Effect of ultrafiltration profiling on outcomes among maintenance hemodialysis patients : a pilot randomized crossover trial

BACKGROUND: More rapid fluid removal during hemodialysis is associated with adverse cardiovascular outcomes and longer dialysis recovery times. The effect of ultrafiltration (UF) profiling, independent of concomitant sodium profiling, on markers of intradialytic hemodynamics and other outcomes has been inadequately studied.

METHODS: Four-phase, blinded crossover trial. Participants (UF rates > 10 mL/h/kg) were assigned in random order to receive hemodialysis with UF profiling (constantly declining UF rate, intervention) vs. hemodialysis with conventional UF (control). Each 3-week 9-treatment period was followed by a 1-week 3-treatment washout period. Participants crossed into each study arm twice (2 phases/arm); 18 treatments per treatment type. The primary outcomes were intradialytic hypotension, pre- to post-dialysis troponin T change, and change from baseline in left ventricular global longitudinal strain. Other outcomes included intradialytic symptoms and blood volume measured-plasma refill (post-dialysis volume status measure), among others. Each participant served as their own control.

RESULTS: On average, the 34 randomized patients (mean age 56 years, 24% female, mean dialysis vintage 6.3 years) had UF rates > 10 mL/h/kg in 56% of treatments during the screening period. All but 2 patients completed the 15-week study (prolonged hospitalization, kidney transplant). There was no significant difference in intradialytic hypotension, troponin T change, or left ventricular strain between hemodialysis with UF profiling and conventional UF. With UF profiling, participants had significantly lower odds of light-headedness and plasma refill compared to hemodialysis with conventional UF.

CONCLUSIONS: Ultrafiltration (UF) profiling did not reduce the odds of treatment-related cardiac stress but did reduce the odds of light-headedness and post-dialysis hypervolemia.

TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03301740 (registered October 4, 2017).

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:34

Enthalten in:

Journal of nephrology - 34(2021), 1 vom: 25. Feb., Seite 113-123

Sprache:

Englisch

Beteiligte Personen:

Flythe, Jennifer E [VerfasserIn]
Tugman, Matthew J [VerfasserIn]
Narendra, Julia H [VerfasserIn]
Assimon, Magdalene M [VerfasserIn]
Li, Quefeng [VerfasserIn]
Wang, Yueting [VerfasserIn]
Brunelli, Steven M [VerfasserIn]
Hinderliter, Alan L [VerfasserIn]

Links:

Volltext

Themen:

9NEZ333N27
Blood pressure
Cardiovascular
Clinical trial
Echocardiogram
Hemodialysis
Hypotension
Journal Article
Randomized Controlled Trial
Sodium
Symptoms
Ultrafiltration

Anmerkungen:

Date Completed 18.08.2021

Date Revised 02.02.2022

published: Print-Electronic

ClinicalTrials.gov: NCT03301740

Citation Status MEDLINE

doi:

10.1007/s40620-020-00862-6

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM315465611