Departments of Epidemiology & Population Health and Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
Dialyze Direct, Neptune City, New Jersey, USA.
Hemodial Int. 2022 Jul;26(3):424-434. doi: 10.1111/hdi.13012. Epub 2022 Apr 6.
Post-dialysis recovery time (DRT) has an important relationship to quality of life and survival, as identified in studies of ESRD patients on conventional dialysis. ESRD patients are often discharged from hospitals to skilled nursing facilities (SNFs) where on-site treatment using home hemodialysis technology is increasingly offered, but nothing is known about DRT in this patient population.
From November 4, 2019 to June 11, 2021, within a dialysis organization providing service across 12 states and 154 SNFs, patients receiving in-SNF, more frequent dialysis (MFD) (modeled to deliver 14 treatment hours minimum per week and stdKt/V ≥2.0) were asked to describe their post-dialysis recovery time following their previous treatment, within predefined categoric choices: 0-½, ½-1, 1-2, 2-4, 4-8, 8-12 h, by next morning, or not even by next morning. Patients reporting DRT following at least one full-week treatment opportunity were included in a mixed model logistic regression of rapid recovery (DRT ≤2 h).
Two thousand three hundred and nine patients met the statistical modeling inclusion criteria, providing DRT on 108,876 dialysis sessions, while receiving mean (SD) 4.3 (0.96) weekly dialysis treatments. 2118 (92%) reported DRT ≤2 h. Results appeared biologically plausible, as lower odds of rapid DRT were observed for patients who were older, missed their previous treatment, or experienced intradialytic hypotension. Greater odds of rapid DRT were observed in patients receiving five dialyses in the previous week or having 160-179 mmHg pre-hemodialysis systolic blood pressure. Rapid recovery was associated with reduced mortality or hospitalization.
SNF dialysis patients receiving 5x per week MFD report rapid recovery time ≤2 h in 92% of dialyses despite advanced age, frailty, and comorbidities. Future studies will assess the practical ramifications of rapid DRT perception/experience on nursing home rehabilitation programs, which could impact patient health beyond the nursing home stay.
透析后恢复期（DRT）与生活质量和生存密切相关，这在接受常规透析的终末期肾病（ESRD）患者的研究中已经得到证实。ESRD 患者通常从医院出院到提供现场治疗的熟练护理机构（SNF），在这些机构中越来越多地提供家庭血液透析技术，但对于这一患者群体的 DRT 尚不清楚。
从 2019 年 11 月 4 日至 2021 年 6 月 11 日，在一家横跨 12 个州和 154 家 SNF 提供服务的透析机构中，接受现场、更频繁透析（MFD）（模拟每周至少提供 14 个治疗小时，stdKt/V≥2.0）的患者被要求描述他们在接受上次治疗后的透析后恢复期，在预先定义的分类选择范围内：0-½、½-1、1-2、2-4、4-8、8-12 小时、次晨、或甚至次晨未恢复。在至少一次完整周治疗机会后报告 DRT 的患者被纳入快速恢复（DRT≤2 小时）的混合模型逻辑回归分析。
2309 名患者符合统计建模纳入标准，在 108876 次透析治疗中提供 DRT，同时接受平均（SD）4.3（0.96）次/周透析治疗。2118 名（92%）患者报告 DRT≤2 小时。结果似乎具有生物学意义，因为对于年龄较大、错过上次治疗或经历透析中低血压的患者，快速 DRT 的可能性较低。在过去一周接受五次透析或透析前收缩压为 160-179mmHg 的患者中，快速 DRT 的可能性更高。快速恢复与降低死亡率或住院率相关。
尽管年龄较大、虚弱和合并症较多，但每周接受 5 次 MFD 的 SNF 透析患者在 92%的透析中报告 DRT 恢复期≤2 小时。未来的研究将评估快速 DRT 感知/体验对疗养院康复计划的实际影响，这可能会影响患者在疗养院之外的健康。
