Minimized weight gain between hemodialysis contributes to a reduced risk of death.
The risk of death is higher in dialysis patients compared to age matched healthy subjects, the main reason being cardiovascular. This prospective study investigated if the extent of ultrafiltration was of importance for the outcome.


METHODS
88 hemodialysis patients were included and followed prospectively. The outcome was registered in regard to death, acute myocardial infarction or coronary vascular intervention. The extent of ultrafiltration needed at dialysis was calculated as a mean during the observation period as were other variables. The mean extent of ultrafiltration was compared for patients who had survived without end-points (group 1, n=53) versus those who reached any end-point during the period (group 2, n=35).


RESULTS
In total, 40% of the patients reached end-point during the observation period. There was no difference at baseline between the groups in regard to age, prevalence of diabetes mellitus or history of previous cardiovascular disease, KT/V, residual renal function ultrafiltration need, C-reactive protein, s-albumin, cholesterol, LDL-cholesterol, HDL-cholesterol, appetite or wellbeing, while triglyceride was lower in group 2 (p=0.035). The observation period for group 1 was at a mean 24.7 months (SD13.1) and for those in group 2 at a mean 13.8 (+/-11.7 months, p<0.001). Patients representing group 1 at 24 and 30 months had less need of ultrafiltration than those in group 2. Thus, the need of ultrafiltration was about 27% lower at 24 months (for 29 persons in group 1: 3.63+/-1.93 weight% versus 4.97+/-1.70 weight% for 9 patients from group 2, p=0.046) and 46% at 30 months (for 18 from group 1: 3.48+/-1.95 versus 6.45+/-1.55 for 3 from group 2, p=0.030). C-reactive protein did not differ significantly between the groups during the period.


CONCLUSIONS
After a prolonged period of 24 months the extent of ultrafiltration need seems to be important for the outcome of the patients. Thereby those with higher need of ultrafiltration had worse prognosis. It seems important to motivate patients to reduce the extent of fluid intake between dialysis to prolong survival.
Stegmayr
B G
BG
Division of Nephrology, Department of Internal Medicine, University Hospital, Umea, Sweden. bernd.stegmayr@medicin.umu.se
Brannstrom
M
M
Bucht
S
S
Dimeny
E
E
Ekspong
A
A
Granroth
B
B
Grontoft
K C
KC
Hadimeri
H
H
Holmberg
B
B
Ingman
B
B
Isaksson
B
B
Johansson
G
G
Lindberger
K
K
Lundberg
L
L
Lundstrom
O
O
Mikaelsson
L
L
Mortzell
M
M
Olausson
E
E
Persson
B
B
Svensson
L
L
Wikdahl
A M
AM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D017583:Hemodiafiltration; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000401:mortality* / Q000628:therapy; D015430:Weight Gain
D002097:C-Reactive Protein