.; Kalantar-Zadeh, Kamyar; Streja, Elani
- Issue Date
- 2018
- Keywords
- Ultrafiltration; Ultrafiltration rate; Mortality; Hemodialysis
- Citation
- Nephron, v.139, no.1, pp 13 - 22
- Pages
- 10
- Journal Title
- Nephron
- Volume
- 139
- Number
- 1
- Start Page
- 13
- End Page
- 22
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/6875
- DOI
- 10.1159/000486323
- ISSN
- 1660-8151
- Abstract
- Background/Aims: Ultrafiltration rate (UFR) appears to be associated with mortality in prevalent hemodialysis (HD) patients. However, the association of UFR with mortality in incident HD patients remains unknown. Methods: We examined a US cohort of 110,880 patients who initiated HD from 2007 to 2011. Baseline UFR was divided into 5 groups (<4, 4 to <6, 6 to <8, 8 to <10, and >= 10 mL/h/kg body weight [BW]). We examined predictors of higher baseline UFR using logistic regression and the association of baseline UFR and all-cause and cardiovascular (CV) mortality using Cox proportional hazard models with adjustments for demographics, comorbidities, and markers of malnutrition-inflammation-cachexia syndrome. Results: Patients were 63 +/- 15 years, with 43% women, 32% African Americans, and had a mean baseline UFR of 7.5 +/- 3.1 mL/h/kg BW. In the fully adjusted logistic regression models, factors associated with higher UFR (>= 7.5 mL/h/kg BW) included Hispanic ethnicity, diabetes, and higher dietary protein intake. There was a linear association between UFR and all-cause and CV mortality, where UFR >= 10 mL/h/kg BW (reference UFR 6-<8 mL/h/kg BW) conferred the highest risk in both unadjusted (HR 1.15 [95% CI 1.10-1.19]) and adjusted models (HR 1.23 [95% CI 1.16-1.31]). The linear association with all-cause mortality remained consistent across strata of age, urine volume, and treatment time. Conclusions: Higher UFR is independently associated with higher all-cause and CV mortality in incident HD patients. Clinical trials are warranted to examine the effects of lowering UFR on outcomes. (C) 2018 S. Karger AG, Basel
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Collections - College of Medicine > Department of Internal Medicine > 1. Journal Articles
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