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Ultrafiltration rates and intradialytic hypotension: A case–control sampling of pooled haemodialysis data
Author(s) -
Thongdee Chitrada,
Phinyo Phichayut,
Patumad Jayanton,
Satirapoj Bancha,
Spilles Nantana,
Laonapaporn Boonruksa,
Tantiyavarong Pichaya,
Tasanarong Adis
Publication year - 2021
Publication title -
journal of renal care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.381
H-Index - 27
eISSN - 1755-6686
pISSN - 1755-6678
DOI - 10.1111/jorc.12340
Subject(s) - medicine , odds ratio , confidence interval , logistic regression , ultrafiltration (renal) , hemodialysis , rate ratio , incidence (geometry) , chemistry , physics , chromatography , optics
Background Intradialytic hypotension (IDH) is one of the most critical adverse events during maintenance haemodialysis. Previous studies reported the association of fluid removal rate with the occurrence of IDH. Objective We aimed to identify the optimal threshold of ultrafiltration rate to prevent the occurrence of IDH events. Design, Participants and Measurements Prognostic factor research with a retrospective case–control design was conducted. Patient data were gathered from four haemodialysis units from January to December 2017. All the haemodialysis records were independently justified, whether IDH occurred or not, based on the standard definition. A total of 10 haemodialysis sessions were sampled from each patient's pool based on the incidence of events. The association of ultrafiltration rates and IDH events was explored by multivariable multilevel logistic regression. Results A total of 1080 haemodialysis sessions from 108 patients were included: 149 (13.8%) with IDH and 931 (86.2%) without IDH. After adjusting for all pre‐specified risk factors and imbalance baselines, the odds ratio of IDH were 1.22 (95% confidence interval [CI]: 0.59, 2.52) for rate 10–12 ml/kg/h; 2.52 (95% CI: 1.20, 5.29) for rate 12–14 ml/kg/h; 4.02 (95% CI: 1.61, 10.03) for rate 14–16 ml/kg/h; and 7.41 (95% CI: 2.53, 21.68) for rate >16 ml/kg/h comparing to the referent rate of <10 ml/kg/h. Conclusion The ultrafiltration rate should be limited to 12 ml/kg/h. If a higher rate of fluid removal was indicated, it should not exceed 16 ml/kg/h to avoid the occurrence of IDH.