The association of standard Kt/V and surface area‐normalized standard Kt/V with clinical outcomes in hemodialysis patients
Abstract Introduction A previous study demonstrated that the surface area‐normalized standard Kt/V (SAstdKt/V) was better associated with mortality than standard Kt/V (stdKt/V). This study investigates the association of SAstdKt/V and stdKt/V with mortality, anemia, and hypoalbuminemia in a larger patient cohort with a longer follow‐up period. Methods We included adult patients on thrice‐weekly hemodialysis in the USRDS database and excluded amputated patients. StdKt/V and SAstdKt/V were calculated from the available single‐pool Kt/V. Patients were categorized into five groups according to their stdKt/V and SAstdKt/V: <2.00, 2.00–2.19, 2.20–2.39, 2.40–2.59, and ≥2.60. Hazard ratios (HR) and odds ratios (OR) were calculated using Cox and logistic regression analysis respectively. Findings There were 507,656 patients included in the analysis. The patients had a median age of 65.5 years with a median follow‐up period of 2 years. Thirty‐four percent died during follow‐up. HRs for mortality progressively decreased as SAstdKt/V increased in both unadjusted and adjusted models. Unlike SAstdKt/V, HRs were the lowest in the categories with stdKt/V of 2.40–2.59 and they increased in the higher stdKt/V category. The adjusted HR for SAstdKt/V vs. stdKt/V were 0.68 vs. 0.62 in the category of 2.40–2.59, and 0.63 vs. 0.73 in the category of ≥2.60. The adjusted ORs for anemia progressively decreased as SAstdKt/V increased, whereas ORs decreased to the lowest in stdKt/V category 2.40–2.59 and increased in the ≥2.60 category. The adjusted ORs for hypoalbuminemia progressively decreased as SAstdKt/V and stdKt/V increased which were both 0.45 in 2.40–2.59 category and decreased to 0.29 and 0.42 in the ≥2.60 category. Discussion SAstdKt/V is better associated with mortality, anemia, and hypoalbuminemia than stdKt/V. SAstdKt/V is a better parameter in defining hemodialysis dosing which can be calculated by an available online tool. Further studies to determine the optimal SAstdKt/V dose required to achieve improved clinical outcomes with better cost‐effectiveness are needed..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
Hemodialysis International - 24(2020), 4, Seite 495-505 |
| Beteiligte Personen: |
Pattharanitima, Pattharawin [VerfasserIn] |
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| BKL: |
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| Anmerkungen: |
© 2020 International Society for Hemodialysis |
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| Umfang: |
11 |
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| doi: |
10.1111/hdi.12865 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
WLY006965202 |
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| 520 | |a Abstract Introduction A previous study demonstrated that the surface area‐normalized standard Kt/V (SAstdKt/V) was better associated with mortality than standard Kt/V (stdKt/V). This study investigates the association of SAstdKt/V and stdKt/V with mortality, anemia, and hypoalbuminemia in a larger patient cohort with a longer follow‐up period. Methods We included adult patients on thrice‐weekly hemodialysis in the USRDS database and excluded amputated patients. StdKt/V and SAstdKt/V were calculated from the available single‐pool Kt/V. Patients were categorized into five groups according to their stdKt/V and SAstdKt/V: <2.00, 2.00–2.19, 2.20–2.39, 2.40–2.59, and ≥2.60. Hazard ratios (HR) and odds ratios (OR) were calculated using Cox and logistic regression analysis respectively. Findings There were 507,656 patients included in the analysis. The patients had a median age of 65.5 years with a median follow‐up period of 2 years. Thirty‐four percent died during follow‐up. HRs for mortality progressively decreased as SAstdKt/V increased in both unadjusted and adjusted models. Unlike SAstdKt/V, HRs were the lowest in the categories with stdKt/V of 2.40–2.59 and they increased in the higher stdKt/V category. The adjusted HR for SAstdKt/V vs. stdKt/V were 0.68 vs. 0.62 in the category of 2.40–2.59, and 0.63 vs. 0.73 in the category of ≥2.60. The adjusted ORs for anemia progressively decreased as SAstdKt/V increased, whereas ORs decreased to the lowest in stdKt/V category 2.40–2.59 and increased in the ≥2.60 category. The adjusted ORs for hypoalbuminemia progressively decreased as SAstdKt/V and stdKt/V increased which were both 0.45 in 2.40–2.59 category and decreased to 0.29 and 0.42 in the ≥2.60 category. Discussion SAstdKt/V is better associated with mortality, anemia, and hypoalbuminemia than stdKt/V. SAstdKt/V is a better parameter in defining hemodialysis dosing which can be calculated by an available online tool. Further studies to determine the optimal SAstdKt/V dose required to achieve improved clinical outcomes with better cost‐effectiveness are needed. | ||
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| 700 | 1 | |a El Shamy, Osama |4 aut | |
| 700 | 1 | |a Chaudhary, Kumardeep |4 aut | |
| 700 | 1 | |a Sharma, Shuchita |4 aut | |
| 700 | 1 | |a Coca, Steven G. |4 aut | |
| 700 | 1 | |a Nadkarni, Girish N. |4 aut | |
| 700 | 1 | |a Uribarri, Jaime |4 aut | |
| 700 | 1 | |a Chan, Lili |4 aut | |
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