Elsevier

Kidney International

Volume 79, Issue 2, 2 January 2011, Pages 250-257
Kidney International

Original Article
Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality

https://doi.org/10.1038/ki.2010.383Get rights and content
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Patients receiving hemodialysis have high rates of cardiovascular morbidity and mortality that may be related to the hemodynamic effects of rapid ultrafiltration. Here we tested whether higher dialytic ultrafiltration rates are associated with greater all-cause and cardiovascular mortality, and hospitalization for cardiovascular disease. We used data from the Hemodialysis Study, an almost-7-year randomized clinical trial of 1846 patients receiving thrice-weekly chronic dialysis. The ultrafiltration rates were divided into three categories: up to 10 ml/h/kg, 10–13 ml/h/kg, and over 13 ml/h/kg. Compared to ultrafiltration rates in the lowest group, rates in the highest were significantly associated with increased all-cause and cardiovascular-related mortality with adjusted hazard ratios of 1.59 and 1.71, respectively. Overall, ultrafiltration rates between 10–13 ml/h/kg were not associated with all-cause or cardiovascular mortality; however, they were significantly associated among participants with congestive heart failure. Cubic spline interpolation suggested that the risk of all-cause and cardiovascular mortality began to increase at ultrafiltration rates over 10 ml/h/kg regardless of the status of congestive heart failure. Hence, higher ultrafiltration rates in hemodialysis patients are associated with a greater risk of all-cause and cardiovascular death.

KEYWORDS

cardiovascular death
hemodialysis
mortality
ultrafiltration

Cited by (0)

SMB has served on medical advisory boards for Amgen and C.B. Fleet Company; his spouse is an employee at Genzyme. He has received speaking honoraria from Fresenius Medical Care and Genzyme, and is on retainer as an expert witness for C.B. Fleet Company and Proctor and Gamble.