Weekly standard Kt/Vurea and clinical outcomes in home and in-center hemodialysis

Matthew B. Rivara, Vanessa Ravel, Elani Streja, Yoshitsugu Obi, Melissa Soohoo, Alfred K. Cheung, Jonathan Himmelfarb, Kamyar Kalantar-Zadeh, Rajnish Mehrotra

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Background and objectives Patients undergoing hemodialysis with a frequency other than thrice weekly are not included in current clinical performance metrics for dialysis adequacy. The weekly standard Kt/Vurea incorporates treatment frequency, but there are limited data on its association with clinical outcomes. Design, setting, participants, & measurements We used multivariable regression to examine the association of dialysis standard Kt/Vurea with BP and metabolic control (serum potassium, calcium, bicarbonate, and phosphorus) in patients incidental to dialysis treated with home (n=2373) or in-center hemodialysis (n=109,273). We further used Cox survival models to examine the association of dialysis standard Kt/Vurea with mortality, hospitalization, and among patients on home hemodialysis, transfer to in-center hemodialysis. Results After adjustment for potential confounders, patients with dialysis standard Kt/Vurea <2.1 had higher BPs compared with patients with standard Kt/Vurea 2.1 to <2.3 (3.4 mmHg higher [P<0.001] for home hemodialysis and 0.9 mm Hg higher [P<0.001] for in-center hemodialysis). There were no clinically meaningful associations between dialysis standard Kt/Vurea and markers of metabolic control, irrespective of dialysis modality. There was no association between dialysis standard Kt/Vurea and risk for mortality, hospitalization, or transfer to in-center hemodialysis among patients undergoing home hemodialysis. Among patients on in-center hemodialysis, dialysis standard Kt/Vurea <2.1 was associated with higher risk (adjusted hazard ratio, 1.11; 95% confidence interval, 1.07 to 1.14) and standard Kt/Vurea ≥2.3 was associated with lower risk (adjusted hazard ratio, 0.97; 95% confidence interval, 0.94 to 0.99) for death compared with standard Kt/Vurea 2.1 to <2.3. Additional analyses limited to patients with available data on residual kidney function showed similar relationships of dialysis and total (dialysis plus kidney) standard Kt/Vurea with outcomes. Conclusions Current targets for standard Kt/Vurea have limited utility in identifying individuals at increased risk for adverse clinical outcomes for those undergoing home hemodialysis but may enhance risk stratification for in-center hemodialysis.

Original languageEnglish
Pages (from-to)445-455
Number of pages11
JournalClinical Journal of the American Society of Nephrology
Volume13
Issue number3
DOIs
StatePublished - 7 Mar 2018
Externally publishedYes

Keywords

  • Bicarbonates
  • Blood pressure
  • Blood Pressure Determination
  • Calcium bicarbonate
  • Confidence Intervals
  • Epidemiology and outcomes
  • Hemodialysis adequacy
  • Hemodialysis, Home
  • Hospitalization
  • Mortality risk
  • Odds Ratio
  • Phosphorus
  • Potassium
  • Renal dialysis
  • Risk

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