Long Dialysis Recovery Time and Fluid Management

San Diego—A large proportion of patients on conventional hemodialysis face long dialysis recovery time, which is associated with increased mortality and shorter time to hospitalization. Wael F. Hussein, MD, and colleagues recently conducted a study to examine the association of fluid management and hemodynamics with recovery time in conventional hemodialysis patients.

The researchers reported results of the study during a poster session at Kidney Week 2015. The poster was titled Fluid Management Parameters Are Associated with Dialysis Recovery Time in Conventional Hemodialysis.

Data on dialysis recovery was obtained by asking patients “How long does it take you to recover from a dialysis session?” Responses were recorded for 2689 patients receiving conventional hemodialysis three times a week. The patients received dialysis in 46 centers in three states. The researchers used ordinal logistic regression to assess the association between patient and dialysis characteristics with dialysis recovery time. Statistical adjustments were made for patient demographics, comorbidities, and body weight.

Of the 2689 patients, 43% were female, 20% were black, median age was 63 years, and median dialysis vintage was 3.3 years. The median length of dialysis session was 203 minutes.

The researchers stratified dialysis recovery time in categories of complete recovery: immediate recovery; >0 to ≤2 hours; >2 to ≤6 hours; >6 to ≤12 hours; and >12 hours. Proportions of patient-reported recovery times in each of the categories were 27%, 28%, 17%, 9%, and 20%, respectively. In multivariable analysis, there was an association between longer dialysis recovery time and female sex, non-black race, lower serum albumin, chronic heart failure, cerebrovascular disease, missed dialysis sessions, higher pre-dialysis systolic blood pressure, and larger ultrafiltration volume.

Rates of ultrafiltration were divided into three categories: <10, 10 to <13, and 313 mg/kg/hour. Compared with the lowest ultrafiltration rate, there was an association between ultrafiltration rate 313 mg/kg/hour and longer dialysis recovery rate (odds ratio of 1.16 (95% confidence interval [CI], 0.99-1.36) and 1.28 (95% CI, 1.06-1.54) in the unadjusted and adjusted analyses, respectively.

“Long dialysis recovery time affects a large proportion of hemodialysis patients. Optimizing ultrafiltration rate and controlling intradialytic hypotension are critical measures to improve quality of life for these patients,” the researchers said.

Source: Hussein WF, Arramreddy R, Reiterman M, Sun SJ, Schiller B. Fluid management parameters are associated with dialysis recovery time in conventional hemodialysis. Poster presented during American Society of Nephrology Kidney Week 2015, November 6, 2015, San Diego, California.