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Objective: Cardiovascular events are more commonly observed during hemodialysis sessions after a long interdialytic interval compared to average weekly hemodialysis sessions, and ultrafiltration rate (UFR) was reported to be associated with cardiovascular outcomes. Whether the UFR during hemodialysis sessions after a long interdialytic interval is a better predictor of cardiovascular outcome than the average weekly UFR is unknown. Methods: The charts of patients aged >18 years with end-stage renal disease that received hemodialysis treatment Siriraj Hospital during January 2008 to December 2017 were retrospectively reviewed. Results: Two hundred and forty-one patients (52.8% females) were included. During the median time follow-up of 54 months, the rate of adverse cardiovascular outcomes was 7.26 events/100-patient-years, and the mortality rate was 8.40 deaths/100-patient-years. Mean UFR was significantly higher in the long interdialytic interval hemodialysis sessions than in the average weekly UFR sessions (14.07±5.29 vs. 13.13±5.14 ml/h/kg, p<0.001). Compared with UFR of ≤10 ml/h/kg, the adjusted hazard ratio (HR) for mortality in the UFR >13 ml/h/kg subgroup was 1.29 (95% CI: 0.65-2.56) and 1.05 (95% CI: 0.55-2.03) in the long interdialytic interval hemodialysis sessions and the average weekly UFR, respectively. The adjusted HR for adverse cardiovascular outcome in the UFR >13 ml/h/kg subgroup was 1.32 (95% CI: 0.64-2.80) and 0.72 (95% CI: 0.36-1.35) in the long interdialytic interval hemodialysis sessions and the average weekly UFR, respectively. Conclusion: This study revealed that the UFR in long interdialytic hemodialysis sessions has the trend to be associated with more adverse cardiovascular outcomes and all-cause mortality than the average weekly UFR. A larger population is needed to further elucidate the relationship between UFR and outcomes in Thai hemodialysis population.

siriraj medical journal

Effect of Ultrafiltration Rate in Long Interdialytic Interval Hemodialysis Session versus Average Weekly Ultrafiltration Rate on Mortality Rate and Adverse Cardiovascular Outcomes in Maintenance Hemodialysis Patients