TY - JOUR
T1 - The association of standard Kt/V and surface area-normalized standard Kt/V with clinical outcomes in hemodialysis patients
AU - Pattharanitima, Pattharawin
AU - Chauhan, Kinsuk
AU - El Shamy, Osama
AU - Chaudhary, Kumardeep
AU - Sharma, Shuchita
AU - Coca, Steven G.
AU - Nadkarni, Girish N.
AU - Uribarri, Jaime
AU - Chan, Lili
N1 - Funding Information:
: GNN has received operational funding from Goldfinch Bio in the past 3 years. S.G.C. has received consulting fees from CHF Solutions, Quark Biopharma, Takeda Pharmaceuticals, Janssen Pharmaceuticals, pulseData, Goldfinch Bio, Relypsa, Bayer and inRegen in the past 3 years. S.G.C. owns stock options in pulseData. G.N.N. and S.G.C. receive financial compensation as consultants and advisory board members for RenalytixAI, Inc., and own equity and stock options in RenalytixAI. G.N.N. and S.G.C. are scientific co‐founders of RenalytixAI. Other authors declare that they have no conflict of interest. The results presented in this paper have not been published previously in whole or part, except in abstract format. Conflict of Interest
Funding Information:
The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government.
Publisher Copyright:
© 2020 International Society for Hemodialysis
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Introduction: A previous study demonstrated that the surface area-normalized standard Kt/V (SAstdKt/V) was better associated with mortality than standard Kt/V (stdKt/V). This study investigates the association of SAstdKt/V and stdKt/V with mortality, anemia, and hypoalbuminemia in a larger patient cohort with a longer follow-up period. Methods: We included adult patients on thrice-weekly hemodialysis in the USRDS database and excluded amputated patients. StdKt/V and SAstdKt/V were calculated from the available single-pool Kt/V. Patients were categorized into five groups according to their stdKt/V and SAstdKt/V: <2.00, 2.00–2.19, 2.20–2.39, 2.40–2.59, and ≥2.60. Hazard ratios (HR) and odds ratios (OR) were calculated using Cox and logistic regression analysis respectively. Findings: There were 507,656 patients included in the analysis. The patients had a median age of 65.5 years with a median follow-up period of 2 years. Thirty-four percent died during follow-up. HRs for mortality progressively decreased as SAstdKt/V increased in both unadjusted and adjusted models. Unlike SAstdKt/V, HRs were the lowest in the categories with stdKt/V of 2.40–2.59 and they increased in the higher stdKt/V category. The adjusted HR for SAstdKt/V vs. stdKt/V were 0.68 vs. 0.62 in the category of 2.40–2.59, and 0.63 vs. 0.73 in the category of ≥2.60. The adjusted ORs for anemia progressively decreased as SAstdKt/V increased, whereas ORs decreased to the lowest in stdKt/V category 2.40–2.59 and increased in the ≥2.60 category. The adjusted ORs for hypoalbuminemia progressively decreased as SAstdKt/V and stdKt/V increased which were both 0.45 in 2.40–2.59 category and decreased to 0.29 and 0.42 in the ≥2.60 category. Discussion: SAstdKt/V is better associated with mortality, anemia, and hypoalbuminemia than stdKt/V. SAstdKt/V is a better parameter in defining hemodialysis dosing which can be calculated by an available online tool. Further studies to determine the optimal SAstdKt/V dose required to achieve improved clinical outcomes with better cost-effectiveness are needed.
AB - Introduction: A previous study demonstrated that the surface area-normalized standard Kt/V (SAstdKt/V) was better associated with mortality than standard Kt/V (stdKt/V). This study investigates the association of SAstdKt/V and stdKt/V with mortality, anemia, and hypoalbuminemia in a larger patient cohort with a longer follow-up period. Methods: We included adult patients on thrice-weekly hemodialysis in the USRDS database and excluded amputated patients. StdKt/V and SAstdKt/V were calculated from the available single-pool Kt/V. Patients were categorized into five groups according to their stdKt/V and SAstdKt/V: <2.00, 2.00–2.19, 2.20–2.39, 2.40–2.59, and ≥2.60. Hazard ratios (HR) and odds ratios (OR) were calculated using Cox and logistic regression analysis respectively. Findings: There were 507,656 patients included in the analysis. The patients had a median age of 65.5 years with a median follow-up period of 2 years. Thirty-four percent died during follow-up. HRs for mortality progressively decreased as SAstdKt/V increased in both unadjusted and adjusted models. Unlike SAstdKt/V, HRs were the lowest in the categories with stdKt/V of 2.40–2.59 and they increased in the higher stdKt/V category. The adjusted HR for SAstdKt/V vs. stdKt/V were 0.68 vs. 0.62 in the category of 2.40–2.59, and 0.63 vs. 0.73 in the category of ≥2.60. The adjusted ORs for anemia progressively decreased as SAstdKt/V increased, whereas ORs decreased to the lowest in stdKt/V category 2.40–2.59 and increased in the ≥2.60 category. The adjusted ORs for hypoalbuminemia progressively decreased as SAstdKt/V and stdKt/V increased which were both 0.45 in 2.40–2.59 category and decreased to 0.29 and 0.42 in the ≥2.60 category. Discussion: SAstdKt/V is better associated with mortality, anemia, and hypoalbuminemia than stdKt/V. SAstdKt/V is a better parameter in defining hemodialysis dosing which can be calculated by an available online tool. Further studies to determine the optimal SAstdKt/V dose required to achieve improved clinical outcomes with better cost-effectiveness are needed.
KW - Adequacy of dialysis
KW - anemia
KW - nutrition
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=85089509221&partnerID=8YFLogxK
U2 - 10.1111/hdi.12865
DO - 10.1111/hdi.12865
M3 - Article
C2 - 32809268
AN - SCOPUS:85089509221
SN - 1492-7535
VL - 24
SP - 495
EP - 505
JO - Hemodialysis International
JF - Hemodialysis International
IS - 4
ER -