The relationship between hemodialysis prescription/dose and patient mortality

DOI Web Site 2 Citations 66 References
  • Suzuki Kazuyuki
    The Committee of Renal Data Registry, the Japanese Society for Dialysis Treatment
  • Iseki Kunitoshi
    The Committee of Renal Data Registry, the Japanese Society for Dialysis Treatment
  • Nakai Shigeru
    The Committee of Renal Data Registry, the Japanese Society for Dialysis Treatment
  • Morita Osamu
    The Committee of Renal Data Registry, the Japanese Society for Dialysis Treatment
  • Itami Yoshitomo
    The Committee of Renal Data Registry, the Japanese Society for Dialysis Treatment
  • Tsubakihara Yoshiharu
    The Committee of Renal Data Registry, the Japanese Society for Dialysis Treatment

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Other Title
  • 血液透析条件・透析量と生命予後　　‐日本透析医学会の統計調査結果から‐
  • 血液透析条件・透析量と生命予後--日本透析医学会の統計調査結果から
  • ケツエキ トウセキ ジョウケン トウセキリョウ ト セイメイ ヨゴ ニホン トウセキ イガッカイ ノ トウケイ チョウサ ケッカ カラ
  • ―日本透析医学会の統計調査結果から―

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Abstract

A retrospective observational study was conducted to determine the relationship between the hemodialysis (HD) prescription/dose and patient mortality using data from the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR). The 1-year mortality (up to the end of 2003) and 5-year mortality (up to the end of 2007) risks of thrice-weekly HD patients as of the end of 2002 were assessed by performing a logistic regression analysis of HD prescription and dose data, using a cause of death other than accident or suicide as the endpoint. The standard HD prescription (determined by average values) at the end of 2002 was as follows : dialysis time (DT), 239 min ; blood flow rate (Qb), 192 mL/min ; dialyzer membrane area (DMA), 1.55 m2 ; and dialysis fluid flow (Qd), 486 mL/min. On average, the standardized HD dose of urea (Kt/V urea) was 1.32, and the nonexponential HD dose (Kt urea) was 40.7 L. The results of the prognostic analysis showed that when a DT of ≥240 and<270 min was regarded as the reference, the mortality risk was higher in the group of patients with a DT shorter than this, and tended to be lower in the patients with a longer DT. When a Qb of ≥200 and<220 mL/min was regarded as the reference, the mortality risk was higher in patients with a lower Qb and tended to be lower in the group of patients with a higher Qb. The mortality risk was higher in the group of patients with a DMA of<1.2 m2, but there was no clear relationship between the mortality risk and DMA values other than 1.2 m2. When a Kt/V urea of ≥1.4 and<1.6 or a Kt urea of ≥38.8 and<42.7 L was used as the reference, the group of patients with an HD dose smaller than this showed an increased mortality risk, and patients with a larger HD dose exhibited a decreased mortality risk. These results were favorable in patients receiving HD for 5 years or more at the time of the present study, who were assumed to have no residual renal function. These results suggest that the prognosis of thrice-weekly HD patients may be improved by increasing the HD dose through a longer DT and increased Qb.

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