Longer Dialysis Recovery Time Predicts Higher Death Risk

[okarol]

February 21, 2014
Longer Dialysis Recovery Time Predicts Higher Death Risk

Starting dialysis at a higher eGFR makes no difference in overall survival.
It also is associated with an increased likelihood of hospitalization.
Longer recovery times after a hemodialysis session are associated with an increased risk of hospitalization and death, according to a new study.

Hugh C. Rayner, MD, of Birmingham Heartlands Hospital in Birmingham, U.K., and colleagues studied 6,040 patients receiving HD in the Dialysis Outcomes and Practice Patterns Study (DOPPS). They analyzed patient responses to the following question: “How long does it take you to recover from a dialysis session?” The median follow-up was 16 months.

The researchers found that 32% of patients reported a recovery time shorter than 2 hours, 41%, 2-6 hours; 17%, 7-12 hours; and 10% longer than 12 hours.

The researchers recorded hospitalization events for 3,119 patients (52%); 826 patients (14%) died. Compared with patients with reported recovery times of 2-6 hours, patients with a reported recovery time of more than 12 hours had a 16% increased risk of a first hospitalization and 30% increased risk of death in adjusted analyses, Dr. Rayner's group reported online ahead of print in the American Journal of Kidney Diseases.

After adjusting for demographic and comorbid factors, each additional hour of recovery time was associated with a 3% increased risk of a first hospitalization and a 5% increased risk of death from any cause.

Longer recovery time was associated with older age, female gender, dialysis vintage, body mass index, diabetes, and psychiatric disorders, as well as greater intradialytic weight loss, longer dialysis session length, and lower dialysate sodium concentration.

In adjusted analyses, each 1% increase in intradialytic weight loss was associated with a 4% increased risk of a patient reporting a longer recovery time (for example, less than 2 hours vs. 2 or more hours, 6 hours or less vs. 7 hours or more, and so on).

Compared with a dialysate sodium concentration of 140 mEq/L, a lower concentration was associated with a 34% increased risk. Each 30-minute increase in dialysis session length was associated with a 5% increased risk. Patients with a psychiatric disorder had 39% increased risk of reporting longer recovery time than those without a psychiatric disorder.

“Recovery time has a significant impact on patients and may be affected by modifiable aspects of the treatment regimen,” the authors wrote. “Hence, the recovery time question potentially could be used as an audit measure of the quality of hemodialysis treatment.”

With respect to study limitations, the researchers pointed out that answers to the recovery time question are subjective and not supported by physiologic measurements.

http://www.renalandurologynews.com/longer-dialysis-recovery-time-predicts-higher-death-risk/article/334761/

[obsidianom]

I would like to see a study on "Dialysis Recovery Time" comparing standard dialysis and Nxstage. From the few patients I have seen or communicated with on Nxstage so far , it appears they recover quicker after dialysis. My wife sure does.  She used to feel sick for a long time after in center dialysis but now with NxStage she feels great after .
I would be interested in our other Nxstage people here in their results with this if they started in center or with standard dialysis. . Compare the two in terms of how you feel after dialysis and let us know.

[cassandra]

In complete agreement with Obsi. In-centre and Home D recovery times are not comparable for me personally (as in subjective). But in-centre conventional (as in 3x a week) is heavier on the body, so the bigger the hit, the longer the recovery time. And the longer those heavier attacks, the sooner the body cracks (I suppose that's meant with 'dialysis vintage')

I'm recovering way quicker with short daily, and with longer every other day D.
After 14 years in-centre, and now in the 2' year HD the recovery time is still getting shorter (although it's not always so, but I had real short recovery times sometimes on in-centre too)

And yes, the whole home hemo was only possible with the Nxstage, in my personal situation.
But the researchers have not even tried to take the type of HD into consideration.
So the research is sorta useless really?

[Bill Peckham]

In complete agreement with Obsi. In-centre and Home D recovery times are not comparable for me personally (as in subjective). But in-centre conventional (as in 3x a week) is heavier on the body, so the bigger the hit, the longer the recovery time. And the longer those heavier attacks, the sooner the body cracks (I suppose that's meant with 'dialysis vintage')

I'm recovering way quicker with short daily, and with longer every other day D.
After 14 years in-centre, and now in the 2' year HD the recovery time is still getting shorter (although it's not always so, but I had real short recovery times sometimes on in-centre too)

And yes, the whole home hemo was only possible with the Nxstage, in my personal situation.
But the researchers have not even tried to take the type of HD into consideration.
So the research is sorta useless really?

DOPPS collects data over time for a random sample of patients from dialysis facilities in more than twenty countries. It is quite hard to find baseline measures that are common across cultures and medical systems. I'm presenting this data for DOPPS in Las Vegas at the NKF's spring meeting (full disclosure: I volunteer on the DOPPS Steering Committee), I'm just going over the first draft PPT of this data that I am going to present. The idea is to find ways to identify how a dialyzor is doing without making them fill out a ten page form - other questions that correlate to an increased mortality risk ask how a person is sleeping (On a scale of 0 to 10 (where 0 represents ‘very bad’ and 10 represents ‘very good’) how would you rate the quality of your sleep overall?), their appetite (During the past 4 weeks, to what extent were you bothered by lack of appetite?), their level of depression (During the past 4 weeks, how much of the time have you felt: (A) So down in the dumps that nothing could cheer you up? (B) Downhearted and blue?) and exercise (How often do you exercise (do physical activity) during your leisure time?). All of these questions correlate to an increased mortality risk - people who answer that they don't exercise, they do feel in dumps, have been bothered by a lack of appetite, are not sleeping well, have an increased mortality risk.

The question is what should be done if someone's answer(s) suggests that they are at an increase risk?

NxStage has published their own data asking people who use NxStage these questions. DOPPS primarily looks at incenter dialysis across the world because that's the data they can access. This data is most useful to track an individual's experience of dialysis rather than compare experiences between dialyzors. I think the trend is important and asking this question over time would give the opportunity to identify people trending in the wrong direction, whether they are using incenter or home dialysis. Not useless.

[homepartnerctl]

I would love to see NxStage's data. Dad recovered quickly after his treatments in the first few years and subsequently took longer as his health declined. Hard to say which came first. But boy would those wanting access to HHD have some great ammunition.  There is such a wait for home modalities and little advocacy in our community. We need more research!

[Dman73]

The longer you have been on earth increases recovery time predicting higher death risk.
I never considered myself a statistic as there are things that you can do to be the exception.

[ianch]

Unless i stuff things up, my recovery time is 15 minutes from waking.   That's after 10 hours plugged in.  That said I UF profile so the last 8 hours is at 100ml/hr or less.  Works like a charm - no equalization.    I don't drink but cheers anyway