Open AccessSoft Target Weight: Theory and Simulation of a Novel Haemodialysis Protocol Which Reduces Excessive Ultrafiltration
Author(s) -
Damien Ashby,
Richard Corbett,
Neill Duncan
Publication year - 2021
Publication title -
the nephron journals/nephron journals
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.951
H-Index - 72
eISSN - 2235-3186
pISSN - 1660-8151
DOI - 10.1159/000519823
Subject(s) - medicine , ultrafiltration (renal) , hemodialysis , protocol (science) , intensive care medicine , nephrology , kidney disease , urology , pathology , chromatography , chemistry , alternative medicine
Excessive ultrafiltration is associated with intra-dialytic symptoms, loss of residual function, and mortality in haemodialysis patients. A major contributor to excessive ultrafiltration is within-individual variation in pre-dialysis weight and the concept of achieving a fixed target weight by the end of each dialysis session. Haemodialysis protocols which allow variable post-dialysis weight have not been proposed. Methods: Weight variation was observed in haemodialysis patients and healthy controls to estimate the proportion of pre-dialysis weight variation which could be considered natural variation. These estimates were used to derive a novel protocol for setting ultrafiltration, which was evaluated by mathematical modelling. Results: Amongst 20 haemodialysis patients, mean (SD) pre-dialysis weight was 102.74 (0.94)% of target weight after a 2-day gap and 103.50 (0.94)% after a 3-day gap. Amongst 10 healthy individuals, mean (SD) daily weight was 100.0 (0.71)% of average weight. A 4-component model of pre-dialysis weight was derived using these estimates, in which the best estimate of pre-dialysis excess fluid is the midpoint of excess weight and average fluid gain, and used to propose a novel protocol for ultrafiltration setting. In simulations, the novel protocol reduced ultrafiltration variation by more than half (standard deviation 0.6 vs. 1.3% of target weight, p < 0.001), without increasing the variation in post-dialysis fluid excess. Excessive ultrafiltration rates (over 13 mL/h/kg) were far less frequent using this protocol (2.6% vs. 7.5% of sessions, p = 0.001). Conclusion: Considering natural weight variation allows the development of a novel protocol for ultrafiltration in which target weight does not have to be achieved precisely: it is therefore a soft target. This protocol, which is predicted to substantially reduce excessive ultrafiltration variation, is a zero-cost intervention with the potential to improve symptoms and clinical outcome for haemodialysis patients.