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Author Topic: Rapid fluid removal during dialysis is associated with cardiovascular morbidity  (Read 7239 times)
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« 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.

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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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, 1013 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 1013 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
« Last Edit: October 20, 2010, 06:40:39 PM by greg10 » Logged

Newbie caretaker, so I may not know what I am talking about :)
Caretaker for my elderly father who has his first and current graft in March, 2010.
Previously in-center hemodialysis in national chain, now doing NxStage home dialysis training.
End of September 2010: after twelve days of training, we were asked to start dialyzing on our own at home, reluctantly, we agreed.
If you are on HD, did you know that Rapid fluid removal (UF = ultrafiltration) during dialysis is associated with cardiovascular morbidity?  http://ihatedialysis.com/forum/index.php?topic=20596
We follow a modified version: UF limit = (weight in kg)  *  10 ml/kg/hr * (130 - age)/100

How do you know you are getting sufficient hemodialysis?  Know your HDP!  Scribner, B. H. and D. G. Oreopoulos (2002). "The Hemodialysis Product (HDP): A Better Index of Dialysis Adequacy than Kt/V." Dialysis & Transplantation 31(1).   http://www.therenalnetwork.org/qi/resources/HDP.pdf
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