Main Article Content
Abstract
Introduction: In haemodialysis (HD) patients, the wrong adjustment of the ideal weight can lead to fluid overload, which can cause episodes of heart failure or, conversely, to a low weight situation, generating hypotension that triggers ischemic heart disease A maximum ultrafiltration (UF) of 10 ml/kg/hr is considered adequate. A higher value is associated with an increase in mortality. Objectives: To analyse the average ultrafiltration rate used in the study centre, and to know what percentage of patients exceeded the maximum recommended ultrafiltration. Material and Method: An observational, prospective study in 58 haemodialysis patients was carried out, analysing the ultrafiltration rate expressed in ml/kg/hr per session for 6 months. A UF rate> 10 ml/kg/hr was defined as the cut-off point, according to the current criteria of adequate rate, to determine which patients had a UF greater than 10 ml/kg/hour in more than 25% of the sessions. Results: During the study period, the average UF rate of all patients was 8.78±2.76 ml/kg/hr, although the percentage of sessions per patient with a UF rate greater than 10 ml/kg/hr was 35.9±29.74%. Conclusion: A high percentage of patients present UF rates above the recommended values. Strategies to decrease values must be sought, with health education on diet and individualized adjustment of dialysis sessions being fundamental aspects.
Keywords
Article Details
Copyright (c) 2020 Mónica Pereira-García, Paula Manso-del- Real, Ra´´ul Fernández-Prado, Alejandro Avello-Escribano, Emilio González-Parra

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Author copyright notice
© Authors grant the publisher the non-exclusive licence to publish the work and consent to its use and distribution under the Creative Commons Attribution - NonCommercial 4.0 International (CC BY-NC 4.0) licence. Read the licensing information and the legal text here. This must be expressly stated wherever necessary.
References
- Go AS, Hertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N.Eng. J. Med. 2004;351:1296-305. DOI: https://doi.org/10.1056/NEJMoa041031
- A Abramson JL, Jurkovitz CT, Vaccarino V, Weintraub WS, McClellan W. Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: the ARIC Study.. Kidney Int. 2003;64:610-5. DOI: https://doi.org/10.1046/j.1523-1755.2003.00109.x
- Tyralla K, Amann K: Morphology of the heart and arteries in renal failure. Kidney Int. 2003; 63: (Suppl 84):S80-3. DOI: https://doi.org/10.1046/j.1523-1755.63.s84.1.x
- Safar ME, London GM, Plante GE: Arterial stiffness and kidney function. Hipertensión 2004;43: 163-8. DOI: https://doi.org/10.1161/01.HYP.0000114571.75762.b0
- Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol. 2009;4(5):914-20. DOI: https://doi.org/10.2215/CJN.03900808
- Preciado P, Zhang H, Thijssen S, Kooman JP, van der Sande FM, Kotanko P. All-cause mortality in relation to changes in relative blood volume during hemodialysis. Nephrol Dial Transplant. 2019;34(8):1401-8. DOI: https://doi.org/10.1093/ndt/gfy286
- Kuipers J, Verboom LM, Ipema KJR, Paans W, Krijnen WP, Gaillard CAJM, et al, The Prevalence of Intradialytic Hypotension in Patients on Conventional Hemodialysis: A Systematic Review with Meta-Analysis. AmJ Nephrol. 2019; 49(6):497-506. DOI: https://doi.org/10.1159/000500877
- Flythe JE, Xue H, Lynch KE, Curhan GC, Brunelli SM. Association of mortality risk with various definitions of intradialytic hypotension. J Am Soc Nephrol. 2015;26(3):724-34. DOI: https://doi.org/10.1681/ASN.2014020222
- Assimon MM, Wenger JB, Wang L, Flythe JE. Ultrafiltration Rate and Mortality in Maintenance Hemodialysis Patients. Am J Kidney Dis. 2016; 68(6):911-22. DOI: https://doi.org/10.1053/j.ajkd.2016.06.020
- Agarwal R, Weir MR. Dry-weight: a concept revisited in an effort to avoid medication-directed approaches for blood pressure control in hemodialysis patients. Clin J Am Soc Nephrol. 2010;5:1255-260. DOI: https://doi.org/10.2215/CJN.01760210
- Park J, Rhee CM, Sim JJ, Kim YL, Ricks J, Streja E, et al. A comparative effectiveness research study of the change in blood pressure during hemodialysis treatment and survival. Kidney Int. 2013;84:795-802. DOI: https://doi.org/10.1038/ki.2013.237
- Davies SJ, Davenport A. The role of bioimpedance and biomarkers in helping to aid clinical decision-making of volume assessments in dialysis patients. Kidney Int. 2014;86:489-96. DOI: https://doi.org/10.1038/ki.2014.207
- Daugirdas JT. Intradialytic hypotension and splanchnic shifting: Integrating an overlooked mechanism with the detection of ischemia-related signals during hemodialysis. Semin Dial. 2019;32(3):243-7. DOI: https://doi.org/10.1111/sdi.12781
- Lee Y, Okuda Y, Sy J, Kim SR, Obi Y, Kovesdy CP, et al. Ultrafiltration Rate Effects Declines in Residual Kidney Function in Hemodialysis Patients. Am J Nephrol. 2019:1-8. DOI: https://doi.org/10.1159/000503918
- Chou JA, Kalantar-Zadeh K. Volume Balance and Intradialytic Ultrafiltration Rate in the Hemodialysis Patient. Curr Heart Fail Rep. 2017;14(5):421-7. DOI: https://doi.org/10.1007/s11897-017-0356-6
References
Go AS, Hertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N.Eng. J. Med. 2004;351:1296-305. DOI: https://doi.org/10.1056/NEJMoa041031
A Abramson JL, Jurkovitz CT, Vaccarino V, Weintraub WS, McClellan W. Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: the ARIC Study.. Kidney Int. 2003;64:610-5. DOI: https://doi.org/10.1046/j.1523-1755.2003.00109.x
Tyralla K, Amann K: Morphology of the heart and arteries in renal failure. Kidney Int. 2003; 63: (Suppl 84):S80-3. DOI: https://doi.org/10.1046/j.1523-1755.63.s84.1.x
Safar ME, London GM, Plante GE: Arterial stiffness and kidney function. Hipertensión 2004;43: 163-8. DOI: https://doi.org/10.1161/01.HYP.0000114571.75762.b0
Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol. 2009;4(5):914-20. DOI: https://doi.org/10.2215/CJN.03900808
Preciado P, Zhang H, Thijssen S, Kooman JP, van der Sande FM, Kotanko P. All-cause mortality in relation to changes in relative blood volume during hemodialysis. Nephrol Dial Transplant. 2019;34(8):1401-8. DOI: https://doi.org/10.1093/ndt/gfy286
Kuipers J, Verboom LM, Ipema KJR, Paans W, Krijnen WP, Gaillard CAJM, et al, The Prevalence of Intradialytic Hypotension in Patients on Conventional Hemodialysis: A Systematic Review with Meta-Analysis. AmJ Nephrol. 2019; 49(6):497-506. DOI: https://doi.org/10.1159/000500877
Flythe JE, Xue H, Lynch KE, Curhan GC, Brunelli SM. Association of mortality risk with various definitions of intradialytic hypotension. J Am Soc Nephrol. 2015;26(3):724-34. DOI: https://doi.org/10.1681/ASN.2014020222
Assimon MM, Wenger JB, Wang L, Flythe JE. Ultrafiltration Rate and Mortality in Maintenance Hemodialysis Patients. Am J Kidney Dis. 2016; 68(6):911-22. DOI: https://doi.org/10.1053/j.ajkd.2016.06.020
Agarwal R, Weir MR. Dry-weight: a concept revisited in an effort to avoid medication-directed approaches for blood pressure control in hemodialysis patients. Clin J Am Soc Nephrol. 2010;5:1255-260. DOI: https://doi.org/10.2215/CJN.01760210
Park J, Rhee CM, Sim JJ, Kim YL, Ricks J, Streja E, et al. A comparative effectiveness research study of the change in blood pressure during hemodialysis treatment and survival. Kidney Int. 2013;84:795-802. DOI: https://doi.org/10.1038/ki.2013.237
Davies SJ, Davenport A. The role of bioimpedance and biomarkers in helping to aid clinical decision-making of volume assessments in dialysis patients. Kidney Int. 2014;86:489-96. DOI: https://doi.org/10.1038/ki.2014.207
Daugirdas JT. Intradialytic hypotension and splanchnic shifting: Integrating an overlooked mechanism with the detection of ischemia-related signals during hemodialysis. Semin Dial. 2019;32(3):243-7. DOI: https://doi.org/10.1111/sdi.12781
Lee Y, Okuda Y, Sy J, Kim SR, Obi Y, Kovesdy CP, et al. Ultrafiltration Rate Effects Declines in Residual Kidney Function in Hemodialysis Patients. Am J Nephrol. 2019:1-8. DOI: https://doi.org/10.1159/000503918
Chou JA, Kalantar-Zadeh K. Volume Balance and Intradialytic Ultrafiltration Rate in the Hemodialysis Patient. Curr Heart Fail Rep. 2017;14(5):421-7. DOI: https://doi.org/10.1007/s11897-017-0356-6