Renal Research Institute, New York, New York.
Katz School of Science and Health at Yeshiva University, New York, New York.
Clin J Am Soc Nephrol. 2023 Jun 1;18(6):767-776. doi: 10.2215/CJN.0000000000000144. Epub 2023 Apr 19.
We hypothesized that the association of ultrafiltration rate with mortality in hemodialysis patients was differentially affected by weight and sex and sought to derive a sex- and weight-indexed ultrafiltration rate measure that captures the differential effects of these parameters on the association of ultrafiltration rate with mortality.
Data were analyzed from the US Fresenius Kidney Care (FKC) database for 1 year after patient entry into a FKC dialysis unit (baseline) and over 2 years of follow-up for patients receiving thrice-weekly in-center hemodialysis. To investigate the joint effect of baseline-year ultrafiltration rate and postdialysis weight on survival, we fit Cox proportional hazards models using bivariate tensor product spline functions and constructed contour plots of weight-specific mortality hazard ratios over the entire range of ultrafiltration rate values and postdialysis weights (W).
In the studied 396,358 patients, the average ultrafiltration rate in ml/h was related to postdialysis weight (W) in kg: 3W+330. Ultrafiltration rates associated with 20% or 40% higher weight-specific mortality risk were 3W+500 and 3W+630 ml/h, respectively, and were 70 ml/h higher in men than in women. Nineteen percent or 7.5% of patients exceeded ultrafiltration rates associated with a 20% or 40% higher mortality risk, respectively. Low ultrafiltration rates were associated with subsequent weight loss. Ultrafiltration rates associated with a given mortality risk were lower in high-body weight older patients and higher in patients on dialysis for more than 3 years.
Ultrafiltration rates associated with various levels of higher mortality risk depend on body weight, but not in a 1:1 ratio, and are different in men versus women, in high-body weight older patients, and in high-vintage patients.
我们假设超滤率与血液透析患者死亡率之间的关联受体重和性别影响不同，并试图得出一种性别和体重指数超滤率的测量方法，以捕捉这些参数对超滤率与死亡率之间关联的不同影响。
对美国弗雷森纽斯肾脏护理（FKC）数据库中患者进入 FKC 透析单位后 1 年（基线）的数据以及接受每周 3 次中心血液透析的患者 2 年的随访数据进行了分析。为了研究基线超滤率和透析后体重对生存的联合影响，我们使用双变量张量积样条函数拟合 Cox 比例风险模型，并构建了体重特异性死亡率风险比的轮廓图，该图涵盖了整个超滤率值和透析后体重（W）范围。
在所研究的 396358 名患者中，ml/h 的平均超滤率与透析后体重（W）kg 相关：3W+330。与体重特异性死亡率风险增加 20%或 40%相关的超滤率分别为 3W+500 和 3W+630 ml/h，男性比女性高 70 ml/h。19%或 7.5%的患者超过了与死亡率风险增加 20%或 40%相关的超滤率。低超滤率与随后的体重减轻有关。与给定死亡率风险相关的超滤率在高体重老年患者中较低，在透析时间超过 3 年的患者中较高。
与不同水平的更高死亡率风险相关的超滤率取决于体重，但不是 1:1 的比例，并且在男性与女性、高体重老年患者和高龄患者之间存在差异。
