title: Intradialytic ultrafiltration volume and vascular access outcomes: a Japan Dialysis Outcomes and Practice Patterns Study subanalysis.
abstract: BACKGROUND
  The relationship between intradialytic ultrafiltration volume and vascular access (VA) patency remains unclear. Using data from the Japan Dialysis Outcomes and Practice Patterns Study, we analyzed whether large-volume ultrafiltration was associated with VA failure in hemodialysis patients.
  
  
  METHODS
  We included 2736 patients for whom it was possible to evaluate VA patency and bodyweight change during dialysis. Patients were divided into three groups according to the tertile of intradialytic ultrafiltration by bodyweight: low, -9.5%-3.8%; middle, 3.8%-5.1%; and high, 5.1%-13.7%. Primary VA patency was defined as the time to first VA intervention, and secondary patency as the time to creation of a new VA. Hazard ratios for VA failure were compared across groups by using Cox regression models adjusted for age, sex, body mass index, diabetes, hemoglobin and phosphorus levels, Kt/V, and erythropoiesis-stimulating agent and antiplatelet use.
  
  
  RESULTS
  For the low, middle, and high groups, the incidences of primary and secondary VA patency were 4.7, 5.6, and 6.7 events/100 person-years and 1.3, 1.6, and 1.7 events/100 person-years, respectively. Adjusted hazard ratios for primary VA patency in the middle and high groups versus the low group were 1.16 (95% confidence interval [CI], 0.88-1.52) and 1.41 (95% CI, 1.07-1.87), respectively; those for secondary VA patency were 1.29 (95% CI, 0.78-2.13) and 1.45 (95% CI, 0.86-2.45), respectively.
  
  
  CONCLUSIONS
  Large-volume ultrafiltration during dialysis tended to increase VA failure in hemodialysis patients. We thus recommend smaller ultrafiltration volumes during hemodialysis to secure VA safely.
authors.affiliation: Bosei Hospital, Saitama - Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Asano
authors.affiliation: Bosei Hospital, Saitama - Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Oguchi
authors.affiliation: J-DOPPS Research Group - Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
authors.affiliation: Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto - Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Onishi
authors.affiliation: Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto - Japan.|Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto - Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: J-DOPPS Research Group - Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.affiliation: J-DOPPS Research Group - Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiba
authors.affiliation: J-DOPPS Research Group - Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000639:trends; D001835:Body Weight; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000639:trends; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000639:trends; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency