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Dialysis Discussion => Dialysis: News Articles => Topic started by: greg10 on October 20, 2010, 10:02:44 AM

Title: Rapid fluid removal during dialysis is associated with cardiovascular morbidity
Post by: greg10 on October 20, 2010, 10:02:44 AM

If you are doing hemodialysis, you should know this number ***** 10 ml/h/kg********* should be your limit for fluid removal (also known as ultrafiltration (UF)).  Especially true if you have a heart condition (such as congestive heart failure).
This means if you are 60 kg, or about 130 lbs, you should not remove more than 600 ml per hour.

I can't believe no nephrologist ever told us that.  Did your nephrologist tell you this number?  The Fresenius machine is set up for about 2000 ml/hr, the NxStage about 1500 ml/hr limit.  The machines are often inaccurate.

http://www.nature.com/ki/journal/vaop/ncurrent/abs/ki2010383a.html
Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality

Jennifer E Flythe1, Stephen E Kimmel2 and Steven M Brunelli1
1Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
2Cardiology Division, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

Correspondence: Steven M. Brunelli, Renal Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, MRB-4, Boston, Massachusetts 02115, USA. E-mail: sbrunelli@partners.org

Received 27 May 2010; Revised 5 July 2010; Accepted 10 August 2010; Published online 6 October 2010.
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Abstract

Patients receiving hemodialysis have high rates of cardiovascular morbidity and mortality that may be related to the hemodynamic effects of rapid ultrafiltration. Here we tested whether higher dialytic ultrafiltration rates are associated with greater all-cause and cardiovascular mortality, and hospitalization for cardiovascular disease. We used data from the Hemodialysis Study, an almost-7-year randomized clinical trial of 1846 patients receiving thrice-weekly chronic dialysis. The ultrafiltration rates were divided into three categories: up to 10 ml/h/kg, 10–13 ml/h/kg, and over 13 ml/h/kg. Compared to ultrafiltration rates in the lowest group, rates in the highest were significantly associated with increased all-cause and cardiovascular-related mortality with adjusted hazard ratios of 1.59 and 1.71, respectively. Overall, ultrafiltration rates between 10–13 ml/h/kg were not associated with all-cause or cardiovascular mortality; however, they were significantly associated among participants with congestive heart failure. Cubic spline interpolation suggested that the risk of all-cause and cardiovascular mortality began to increase at ultrafiltration rates over 10 ml/h/kg regardless of the status of congestive heart failure. Hence, higher ultrafiltration rates in hemodialysis patients are associated with a greater risk of all-cause and cardiovascular death.
Keywords: cardiovascular death; hemodialysis; mortality; ultrafiltration