Rapid fluid removal during dialysis is associated with cardiovascular morbidity

[okarol]

Kidney International (2011) 79, 250–257; doi:10.1038/ki.2010.383; published online 6 October 2010

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

Original Article: http://www.nature.com/ki/journal/v79/n2/full/ki2010383a.html

[debby]

so if we run a filtration rate of 1.5 are we okay

[greg10]

so if we run a filtration rate of 1.5 are we okay

Debby, this depends on your weight.  If you weigh 50 kg (110 lbs), you should not go over 50 kg x 10 ml/kg/hr or 500 ml/hr or 0.5 l/hr ultrafiltration rate.  This paper concluded that:
"risk of all-cause and cardiovascular mortality began to increase at ultrafiltration rates over 10ml/h/kg regardless of the status of congestive heart failure"
So, unless you weigh 150 kg (330 lbs), running at 1.5 l/hr may not be safe.

[Ken Shelmerdine]

I thought the idea of increased mortality rates due to high speed fluid removal has already been clinically studied with the same conclusions.

[Bill Peckham]

I thought the idea of increased mortality rates due to high speed fluid removal has already been clinically studied with the same conclusions.

It can not be over stated.