Impact of rapid ultrafiltration rate on changes in the echocardiographic left atrial volume index in patients undergoing haemodialysis: a longitudinal observational study.
Optimal fluid management is essential when caring for a patient on haemodialysis (HD). However, if the fluid removal is too rapid, the resultant higher ultrafiltration rate (UFR) disadvantageously promotes haemodynamic instability and cardiac injury. We evaluated the effects of a rapid UFR on changes in the echocardiographic left atrial volume index (LAVI) over a period of time.



Longitudinal observational study.



A total of 124 new patients on HD.



Echocardiography was performed at baseline and repeated after 19.7 months (range 11.3-23.1 months). Changes in LAVI (ΔLAVI/year, mL/m2/year) were calculated. The UFR was expressed in mL/hour/kg, and we used the mean UFR over 30 days (∼12-13 treatments).



The 75th centile of the ΔLAVI/year distribution was regarded as a 'pathological' increment.



The mean interdialytic weight gain was 1.73±0.94 kg, and the UFR was 8.01±3.87 mL/hour/kg. The significant pathological increment point in ΔLAVI/year was 4.89 mL/m2/year. Correlation analysis showed that ΔLAVI/year was closely related to the baseline blood pressure, haemoglobin level, residual renal function and UFR. According to the receiver operating characteristics curve, the 'best' cut-off value of UFR for predicting the pathological increment was 10 mL/hour/kg, with an area under the curve of 0.712. In multivariate analysis, systolic blood pressure, a history of coronary artery disease, haemoglobin <10 g/dL and high UFR were significant predictors. An increase of 1 mL/hour/kg in the UFR was associated with a 22% higher risk of a worsening LAVI (OR 1.22, 95% CI 1.05 to 1.41).



An increased haemodynamic load could affect left atrial remodelling in incident patients on HD. Thus, close monitoring and optimal control of UFR are needed.
Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea.|Department of Clinical Immunology, Hallym University Sacred Heart Hospital, Anyang, Korea.
Jwa-Kyung
JK
Kim
Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea.
Young Rim
YR
Song
Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea.
GunHa
G
Park
Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea.
Hyung Jik
HJ
Kim
Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea.|Department of Clinical Immunology, Hallym University Sacred Heart Hospital, Anyang, Korea.
Sung Gyun
SG
Kim
D000368:Aged; D019540:Area Under Curve; D001794:Blood Pressure; D001810:Blood Volume; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology*; D017583:Hemodiafiltration / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D012372:ROC Curve; D015430:Weight Gain
Left atrial volume index; ultrafiltration rate